| Autor: |
Pierre, Lovinfosse, Selma, Ben Mustapha, Nadia, Withofs |
| Rok vydání: |
2019 |
| Předmět: |
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| Zdroj: |
Eur J Nucl Med Mol Imaging |
| ISSN: |
1619-7089 |
| Popis: |
PURPOSE: Radiographic changes of brain metastases after stereotactic radiosurgery (SRS) can signify tumor recurrence and/or radiation necrosis (RN), however standard imaging modalities cannot easily distinguish between these two entities. We investigated whether (18)F-Fluorocholine uptake in surgical samples of the resected lesions correlates with pathologic evidence of recurrent tumor and PET imaging. METHODS: 14 patients previously treated with SRS that developed radiographic changes were included. All patients underwent a pre-operative 40-min dynamic PET/CT concurrent with 392±11 MBq bolus injection of (18)F-Fluorocholine. (18)F-Fluorocholine pharmacokinetics were evaluated by standardized uptake value (SUV), graphical analysis (Patlak plot; K(i)(P)) and an irreversible 2-compartment model (K(1), k(2), k(3) and K(i)). 12 out of 14 patients were administered an additional 72±14 MBq injection of (18)F-Fluorocholine 95±26 minutes prior to surgical resection. 113 resected samples from 12 patients were blindly reviewed by a neuropathologist to assess the viable tumor and necrotic content, microvascular proliferation, reactive gliosis and mono- and polymorphonuclear inflammatory infiltrates. Correlation between these metrics (18)F-Fluorocholine SUV was investigated with a linear mixed model. Comparison of survival distributions of two groups of patients (population median split of PET SUV(max)) was performed with the log-rank test. RESULTS: 10 out of 12 patients for which surgical samples were acquired exhibited pathologic recurrence. Strong correlation was observed between SUV(max) as measured from a surgically removed sample with highest uptake and by PET (Pearson’s r=0.66). Patients with (18)F-Fluorocholine PET SUV(max) >6 experienced poor survival. Surgical samples with viable tumor had higher (18)F-fluorocholine uptake (SUV) than those without tumor (4.5±3.7 and 2.6±3.0; p=0.01). (18)F-fluorocholine count data from surgical samples is driven not only by the percentage viable tumor, but also by the degree of inflammation and reactive gliosis. (p≤0.02; multivariate regression). CONCLUSIONS: (18)F-Fluorocholine accumulation is increased in viable tumor, however inflammation and gliosis may also lead to elevated uptake. Higher (18)F-Fluorocholine PET uptake portends worse prognosis. Kinetic analysis of dynamic (18)F-Fluorocholine PET imaging supports the adequacy of the simpler static SUV metric. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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