Peggy Gandia1,2, Cyril Jaudet3, Hendrik Everaert3, Johannes Heemskerk3, Anne Marie Vanbinst4, Johan de Mey4, Johnny Duerinck5, Bart Neyns6, Mark de Ridder7, Etienne Chatelut1,8, Didier Concordet9. 1. CRCT, Université de Toulouse, Inserm, UPS, Toulouse, France. 2. Toxalim, Université de Toulouse, INRA, ENVT, 23 chemin des Capelles, BP 87614, 31076, Toulouse Cedex 3, France. 3. Department of Nuclear Medicine, UZ Brussel, Brussels, Belgium. 4. Department of Radiology, UZ Brussel, Brussels, Belgium. 5. Department of Neurosurgery, UZ Brussel, Brussels, Belgium. 6. Department of Medical Oncology, UZ Brussel, Brussels, Belgium. 7. Department of Radiotherapy, UZ Brussel, Brussels, Belgium. 8. Institut Claudius Regaud, Toulouse, France. 9. Toxalim, Université de Toulouse, INRA, ENVT, 23 chemin des Capelles, BP 87614, 31076, Toulouse Cedex 3, France. d.concordet@envt.fr.
Abstract
BACKGROUND AND AIMS: 18F-fluoro-ethyl-tyrosine (FET) is a radiopharmaceutical used in positron emission tomography (PET)-computed tomography in patients with glioma. We propose an original approach combining a radiotracer-pharmacokinetic exploration performed at the voxel level (three-dimensional pixel) and voxel classification to identify tumor tissue. Our methodology was validated using the standard FET-PET approach and magnetic resonance imaging (MRI) data acquired according to the current clinical practices. METHODS: FET-PET and MRI data were retrospectively analyzed in ten patients presenting with progressive high-grade glioma. For FET-PET exploration, radioactivity acquisition started 15 min after radiotracer injection, and was measured each 5 min during 40 min. The tissue segmentation relies on population pharmacokinetic modeling with dependent individuals (voxels). This model can be approximated by a linear mixed-effects model. The tumor volumes estimated by our approach were compared with those determined with the current clinical techniques, FET-PET standard approach (i.e., a cumulated value of FET signal is computed during a time interval) and MRI sequences (T1 and T2/fluid-attenuated inversion recovery [FLAIR]), used as references. The T1 sequence is useful to identify highly vascular tumor and necrotic tissues, while the T2/FLAIR sequence is useful to isolate infiltration and edema tissue located around the tumor. RESULTS: With our kinetic approach, the volumes of tumor tissue were larger than the tissues identified by the standard FET-PET and MRI T1, while they were smaller than those determined with MRI T2/FLAIR. CONCLUSION: Our results revealed the presence of suspected tumor voxels not identified by the standard PET approach.
BACKGROUND AND AIMS: 18F-fluoro-ethyl-tyrosine (FET) is a radiopharmaceutical used in positron emission tomography (PET)-computed tomography in patients with glioma. We propose an original approach combining a radiotracer-pharmacokinetic exploration performed at the voxel level (three-dimensional pixel) and voxel classification to identify tumor tissue. Our methodology was validated using the standard FET-PET approach and magnetic resonance imaging (MRI) data acquired according to the current clinical practices. METHODS:FET-PET and MRI data were retrospectively analyzed in ten patients presenting with progressive high-grade glioma. For FET-PET exploration, radioactivity acquisition started 15 min after radiotracer injection, and was measured each 5 min during 40 min. The tissue segmentation relies on population pharmacokinetic modeling with dependent individuals (voxels). This model can be approximated by a linear mixed-effects model. The tumor volumes estimated by our approach were compared with those determined with the current clinical techniques, FET-PET standard approach (i.e., a cumulated value of FET signal is computed during a time interval) and MRI sequences (T1 and T2/fluid-attenuated inversion recovery [FLAIR]), used as references. The T1 sequence is useful to identify highly vascular tumor and necrotic tissues, while the T2/FLAIR sequence is useful to isolate infiltration and edema tissue located around the tumor. RESULTS: With our kinetic approach, the volumes of tumor tissue were larger than the tissues identified by the standard FET-PET and MRI T1, while they were smaller than those determined with MRI T2/FLAIR. CONCLUSION: Our results revealed the presence of suspected tumor voxels not identified by the standard PET approach.
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