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Assessment of histological response of paediatric bone sarcomas using FDG PET in comparison to morphological volume measurement and standardized MRI parameters
Authors:Timm Denecke  Patrick Hundsdörfer  Daniel Misch  Ingo G Steffen  Stefan Schönberger  Christian Furth  Michail Plotkin  Juri Ruf  Hubertus Hautzel  Brigitte Stöver  Regine Kluge  Uta Bierbach  Sylke Otto  James F Beck  Christiane Franzius  Günter Henze  Holger Amthauer
Institution:1. Klinik für Strahlenheilkunde, Campus Virchow-Klinikum, Charité—Universit?tsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
2. Klinik für P?diatrie m.S. Onkologie und H?matologie, Otto-Heubner-Zentrum, Campus Virchow-Klinikum, Charité—Universit?tsmedizin Berlin, Berlin, Germany
3. Klinik für Kinder-Onkologie, -H?matologie und -Immunologie, Universit?tsklinikum der Heinrich-Heine-Universit?t Düsseldorf, Düsseldorf, Germany
4. Klinik für Radiologie und Nuklearmedizin, Universit?tsklinikum Magdeburg A.?.R., Otto-von-Guericke-Universit?t Magdeburg, Magdeburg, Germany
5. Nuklearmedizinische Klinik, Universit?tsklinikum der Heinrich Heine Universit?t Düsseldorf, Düsseldorf, Germany
6. Klinik und Poliklinik für Nuklearmedizin, Universit?tsklinikum Leipzig A.?.R., Leipzig, Germany
7. Abteilung für Kinder-H?matologie, -Onkologie und -H?mostaseologie, Universit?tsklinikum Leipzig A.?.R., Leipzig, Germany
8. Institut für Diagnostische Radiologie und Neuroradiologie, Universit?tsklinikum Greifswald, Greifswald, Germany
9. Abteilung für P?diatrische H?matologie und Onkologie, Universit?tsklinikum Greifswald, Greifswald, Germany
10. MR- und PET/CT-Zentrum, Bremen-Mitte, Germany
11. Klinik und Poliklinik für Nuklearmedizin, Universit?tsklinikum Münster, Münster, Germany
Abstract:

Purpose

The objective of this study was to evaluate positron emission tomography (PET) using 18F-fluoro-2-deoxy-D-glucose (FDG) in comparison to volumetry and standardized magnetic resonance imaging (MRI) parameters for the assessment of histological response in paediatric bone sarcoma patients.

Methods

FDG PET and local MRI were performed in 27 paediatric sarcoma patients Ewing sarcoma family of tumours (EWS), n?=?16; osteosarcoma (OS), n?=?11] prior to and after neoadjuvant chemotherapy before local tumour resection. Several parameters for assessment of response of the primary tumour to therapy by FDG PET and MRI were evaluated and compared with histopathological regression of the resected tumour as defined by Salzer-Kuntschik.

Results

FDG PET significantly discriminated responders from non-responders using the standardized uptake value (SUV) reduction and the absolute post-therapeutic SUV (SUV2) in the entire patient population (?SUV, p?=?0.005; SUV2, p?=?0.011) as well as in the subgroup of OS patients (?SUV, p?=?0.009; SUV2, p?=?0.028), but not in the EWS subgroup. The volume reduction measured by MRI/CT did not significantly discriminate responders from non-responders either in the entire population (p?=?0.170) or in both subgroups (EWS, p?=?0.950; OS, p?=?1.000). The other MRI parameters alone or in combination were unreliable and did not improve the results. Comparing diagnostic parameters of FDG PET and local MRI, metabolic imaging showed high superiority in the subgroup of OS patients, while similar results were observed in the population of EWS.

Conclusion

FDG PET appears to be a useful tool for non-invasive response assessment in the group of OS patients and is superior to MRI. In EWS patients, however, neither FDG PET nor volumetry or standardized MRI criteria enabled a reliable response assessment to be made after neoadjuvant treatment.
Keywords:
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