Assessment of intratumor heterogeneity in mesenchymal uterine tumor by an 18 F-FDG PET/CT texture analysis
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ORIGINAL ARTICLE
Assessment of intratumor heterogeneity in mesenchymal uterine tumor by an 18F-FDG PET/CT texture analysis Tetsuya Tsujikawa1 · Makoto Yamamoto2 · Kunihiro Shono1 · Shizuka Yamada2 · Hideaki Tsuyoshi2 · Yasushi Kiyono1 · Hirohiko Kimura3 · Hidehiko Okazawa1 · Yoshio Yoshida2
Received: 21 July 2017 / Accepted: 8 September 2017 © The Japanese Society of Nuclear Medicine 2017
Abstract Objective The aim of this study was to retrospectively evaluate the clinical significance of 18F-FDG PET/CT textural features for discriminating uterine sarcoma from leiomyoma. Methods Fifty-five patients with suspected uterine sarcoma based on ultrasound and MRI findings who underwent pretreatment 18F-FDG PET/CT were included. Fifteen patients were histopathologically proven to have uterine sarcoma, 14 patients by surgical operation and one by biopsy, and 40 patients were diagnosed with leiomyoma by surgical operation or in a follow-up for at least 2 years. A texture analysis was performed on PET/CT images from which second- and higher order textural features were extracted in addition to standardized uptake values (SUVs) and other first-order features. The accuracy of PET features for differentiating between uterine sarcoma and leiomyoma was evaluated using a receiver-operating-characteristic (ROC) analysis. Results The intratumor distribution of 18F-FDG was more heterogeneous in uterine sarcoma than in leiomyoma. Entropy, correlation, and uniformity calculated from normalized gray-level co-occurrence matrices and SUV
standard deviation derived from histogram statistics showed greater area under the ROC curves (AUCs) than did maximum SUV for differentiating between sarcoma and leiomyoma. Entropy, as a single feature, yielded the greatest AUC of 0.974 and the optimal cut-off value of 2.85 for entropy provided 93% sensitivity, 90% specificity, and 92% accuracy. When combining conventional features with textural ones, maximum SUV (cutoff: 6.0) combined with entropy (2.85) and correlation (0.73) provided the best diagnostic performance (100% sensitivity, 94% specificity, and 95% accuracy). Conclusions In combination with the conventional histogram statistics and/or volumetric parameters, 18F-FDG PET/CT textural features reflecting intratumor metabolic heterogeneity are useful for differentiating between uterine sarcoma and leiomyoma.
Electronic supplementary material The online version of this article (doi:10.1007/s12149-017-1208-x) contains supplementary material, which is available to authorized users.
Uterine leiomyoma is a common benign uterine tumor of mesenchymal origin that occurs in 25–30% of women older than 30 years of age [1]. In contrast, mesenchymal tumors other than uterine leiomyomas, such as uterine sarcomas, are uncommon [2]. Uterine sarcomas constitute only 3–7% of uterine malignancies, including carcinosarcoma (CS), leiomyosarcoma (LMS), low- or high-grade endometrial stromal sarcoma (L-, H-ESS), and adenosarcoma. Due to the possibility of the conservative treatment of uterine leiomyoma as we
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