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Characterisation of malignant peripheral nerve sheath tumours in neurofibromatosis-1 using heterogeneity analysis of 18F-FDG PET

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)1-8
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Accepted/In press12 May 2017
Published7 Jun 2017


King's Authors


Purpose: Measurement of heterogeneity in 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) images is reported to improve tumour phenotyping and response assessment in a number of cancers. We aimed to determine whether measurements of 18F-FDG heterogeneity could improve differentiation of benign symptomatic neurofibromas from malignant peripheral nerve sheath tumours (MPNSTs). Methods: 18F-FDG PET data from a cohort of 54 patients (24 female, 30 male, mean age 35.1 years) with neurofibromatosis-1 (NF1), and clinically suspected malignant transformation of neurofibromas into MPNSTs, were included. Scans were performed to a standard clinical protocol at 1.5 and 4h post injection. Six first- (including 3 standardised uptake value (SUV) parameters), 4 second- (derived from grey level co-occurrence matrices) and 4 high-order (derived from neighbourhood grey-tone difference matrices) statistical features were calculated from tumour volumes of interest. Each patient had histological verification or at least five years clinical follow up as the reference standard with regards to the characterisation of tumours as benign (n=30) or malignant (n=24). Results: There was a significant difference between benign and malignant tumours for all 6 first-order parameters (at 1.5 and 4h) (p<0.0001), for second-order entropy (only at 4h) and for all high-order features (at 1.5h and 4h, except contrast at 4h) (p<0.0001 – 0.047). Similarly, area under receiver operating characteristic curves was high (0.669-0.997, p<0.05) for the same features as well as 1.5h second-order entropy. No first-, second- or high-order feature performed better than maximum SUV (SUVmax) at differentiating benign from malignant tumours. Conclusions: 18F-FDG uptake in MPNSTs is higher than benign symptomatic neurofibromas, as defined by SUV parameters, and more heterogeneous, as defined by first- and high-order heterogeneity parameters. However, heterogeneity analysis does not improve on SUVmax discriminative performance.

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