Positive and Negative Predictive Value of PET-CT in Skull Base Lesions: Case Series and Systematic Literature Review

Abstract

Objectives To study positive (PPV) and negative predictive value (NPV) of positron emission tomography with computed tomography (PET-CT) scans in determining malignancy in skull base lesions and perform a systematic literature review for optimal PET-CT interpretation.

Design Retrospective case series and systematic literature review of the current English literature.

Setting Tertiary referral academic medical center.

Participants All patients with skull base lesions that underwent PET-CT and tissue biopsy from 2010 to 2013.

Main Outcome Measures PPV and NPV of radiologist's report and standardized uptake value (SUV) cutoff of 2.5 and 3, biopsy with pathologic interpretation, clinical follow-up.

Results A total of 31 PET-CT scans of 16 patients were studied; 10 PET-CT were performed upfront for diagnostic purposes and 21 were post-treatment surveillance scans. The PPV of radiologist's interpretation, SUV cutoff of 2.5, and SUV cutoff of 3.0 was 80%, 60%, and 68.4%, with a NPV of 100%, 83.3%, and 75%, respectively. Literature search yielded 500 abstracts; 7 studies met inclusion criteria for detailed review. No consensus or guidelines for optimal SUV cutoff value was found.

Conclusions PET-CT based on SUV cutoff criteria alone has high NPV but low PPV in determining malignancy in skull base lesions. Interpretation by a radiologist experienced in nuclear medicine and neuroradiology, synthesizing clinical, SUV, and radiologic data are of superior value.

Keywords

PET-CT - skull base - SUV

Notes

EBM Level: 3

This article was presented at the 24th Annual North American Skull Base Society Meeting, February 2014, San Diego, California, United States.

