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Comparison of visual and ROI-based brain tumour grading using 18F-FDG PET: ROC analyses.

P T Meyer1, M Schreckenberger, U Spetzger

  • 1Department of Nuclear Medicine, Aachen University of Technology, Germany. philipptobias.meyer@post.rwth-aachen.de phillipptobias.meyer@post.rwth-aachen.de

European Journal of Nuclear Medicine
|April 17, 2001
PubMed
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Simple visual grading scales for fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) brain tumour assessment are as accurate as quantitative methods. The visual grading scale (VGS) showed high accuracy and inter-observer agreement, making it a favorable criterion.

Area of Science:

  • Nuclear Medicine
  • Neuroradiology
  • Oncology

Background:

  • Quantitative and semi-quantitative approaches using fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) are common for brain tumour investigation.
  • Previous studies suggest simple visual interpretation criteria may offer comparable or superior accuracy.
  • The diagnostic performance of a visual grading scale (VGS) versus region of interest (ROI) ratios for FDG-PET brain tumour grading requires further investigation.

Purpose of the Study:

  • To compare the accuracy of a novel six-step visual grading scale (VGS) against three quantitative region of interest (ROI) ratios for FDG-PET brain tumour grading.
  • To evaluate the inter-observer agreement for the VGS in differentiating low-grade from high-grade brain tumours.
  • To determine the optimal method for FDG-PET based brain tumour grading.

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Main Methods:

  • A cohort of 47 patients with brain tumours (17 benign, 30 malignant) underwent FDG-PET imaging.
  • Tumour grading was performed using a six-step visual grading scale (VGS) by three independent observers and three ROI ratios (Tu/Tis, Tu/GM, Tu/WM).
  • Statistical analyses included correlation, inter-observer agreement (kappa), logistic regression, and receiver operating characteristic (ROC) analyses to assess diagnostic accuracy (Az).

Main Results:

  • The VGS demonstrated high correlation with ROI ratios (R=0.79-0.91) and excellent inter-observer agreement (kappa=0.63-0.81).
  • High-grade lesions showed significantly higher FDG uptake than low-grade lesions across all measures (P<0.005 to P<0.0001).
  • The VGS achieved the highest diagnostic accuracy (Az=0.97+/-0.03), outperforming the Tu/Tis ratio (Az=0.88+/-0.06) and showing comparable performance to Tu/GM (Az=0.92+/-0.04) and Tu/WM (Az=0.91+/-0.05).

Conclusions:

  • The visual grading scale (VGS) is a highly accurate and reproducible method for FDG-PET brain tumour grading, comparable to quantitative ROI ratios.
  • The VGS offers a potentially more favorable and easily applicable criterion for brain tumour grading, especially considering its high sensitivity (0.84) and specificity (0.95).
  • The Tu/Tis ratio is less reliable due to its dependence on lesion location, while the VGS provides a robust alternative for assessing tumour grade.