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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Differential diagnosis of MPNST vs. Neurinoma – Can PET-CT help?

Meeting Abstract

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  • Bettina Knie - Klinik für Neurochirurgie, Vivantes Klinikum im Friedrichshain, Berlin
  • Michail Plotkin - Institut für Nuklearmedizin, Vivantes Klinikum im Friedrichshain, Berlin
  • Arend Koch - Institut für Neuropathologie, Charité Universitätsmedizin Berlin
  • Petra Zschieschang - Praxis für Humangenetik, Berlin
  • Dag Moskopp - Klinik für Neurochirurgie, Vivantes Klinikum im Friedrichshain, Berlin

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 191

doi: 10.3205/14dgnc585, urn:nbn:de:0183-14dgnc5851

Published: May 13, 2014

© 2014 Knie et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Malignant peripheral nerve sheath tumors (MPNST) are a rare entity, accounting for 5-10% of soft-tissue-sarcomas. However they are an important differential diagnosis to benign tumors of the peripheral nervous systems regarding treatment and prognosis. The worst prognosis is given if associated with neurofibromatosis I (NF I). MPNST are difficult to detect in NF I individuals. The objective of this study was to evaluate magnetic resonance (MR) imaging and FDG-PET as a diagnostic tool for MPNST in patients with and without NF I and to verify the diagnosis by pathology and clinical follow-up.

Method: Between 2007 and 2013 seven patients underwent surgical treatment in our department. Four of them are NF I individuals. In these patients we detected numerous tumors in MRI. We excised 13 tumors in 15 surgical procedures. The pre-operative diagnostic included CT-scan, MRI and partially F18FDG-PET-CT. The excised tumors have been processed histopathologically. Post-operative diagnostic included MRI and 18FDG-PET-CT. The size of the tumors in MR imaging and the maximum standard uptake value (SUVmax) in 18FDG-PET-CT have been assessed and correlated with the histopathological result and clinical follow-up was undertaken in all patients.

Results: The mean size of the benign tumors in MR imaging was smaller than that of the malignant tumors. Imaging from 18FDG-PET-CT and associated SUVmax of the suspected MPNSTs correlated with the histopathological diagnosis. A size over 5 cm in MR imaging and a SUVmax of more than 6.0 in 18FDG-PET-CT was closely correlated to malignancy of nerve sheath tumors.

Conclusions: On a limited number of cases we demonstrated the benefit from the use of MRI and 18FDG PET-CT scan to augment management of peripheral nerve sheath tumors, especially in the context of NF I, which is characterized by multiple tumors. Features suggestive of malignancy are a larger size and a higher tracer uptake. However, much larger numbers of MPNSTs are required to solve the problem of predicting the tumor grade.