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As medical procedures must be justified socio-economically, we determined cost-effectiveness of [<jats:sup>18<\/jats:sup>F]FET PET for identification of treatment-related changes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We analyzed clinical data from two different studies that assessed the value of FET PET to differentiate between brain and spinal tumor relapse and treatment-related changes in children and adolescents. Cost calculation was based on the German statutory health insurance system perspective. Due to subtle differences in the diagnostic approach of the studies, two separate clinical scenarios including 80 patients with 105 lesions were considered: Decision tree model 1 determined cost-effectiveness of simultaneous [<jats:sup>18<\/jats:sup>F]FET PET and MRI in comparison to MRI alone to identify treatment-related changes. Decision tree model 2 determined cost-effectiveness of [<jats:sup>18<\/jats:sup>F]FET PET alone to identify treatment-related changes when routine MRI findings were suspicious for tumor relapse. Deterministic and probabilistic sensitivity analyses tested the robustness of the results.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Model 1 revealed that the rate of identified treatment-related changes increased by 52% when adding [<jats:sup>18<\/jats:sup>F]FET PET to MRI, resulting in costs of \u20ac3,314.51 for each additional correctly identified lesion with treatment-related changes by [<jats:sup>18<\/jats:sup>F]FET PET that MRI would have misclassified. Model 2 revealed that [<jats:sup>18<\/jats:sup>F]FET PET correctly identified treatment-related changes in 90% of lesions when routine MRI findings were suspicious for tumor relapse, resulting in costs of \u20ac1,740.37 for each lesion.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Integrating [<jats:sup>18<\/jats:sup>F]FET PET in the follow-up of in children and adolescents with brain and spinal tumor may help improving patient care at acceptable costs.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00259-025-07377-x","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T23:41:08Z","timestamp":1748994068000},"page":"4616-4626","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Diagnosis of treatment-related changes in children and adolescents with brain and spinal tumors: a cost-effectiveness analysis using MRI and [18 F]FET PET"],"prefix":"10.1007","volume":"52","author":[{"given":"Jurij","family":"Rosen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Michael","family":"Werner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garry S.","family":"Ceccon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena K.","family":"Rosen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael M.","family":"Wollring","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Stetter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Lohmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix M.","family":"Mottaghy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisbeth","family":"Marner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Law","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gereon R.","family":"Fink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Josef","family":"Langen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2485-1796","authenticated-orcid":false,"given":"Norbert","family":"Galldiks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,4]]},"reference":[{"key":"7377_CR1","doi-asserted-by":"publisher","first-page":"iv1","DOI":"10.1093\/neuonc\/noad149","volume":"25","author":"QT Ostrom","year":"2023","unstructured":"Ostrom QT, Price M, Neff C, Cioffi G, Waite KA, Kruchko C, et al. 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Eur J Nucl Med Mol Imaging. 2019;46:540\u201357. https:\/\/doi.org\/10.1007\/s00259-018-4207-9.","journal-title":"Eur J Nucl Med Mol Imaging"}],"container-title":["European Journal of Nuclear Medicine and Molecular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00259-025-07377-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00259-025-07377-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00259-025-07377-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T08:36:30Z","timestamp":1759394190000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00259-025-07377-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,4]]},"references-count":41,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["7377"],"URL":"https:\/\/doi.org\/10.1007\/s00259-025-07377-x","relation":{},"ISSN":["1619-7070","1619-7089"],"issn-type":[{"value":"1619-7070","type":"print"},{"value":"1619-7089","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,4]]},"assertion":[{"value":"20 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The input data of the present study were derived from the results of previously published studies by Marner et al. [] and Dunkl et al. []. These studies had been performed in line with the principles of the Declaration of Helsinki and the respective institutional review board had approved these studies (Marner et al., file number: H-6\u20132014-095; Dunkl et al., file number: EK 022\/14).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent had been obtained from the legal guardians of the minor study participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The legal guardians of the minor study participants had given written informed consent for assessment of clinical data for scientific purposes and subsequent publication.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"NG received honoraria for lectures from Blue Earth Diagnostics, for advisory board participation from Telix Pharmaceuticals and Servier, and for consultancy services from Telix Pharmaceuticals. PL received honoraria for lectures from Blue Earth Diagnostics. KL received honoraria from Telix Pharmaceuticals for consultancy services. FMM is an Editor of the European Journal of Nuclear Medicine and Molecular Imaging. The other authors disclosed no potential conflicts of interest related to the present work.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}