Ristow Inka, Apostolova Ivayla, Kaul Michael G, Stark Maria, Zapf Antonia, Schmalhofer Marie-Lena, Mautner Victor F, Farschtschi Said, Adam Gerhard, Bannas Peter, Salamon Johannes, Well Lennart
Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
EJNMMI Res. 2024 Dec 27;14(1):127. doi: 10.1186/s13550-024-01189-0.
To intraindividually compare the diagnostic performance of positron emission computed tomography (F-18-FDG-PET/CT) and diffusion-weighted magnetic resonance imaging (DW-MRI) in a non-inferiority design for the discrimination of peripheral nerve sheath tumours as benign (BPNST), atypical (ANF), or malignant (MPNST) in patients with neurofibromatosis type 1 (NF1).
In this prospective single-centre study, thirty-four NF1 patients (18 male; 30 ± 11 years) underwent F-18-FDG-PET/CT and multi-b-value DW-MRI (11 b-values 0 - 800 s/mm²) at 3T. Sixty-six lesions corresponding to 39 BPNST, 11 ANF, and 16 MPNST were evaluated. Two radiologists independently assessed the maximum standardized uptake value (SUV) and mean and minimum apparent diffusion coefficient (ADC) as well as the ADC in areas of lowest signal intensity in each lesion (ADC). The AUCs of DW-MRI and F-18-FDG-PET/CT were compared to determine whether the ADC is non-inferior to SUV (non-inferiority margin equal to -10%). Follow-up of ≥ 24 months (BPNST) or histopathological evaluation (MPNST + ANF) served as diagnostic reference standard. Both SUV and ADC parameters demonstrated good diagnostic accuracy (AUC 94.0%; AUC 91.6% / 90.1% / 92.5%). However, non-inferiority could not be demonstrated for any of the three ADC parameters (lower limits of the confidence intervals of the difference between the AUC of ADC and SUV -12.9% / -14.5% / -11.6%). Inter-rater reliability was excellent for both imaging techniques (Krippendorff's alpha all > 0.94).
Both PET/CT-derived SUV and MRI-derived ADC allow sensitive and non-invasive differentiation of benign and (pre)-malignant peripheral nerve sheath tumours. Nevertheless, DW-MRI cannot be considered as non-inferior to F-18-FDG-PET/CT in this prospective single-centre study.
在一项非劣效性设计中，对1型神经纤维瘤病（NF1）患者的周围神经鞘瘤进行良恶性鉴别，即良性（BPNST）、非典型（ANF）或恶性（MPNST），以个体内比较正电子发射计算机断层扫描（F-18-FDG-PET/CT）和扩散加权磁共振成像（DW-MRI）的诊断性能。
在这项前瞻性单中心研究中，34例NF1患者（18例男性；年龄30±11岁）在3T条件下接受了F-18-FDG-PET/CT和多b值DW-MRI（11个b值，范围为0 - 800 s/mm²）检查。对对应于39例BPNST、11例ANF和16例MPNST的66个病灶进行了评估。两名放射科医生独立评估了最大标准化摄取值（SUV）、平均和最小表观扩散系数（ADC）以及每个病灶最低信号强度区域的ADC（ADC）。比较DW-MRI和F-18-FDG-PET/CT的曲线下面积（AUC），以确定ADC是否不劣于SUV（非劣效性界值等于-10%）。≥24个月的随访（BPNST）或组织病理学评估（MPNST + ANF）作为诊断参考标准。SUV和ADC参数均显示出良好的诊断准确性（AUC分别为94.0%；AUC分别为91.6% / 90.1% / 92.5%）。然而，三个ADC参数中的任何一个均未显示出非劣效性（ADC与SUV的AUC差值的置信区间下限为-12.9% / -14.5% / -11.6%）。两种成像技术的观察者间可靠性均极佳（Krippendorff's alpha均>0.94）。
PET/CT衍生的SUV和MRI衍生的ADC均能对良性和（前）恶性周围神经鞘瘤进行敏感且无创的鉴别。然而，在这项前瞻性单中心研究中，DW-MRI不能被认为不劣于F-18-FDG-PET/CT。