• References

• 1 Gil Z, Even-Sapir E, Margalit N, Fliss DM. Integrated PET/CT system for staging and surveillance of skull base tumors. Head Neck 2007; 29 (6) 537-545
• 2 Harvey RJ, Pitzer G, Nissman DB , et al. PET/CT in the assessment of previously treated skull base malignancies. Head Neck 2010; 32 (1) 76-84
• 3 Wu HB, Wang QS, Wang MF, Zhen X, Zhou WL, Li HS. Preliminary study of 11C-choline PET/CT for T staging of locally advanced nasopharyngeal carcinoma: comparison with 18F-FDG PET/CT. J Nucl Med 2011; 52 (3) 341-346
• 4 Chen YK, Su CT, Chi KH, Cheng RH, Wang SC, Hsu CH. Utility of 18F-FDG PET/CT uptake patterns in Waldeyer's ring for differentiating benign from malignant lesions in lateral pharyngeal recess of nasopharynx. J Nucl Med 2007; 48 (1) 8-14
• 5 Ramakrishnan VR, Lee JY, O'Malley Jr BW, Palmer JN, Chiu AG. 18-FDG-PET in the initial staging of sinonasal malignancy. Laryngoscope 2013; 123 (12) 2962-2966
• 6 Glenn LW. Innovations in neuroimaging of skull base pathology. Otolaryngol Clin North Am 2005; 38 (4) 613-629
• 7 Chen YK, Wang SC, Cheng RH, Yeh CL, Tsui CC, Chia-Hung K. Utility of 18F-FDG uptake in various regions of Waldeyer's ring to differentiate benign from malignant lesions in the midline roof of the nasopharynx. Nucl Med Commun 2014; 35 (9) 922-931
• 8 Yen RF, Ting LL, Cheng MF, Wu YW, Tzen KY, Hong RL. Usefulness of 201TL SPECT/CT relative to 18F-FDG PET/CT in detecting recurrent skull base nasopharyngeal carcinoma. Head Neck 2009; 31 (6) 717-724
• 9 Cheon GJ, Chung JK, So Y , et al. Diagnostic accuracy of F-18 FDG PET in the assessment of posttherapeutic recurrence of head and neck cancer. Clin Positron Imaging 1999; 2 (4) 197-204
• 10 Kao CH, Shiau YC, Shen YY, Yen RF. Detection of recurrent or persistent nasopharyngeal carcinomas after radiotherapy with technetium-99m methoxyisobutylisonitrile single photon emission computed tomography and computed tomography: comparison with 18-fluoro-2-deoxyglucose positron emission tomography. Cancer 2002; 94 (7) 1981-1986
• 11 Li P, Zhuang H, Mozley PD , et al. Evaluation of recurrent squamous cell carcinoma of the head and neck with FDG positron emission tomography. Clin Nucl Med 2001; 26 (2) 131-135
• 12 Mittra ES, Iagaru A, Quon A, Fischbein N. PET Imaging of Skull Base Neoplasms. PET Clin 2007; 2 (4) 489-510
• 13 Lamarre ED, Batra PS, Lorenz RR , et al. Role of positron emission tomography in management of sinonasal neoplasms—a single institution's experience. Am J Otolaryngol 2012; 33 (3) 289-295
• 14 Haerle SK, Soyka MB, Fischer DR , et al. The value of 18F-FDG-PET/CT imaging for sinonasal malignant melanoma. Eur Arch Otorhinolaryngol 2012; 269 (1) 127-133
• 15 Wang CH, Liang JA, Ding HJ , et al. Utility of TL-201 SPECT in clarifying false-positive FDG-PET findings due to osteoradionecrosis in head and neck cancer. Head Neck 2010; 32 (12) 1648-1654
• 16 Ito K, Yokoyama J, Kubota K, Morooka M. Comparison of 18F-FDG and 11C-choline PET/CT for detecting recurrences in patients with nonsquamous cell head and neck malignancies. Nucl Med Commun 2010; 31 (11) 931-937
• 17 Tomura N, Mizuno Y, Saginoya T. PET/CT findings for tumors in the base of the skull: comparison of 18 F-FDG with 11 C-methionine. Acta Radiol 2015; ; [Epub ahead of print]
• 18 Korchi AM, Garibotto V, Lovblad KO, Haller S, Weber DC. Radiologic patterns of necrosis after proton therapy of skull base tumors. Can J Neurol Sci 2013; 40 (6) 800-806
• 19 King AD, Ma BB, Yau YY , et al. The impact of 18F-FDG PET/CT on assessment of nasopharyngeal carcinoma at diagnosis. Br J Radiol 2008; 81 (964) 291-298
• 20 Teo PTH, Tan NC, Khoo JBK. Imaging appearances for recurrent nasopharyngeal carcinoma and post-salvage nasopharyngectomy. Clin Radiol 2013; 68 (11) e629-e638
• 21 Jadvar H, Colletti PM. Competitive advantage of PET/MRI. Eur J Radiol 2014; 83 (1) 84-94
• 22 Buchbender C, Heusner TA, Lauenstein TC, Bockisch A, Antoch G. Oncologic PET/MRI, part 1: tumors of the brain, head and neck, chest, abdomen, and pelvis. J Nucl Med 2012; 53 (6) 928-938
• 23 Kubiessa K, Purz S, Gawlitza M , et al. Initial clinical results of simultaneous 18F-FDG PET/MRI in comparison to 18F-FDG PET/CT in patients with head and neck cancer. Eur J Nucl Med Mol Imaging 2014; 41 (4) 639-648
• 24 Boss A, Stegger L, Bisdas S , et al. Feasibility of simultaneous PET/MR imaging in the head and upper neck area. Eur Radiol 2011; 21 (7) 1439-1446
• 25 Platzek I, Beuthien-Baumann B, Schneider M , et al. PET/MRI in head and neck cancer: initial experience. Eur J Nucl Med Mol Imaging 2013; 40 (1) 6-11
• 26 Kuhn FP, Hüllner M, Mader CE , et al. Contrast-enhanced PET/MR imaging versus contrast-enhanced PET/CT in head and neck cancer: how much MR information is needed?. J Nucl Med 2014; 55 (4) 551-558
• 27 Becker M, Zaidi H. Imaging in head and neck squamous cell carcinoma: the potential role of PET/MRI. Br J Radiol 2014; 87 (1036) 20130677
• 28 Lee SJ, Seo HJ, Cheon GJ , et al. Usefulness of integrated PET/MRI in head and neck cancer: A preliminary study. Nucl Med Mol Imaging 2014; 48 (2) 98-105
• 29 Partovi S, Kohan A, Vercher-Conejero JL , et al. Qualitative and quantitative performance of ¹⁸F-FDG-PET/MRI versus ¹⁸F-FDG-PET/CT in patients with head and neck cancer. AJNR Am J Neuroradiol 2014; 35 (10) 1970-1975
• 30 Queiroz MA, Hüllner M, Kuhn F , et al. PET/MRI and PET/CT in follow-up of head and neck cancer patients. Eur J Nucl Med Mol Imaging 2014; 41 (6) 1066-1075