The diagnostic value of 18 F-FDG PET and MRI in paediatric histiocytosis
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ORIGINAL ARTICLE
The diagnostic value of 18F-FDG PET and MRI in paediatric histiocytosis Wolfgang Peter Mueller & Henriette Ingrid Melzer & Irene Schmid & Eva Coppenrath & Peter Bartenstein & Thomas Pfluger
Received: 21 August 2012 / Accepted: 4 October 2012 / Published online: 25 October 2012 # Springer-Verlag Berlin Heidelberg 2012
Abstract Purpose To analyse the diagnostic value of 18F-FDG PET and MRI for the evaluation of active lesions in paediatric Langerhans cell histiocytosis. Methods We compared 21 18F-FDG PET scans with 21 MRI scans (mean time interval 17 days) in 15 patients (11 male, 4 female, age range 4 months to 19 years) with biopsy-proven histiocytosis. Primary criteria for the lesion-based analysis were signs of vital histiocyte infiltrates (bone marrow oedema and contrast enhancement for MRI; SUV greater than the mean SUVof the right liver lobe for PET). PET and MR images were analysed separately and side-by-side. The results were validated by biopsy or follow-up scans after more than 6 months. Results Of 53 lesions evaluated, 13 were confirmed by histology and 40 on follow-up investigations. The sensitivity and specificity of PET were 67 % and 76 % and of MRI were 81 % and 47 %, respectively. MRI showed seven false-positive bone lesions after successful chemotherapy. PET showed five falsenegative small bone lesions, one false-negative lesion of the skull and three false-negative findings for intracerebral involvement. PET showed one false-positive lesion in the lymphoid tissue of the head and neck region and two false-positive bone W. P. Mueller (*) : H. I. Melzer : P. Bartenstein : T. Pfluger Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Marchioninistraße 15, 81377 Munich, Germany e-mail: [email protected] I. Schmid Department of Paediatric Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany E. Coppenrath Department of Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany
lesions after treatment. Combined PET/MR analysis decreased the number of false-negative findings on primary staging, whereas no advantage over PET alone was seen in terms of false-positive or false-negative results on follow-up. Conclusion Our retrospective analysis suggests a pivotal role of 18F-FDG PET in lesion follow-up due to a lower number of false-positive findings after chemotherapy. MRI showed a higher sensitivity and is indispensable for primary staging, evaluation of brain involvement and biopsy planning. Combined MRI/PET analysis improved sensitivity by decreasing the false-negative rate during primary staging indicating a future role of simultaneous whole-body PET/ MRI for primary investigation of paediatric histiocytosis. Keywords PET/MRI . MR/PET . Histiocytosis . Paediatric oncology
Introduction Langerhans cell histiocytosis (LCH) refers to a group of disorders involving clonal proliferation of activated dendritic cells and macrophages. LCH usually affects children between the ages of 1 and 15 years and is traditionally divided by nu
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