Evaluation of standardized uptake value (SUV) and apparent diffusion coefficient (ADC) as prognostic imaging parameters for primary Ewing sarcoma in hybrid 18F-FDG-PET/MRI
Drews MA, Milosevic A, Schröder JF, Zensen S, Opitz M, Umutlu L, Fendler WP, Herrmann K, Dirksen U, Schaarschmidt BM (2026)
Publication Type: Journal article
Publication year: 2026
Journal
Book Volume: 203
Article Number: 113024
DOI: 10.1016/j.ejrad.2026.113024
Abstract
Purpose Ewing sarcoma (EwS) is the second most prevalent malignant bone tumour among juvenile patients. Due to its highly malignant character, itis crucial to identify patients with unfavourable courses as early as possible. In this context, integrated 18F-FDG-PET/MRI combines high-contrast morphological information with functional diffusion imaging and metabolic data and thereby provides ADC and SUVmax/SUVmean as established parameters for tumour cellularity and metabolic activity in a single examination. Therefore, our study evaluated the use of ADC and SUVmax/SUVmean as prognostic parameters for treatment response and overall survival (OS) in this rare entity. . Methods In a monocentric retrospective study, patients with histopathologically-proven EwS who underwent 18F-FDG-PET/MRI before therapy start were included .A polygonal ROI was drawn encompassing the entire tumour mass on fused PET/MR images to determine SUVmax and SUVmean and copied onto the ADC maps to quantify ADCmean and ADCmin. Dependencies between these parameters and Salzer-Kutschik-Scale(SKS) were analysed by Spearman’s correlation coefficients and Hazard ratio for OS. Results 39 patients (14 female, median age 16yrs[IQR: 11–23]) were evaluated. Strong inverse correlations between SUVmax and ADCmean(ρ = -0.709,p < 0.001) and SUVmean and ADCmean(ρ = -0.689,p < 0.001) were observed. Furthermore, moderate correlations between SKS and SUVmax(ρ = 0.502,p = 0.009), SUVmean(ρ = 0.389,p = 0.049) and ADCmean(ρ = -0.425,p = 0.03) were seen as well as correlations between OS and SUVmax(HR:5.324,95 %-CI 1.065–26.615,p = 0.042) and SUVmean(HR:5.558, 95 %-CI 1.114–27.733,p = 0.037). Conclusion Hence, our study demonstrates a strong correlation between metabolic activity(SUVmax/SUVmean) and tumour cellularity(ADC) in EwS and proposes SUVmax and SUVmean as prognostic markers for neoadjuvant treatment response and OS. ADCmean also correlates inversely with treatment response but calculating ADCmean and SUVmax/SUVmean ratios does not improve prognostic value.
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APA:
Drews, M.A., Milosevic, A., Schröder, J.F., Zensen, S., Opitz, M., Umutlu, L.,... Schaarschmidt, B.M. (2026). Evaluation of standardized uptake value (SUV) and apparent diffusion coefficient (ADC) as prognostic imaging parameters for primary Ewing sarcoma in hybrid 18F-FDG-PET/MRI. European Journal of Radiology, 203. https://doi.org/10.1016/j.ejrad.2026.113024
MLA:
Drews, Marcel A., et al. "Evaluation of standardized uptake value (SUV) and apparent diffusion coefficient (ADC) as prognostic imaging parameters for primary Ewing sarcoma in hybrid 18F-FDG-PET/MRI." European Journal of Radiology 203 (2026).
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