Sequential implementation of DSC-MR perfusion and dynamic [ 18 F]FET PET allows efficient differentiation of glioma progression from treatment-related changes.

Autor: Steidl E; Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Schleusenweg 2-16, Frankfurt am Main, 60528, Germany. eike.steidl@kgu.de.; University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany. eike.steidl@kgu.de.; German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, and German Cancer Research Center (DKFZ), Heidelberg, Germany. eike.steidl@kgu.de., Langen KJ; Inst. of Neuroscience and Medicine, Medical Imaging Physics (INM-4), Research Center Juelich, Juelich, Germany.; Dept. of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany.; Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Aachen, Germany., Hmeidan SA; Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Schleusenweg 2-16, Frankfurt am Main, 60528, Germany.; University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany., Polomac N; Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Schleusenweg 2-16, Frankfurt am Main, 60528, Germany.; University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany., Filss CP; Inst. of Neuroscience and Medicine, Medical Imaging Physics (INM-4), Research Center Juelich, Juelich, Germany.; Dept. of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany., Galldiks N; Inst. of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Research Center Juelich, Juelich, Germany.; Dept. of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.; Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany., Lohmann P; Inst. of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Research Center Juelich, Juelich, Germany.; Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany., Keil F; Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Schleusenweg 2-16, Frankfurt am Main, 60528, Germany.; University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany., Filipski K; University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.; German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, and German Cancer Research Center (DKFZ), Heidelberg, Germany.; Institute of Neurology (Edinger Institute), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany., Mottaghy FM; Dept. of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany.; Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Aachen, Germany.; Dept. of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands., Shah NJ; Inst. of Neuroscience and Medicine, Medical Imaging Physics (INM-4), Research Center Juelich, Juelich, Germany.; Inst. of Neuroscience and Medicine, Molecular Neuroscience and Neuroimaging (INM-11), JARA, Research Center Juelich, Juelich, Germany.; Dept. of Neurology, University Hospital RWTH Aachen, Aachen, Germany.; JARA - BRAIN - Translational Medicine, Aachen, Germany., Steinbach JP; University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.; German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, and German Cancer Research Center (DKFZ), Heidelberg, Germany.; Dr. Senckenberg Institute of Neurooncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany., Hattingen E; Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Schleusenweg 2-16, Frankfurt am Main, 60528, Germany.; University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.; German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, and German Cancer Research Center (DKFZ), Heidelberg, Germany., Maurer GD; University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.; German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, and German Cancer Research Center (DKFZ), Heidelberg, Germany.; Dr. Senckenberg Institute of Neurooncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.
Jazyk: angličtina
Zdroj: European journal of nuclear medicine and molecular imaging [Eur J Nucl Med Mol Imaging] 2021 Jun; Vol. 48 (6), pp. 1956-1965. Date of Electronic Publication: 2020 Nov 26.
DOI: 10.1007/s00259-020-05114-0
Abstrakt: Purpose: Perfusion-weighted MRI (PWI) and O-(2-[ 18 F]fluoroethyl-)-l-tyrosine ([ 18 F]FET) PET are both applied to discriminate tumor progression (TP) from treatment-related changes (TRC) in patients with suspected recurrent glioma. While the combination of both methods has been reported to improve the diagnostic accuracy, the performance of a sequential implementation has not been further investigated. Therefore, we retrospectively analyzed the diagnostic value of consecutive PWI and [ 18 F]FET PET.
Methods: We evaluated 104 patients with WHO grade II-IV glioma and suspected TP on conventional MRI using PWI and dynamic [ 18 F]FET PET. Leakage corrected maximum relative cerebral blood volumes (rCBV max ) were obtained from dynamic susceptibility contrast PWI. Furthermore, we calculated static (i.e., maximum tumor to brain ratios; TBR max ) and dynamic [ 18 F]FET PET parameters (i.e., Slope). Definitive diagnoses were based on histopathology (n = 42) or clinico-radiological follow-up (n = 62). The diagnostic performance of PWI and [ 18 F]FET PET parameters to differentiate TP from TRC was evaluated by analyzing receiver operating characteristic and area under the curve (AUC).
Results: Across all patients, the differentiation of TP from TRC using rCBV max or [ 18 F]FET PET parameters was moderate (AUC = 0.69-0.75; p < 0.01). A rCBV max cutoff > 2.85 had a positive predictive value for TP of 100%, enabling a correct TP diagnosis in 44 patients. In the remaining 60 patients, combined static and dynamic [ 18 F]FET PET parameters (TBR max , Slope) correctly discriminated TP and TRC in a significant 78% of patients, increasing the overall accuracy to 87%. A subgroup analysis of isocitrate dehydrogenase (IDH) mutant tumors indicated a superior performance of PWI to [ 18 F]FET PET (AUC = 0.8/< 0.62, p < 0.01/≥ 0.3).
Conclusion: While marked hyperperfusion on PWI indicated TP, [ 18 F]FET PET proved beneficial to discriminate TP from TRC when PWI remained inconclusive. Thus, our results highlight the clinical value of sequential use of PWI and [ 18 F]FET PET, allowing an economical use of diagnostic methods. The impact of an IDH mutation needs further investigation.
Databáze: MEDLINE
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