The value of intratumoral heterogeneity of (18)F-FDG uptake to differentiate between primary benign and malignant musculoskeletal tumours on PET/CT.
OBJECTIVE
The cumulative standardized uptake value (SUV)-volume histogram (CSH) was reported to be a novel way to characterize heterogeneity in intratumoral tracer uptake. This study investigated the value of fluorine-18 fludeoxyglucose ((18)F-FDG) intratumoral heterogeneity in comparison with SUV to discriminate between primary benign and malignant musculoskeletal (MS) tumours.


METHODS
The subjects comprised 85 pathologically proven MS tumours. The area under the curve of CSH (AUC-CSH) was used as a heterogeneity index, with lower values corresponding with increased heterogeneity. As 22 tumours were indiscernible on (18)F-FDG positron emission tomography, maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean) and AUC-CSH were obtained in 63 positive tumours. The Mann-Whitney U test and receiver operating characteristic (ROC) analysis were used for analyses.


RESULTS
The difference between benign (n = 35) and malignant tumours (n = 28) was significant in AUC-CSH (p = 0.004), but not in SUVmax (p = 0.168) and SUVmean (p = 0.879). The sensitivity, specificity and accuracy for diagnosing malignancy were 61%, 66% and 64% for SUVmax (optical threshold value, >6.9), 54%, 60% and 57% for SUVmean (optical threshold value, >3) and 61%, 86% and 75% for AUC-CSH (optical threshold value, ≤0.42), respectively. The area under the ROC curve was significantly higher in AUC-CSH (0.71) than SUVmax (0.60) (p = 0.018) and SUVmean (0.51) (p = 0.005).


CONCLUSIONS
The heterogeneity index, AUC-CSH, has a higher diagnostic accuracy than SUV analysis in differentiating between primary benign and malignant MS tumours, although it is not sufficiently high enough to obviate histological analysis.


CONCLUSIONS
AUC-CSH can assess the heterogeneity of (18)F-FDG uptake in primary benign and malignant MS tumours, with significantly greater heterogeneity associated with malignant MS tumours. AUC-CSH is more diagnostically accurate than SUV analysis in differentiating between benign and malignant MS tumours.
1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.|2 Department of Radiology, Nanpuh Hospital, Kagoshima, Japan.
Masatoyo
M
Nakajo
2 Department of Radiology, Nanpuh Hospital, Kagoshima, Japan.
Masayuki
M
Nakajo
1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Megumi
M
Jinguji
1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Yoshihiko
Y
Fukukura
1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Yoshiaki
Y
Nakabeppu
2 Department of Radiology, Nanpuh Hospital, Kagoshima, Japan.
Atsushi
A
Tani
1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Takashi
T
Yoshiura
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D019042:Muscle Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18