The Diagnostic Value of ¹⁸F‐FDG PET/CT Bone Marrow Uptake Pattern in Detecting Bone Marrow Involvement in Pediatric Neuroblastoma Patients

Abstract

Objectives. To explore the diagnostic value of 18F-FDG PET/CT bone marrow uptake pattern (BMUP) in detecting bone marrow involvement (BMI) in pediatric neuroblastoma (NB) patients. Methods. Ninety-eight NB patients were enrolled in BMI analysis. Four patterns of bone marrow uptake were categorized based on pretreatment cF-FDG PET/CT images. Some crucial inspection indexes and 18F-FDG PET/CT metabolic parameters were analyzed. The BMUP was divided into BMUP1, BMUP2, BMUP3, and BMUP4. Paired-like homeobox 2b (PHOX2B) of bone marrow and blood, bone marrow biopsy (BMB) result, and 18F-FDG PET/CT were compared to detect BMI. All patients were followed up for at least six months. Results. BMUP had excellent consistency among different physicians. Kappa coefficients of two residents and two attending physicians and between the resident and attending physician, were 0.857, 0.891, and 0.845, respectively. The optimal cut-off value of SUVmax-Bone/Liver was 2.08 to diagnose BMI for BMUP3 patients, and the area under curve (AUC) was 0.873. AUC of PHOX2B of bone marrow (PHOX2B of BM), PHOX2B of blood, BMB, and 18F-FDG PET/CT were 0.916, 0.811, 0.806, and 0.904, respectively. There was no significant difference between PHOX2B of BM and PET/CT. Positive predictive value, negative predictive value, sensitivity, and specificity in diagnosis of BMI were 92.9%, 92.9%, 97.0%, and 83.9% for PET/CT and 96.7%, 80.6%, 89.6%, and 93.5% for PHOX2B of BM, respectively. Conclusions. BMUP of pretreatment 18F-FDG PET/CT is a simple and practical method, which has a relatively high diagnostic efficiency in detecting BMI and might decrease unnecessary invasive inspections in some pediatric NB patients.

18F-FDG PET/CT-based radiomics nomogram could predict bone marrow involvement in pediatric neuroblastoma

“…The bone marrow is the most common site of metastasis in neuroblastoma [ 3 ], and the spread of tumor cells to bone marrow is a grim prognostic factor in neuroblastoma patients [ 4 ]. The prognosis is significantly better in those without bone marrow involvement (BMI) than in those with BMI [ 5 , 6 ]. Moreover, BMI is one of the most important diagnostic criteria and an important risk factor for staging according to the International Neuroblastoma Staging System (INSS) and the International Neuroblastoma Risk Group staging system [ 7 – 9 ].…”

“…According to the recommendations of the INSS, the cytology of aspirates and histology of biopsies are the gold standard with which to assess BMI in patients with neuroblastoma [ 5 , 7 , 8 ]. Considering that most neuroblastoma patients are children, the bone marrow aspirates and biopsies must be performed only by experienced health care providers who have been well-trained in the technique [ 10 ].…”

Computed tomography-based radiomics to assess risk stratification in pediatric malignant peripheral neuroblastic tumors

“…The main reason for this may be that 18F-FDG PET/CT is an integrated imaging modality of PET and CT that can provide both metabolic and anatomical information. [32] In total, 405 patients were included in the risk model. Twenty-three features were selected for submodel 1a and 35 features were selected for submodel 1b.…”

“…The main reason for this may be that 18F-FDG PET/CT is an integrated imaging modality of PET and CT that can provide both metabolic and anatomical information. [32]…”

Comparing the diagnostic value of 18F-FDG PET/CT scan and bone marrow biopsy in newly diagnosed pediatric neuroblastoma and ganglioneuroblastoma

“…The ROC curve analyses showed that the AUCs of BM-SUVmax and BM-SUVmax/HE-SUVmax were 0.398 (95% CI: 0.156–0.640; p = 0.456) and 0.582 (95% CI: 0.319–0.844; p = 0.551), respectively, for predicting BMI. The ROC curve analyses cannot distinguish between patterns C and D. 18 F-FDG PET/CT-guided BMB should be performed to reduce the harm of unnecessary BM aspiration biopsies in patients with pattern C ( 23 ).…”