Intratumoral heterogeneity of F-18 FDG uptake differentiates between gastrointestinal stromal tumors and abdominal malignant lymphomas on PET/CT

Tadashi Watabe, Mitsuaki Tatsumi, Hiroshi Watabe, Kayako Isohashi, Hiroki Kato, Masahiro Yanagawa, Eku Shimosegawa, Jun Hatazawa

Research output: Contribution to journalArticlepeer-review

46 Citations (Scopus)


Objective Gastrointestinal stromal tumors (GISTs) and malignant lymphomas (MLs) in the abdomen are often observed as tumors of unknown origin on F-18 FDG PET/ CT. The purpose of this study was to evaluate the intratumoral metabolic heterogeneity of F-18 FDG uptake on PET to determine if it might be helpful to discriminate between these tumors. Methods The F-18 FDG PET/CT findings of 21 large abdominal tumors were retrospectively evaluated (9 GISTs and 12 MLs). Intratumoral heterogeneity was evaluated by visual scoring (visual score: 0, homogeneous; 1, slightly heterogeneous; 2, moderately heterogeneous; 3, highly heterogeneous) and by the cumulative standardized uptake value (SUV) histograms on transaxial PET images at the maximal cross-sectional tumor diameter. Percent tumor areas above a threshold from 0 to 100% of the maximum SUV were plotted and the area under curve of the cumulative SUV histograms (AUC-CSH) was used as a heterogeneity index, where lower values corresponded with increased heterogeneity. Correlation between the visual score and the AUC-CSH was investigated by the Spearman's rank test. Results GISTs exhibited heterogeneous uptake of F-18 FDG, whereas MLs showed rather homogeneous uptake on visual analysis (visual score: 2.67 ± 0.50 and 0.58 ± 0.79, respectively; p<0.001). The AUC-CSH was significantly lower for the GISTs than for the MLs (0.41 ± 0.14 and 0.64 ± 0.08, respectively; p<0.001). Significant correlations were observed between the visual score and the AUCCSH (ρ = -0.866, p<0.001). Conclusion GISTs exhibited significantly heterogeneous intratumoral tracer uptake as compared with the MLs. Evaluation of the intratumoral heterogeneity of F-18 FDG uptake may help in the discrimination between these tumors.

Original languageEnglish
Pages (from-to)222-227
Number of pages6
JournalAnnals of Nuclear Medicine
Issue number3
Publication statusPublished - 2012 Apr
Externally publishedYes


  • Cumulative standardized uptake value histograms
  • F-18 FDG PET
  • Gastrointestinal stromal tumor
  • Intratumoral heterogeneity
  • Malignant lymphoma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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