Abstract
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Introduction: DF is a locally aggressive connective tissue malignancy occurring in the soft tissues, most commonly the abdominal mesentery, abdominal wall, or extremities. Imaging can play an important role in evaluating the extent of tumor and assessing response to treatment. The role of 18F-FDG PET/CT in DF has yet to be fully defined, with most of the literature consisting of small series and case reports. Biopsy-proven desmoid tumors with a pre-therapy 18F-FDG PET/CT from 2001 through 2019 were retrospectively reviewed, and multiple PET/CT morphologic and metabolic features were assessed. The electronic medical record was cross referenced for demographic, treatment, and follow-up information. Thirty-four DFs in 31 patients (17 F:14 M, mean age 49.8 +/- 20.6 years) were included. Lesion locations included mesentery (16/34, 47%), pleura (6/34, 18%), trunk (4/34, 12%), extremities (4/34, 12%), brachial plexus (3/34, 9%), and retroperitoneum (1/34, 3%). The average largest dimension was 6.3 +/- 4.9 cm (range 1.8 - 22.7 cm) and average volume was 308.8 +/- 810.6 (range 1.1 - 4577 cm3). The mean SUVmax was 4.1 +/- 2.1 (range 1.4 - 13.1), SUVmean 2.4 +/- 1.3 (range 1.0 - 8.9), metabolic tumor volume 151.4 +/- 352.3 cm3 (range 1.0 - 1893.3 cm3), and total lesion glycolysis 295.3 +/- 602.5 g (range 2.1 - 2881.7 g). 23/34 (68%) had irregular margins and 11/34 (32%) had well-circumscribed margins. Pleural lesions were more likely to have well-circumscribed margins (5/6) compared to lesions at other sites (6/28), p = 0.008. There were no significant differences in SUVmax, SUVmean, MTV, or TLG between abdominal (16/34, 47%) vs. extra-abdominal (18/34, 53%) location (all p-values > 0.05). 33/34 lesions had clinical or imaging follow-up with a mean follow-up time of 26.2+/- 28.0 months. 7/33 (21%) lesions developed recurrence or progression following treatment. There was no difference in SUVmax or SUVmean in patients with and without recurrence/progression (SUVmax: 3.7 +/- 0.8 vs. 4.1 +/- 2.3, p = 0.67; SUVmean: 2.0 +/- 0.4 vs. 2.4 +/- 1.5, p = 0.41). MTV, TLG, maximal size, and volume were all greater in patients with recurrence/progression vs. those without (MTV: 431.3 +/- 684.0 vs. 81.8 +/- 153.7 cm3, p = 0.019; TLG: 714.3 +/- 1031.3 vs. 193.6 +/- 400.9 g, p = 0.043; maximal dimension 10.2 +/- 6.7 vs. 5.4 +/- 3.9 cm, p = 0.019; volume: 893.3 +/- 1641.5 cm3 vs. 163.1 +/- 315.1, p = 0.035). 22/34 (65%) lesions had a history of surgery or trauma in the region where the desmoid ultimately developed. DF demonstrates variable FDG activity, but is most commonly moderately FDG avid. The majority of DF occurs in regions of prior surgery or other trauma. Lesions with higher MTV, TLG, greater maximal dimension, and larger morphologic volume were more likely to recur or progress, whereas SUV-based metabolic measures were not predictive of progression or recurrence in this small cohort.
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