Cornelius Deuschl1,2, Christoph Moenninghoff3, Sophia Goericke3, Julian Kirchner4, Susanne Köppen5, Ina Binse6, Thorsten D Poeppel6, Harald H Quick7,8, Michael Forsting3, Lale Umutlu3, Ken Herrmann6, Joerg Hense9, Marc Schlamann3,10. 1. Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, D-45122, Essen, Germany. cornelius.deuschl@uk-essen.de. 2. Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Duisburg, Germany. cornelius.deuschl@uk-essen.de. 3. Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, D-45122, Essen, Germany. 4. Institute of Diagnostic and Interventional Radiology, University Hospital Duesseldorf, Duesseldorf, Germany. 5. Department of Neurology, University Hospital Essen, Essen, Germany. 6. Department of Nuclear Medicine, University Hospital Essen, Essen, Germany. 7. Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Duisburg, Germany. 8. High Field and Hybrid MR Imaging, University Hospital Essen, Essen, Germany. 9. Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany. 10. Department of Neuroradiology, University Hospital Giessen, Essen, Germany.
Abstract
BACKGROUND: The objective of this study was to evaluate the potential of integrated 11C-MET PET/MR for response assessment of relapsed glioblastoma (GBM) receiving bevacizumab treatment. METHODS: Eleven consecutive patients with relapsed GBM were enrolled for an integrated 11C-MET PET/MRI at baseline and at follow-up. Treatment response for MRI was evaluated according to Response Assessment in Neuro-oncology (RANO) criteria and integrated 11C-MET PET was assessed by the T/N ratio. RESULTS: MRI showed no patient with complete response (CR), six of 11 patients with PR, four of 11 patients with SD, and one of 11 patients with progressive disease (PD). PET revealed metabolic response in five of the six patients with partial response (PR) and in two of the four patients with stable disease (SD), whereas metabolic non-response was detected in one of the six patients with PR, in two of the four patients with SD, and in the one patient with PD. Morphological imaging was predictive for PFS and OS when response was defined as CR, PR, SD, and non-response as PD. Metabolic imaging was predictive when using T/N ratio reduction of >25 as discriminator. Based on the morphologic and metabolic findings of this study a proposal for applying integrated PET/MRI for treatment response in relapsed GBM was developed, which was significantly predictive for PFS and OS (P = 0.010 respectively 0,029, log). CONCLUSIONS: This study demonstrates the potential of integrated 11C-MET-PET/MRI for response assessment of GBM and the utility of combined assessment of morphologic and metabolic information with the proposal for assessing relapsed GBM.
BACKGROUND: The objective of this study was to evaluate the potential of integrated 11C-MET PET/MR for response assessment of relapsed glioblastoma (GBM) receiving bevacizumab treatment. METHODS: Eleven consecutive patients with relapsed GBM were enrolled for an integrated 11C-MET PET/MRI at baseline and at follow-up. Treatment response for MRI was evaluated according to Response Assessment in Neuro-oncology (RANO) criteria and integrated 11C-MET PET was assessed by the T/N ratio. RESULTS: MRI showed no patient with complete response (CR), six of 11 patients with PR, four of 11 patients with SD, and one of 11 patients with progressive disease (PD). PET revealed metabolic response in five of the six patients with partial response (PR) and in two of the four patients with stable disease (SD), whereas metabolic non-response was detected in one of the six patients with PR, in two of the four patients with SD, and in the one patient with PD. Morphological imaging was predictive for PFS and OS when response was defined as CR, PR, SD, and non-response as PD. Metabolic imaging was predictive when using T/N ratio reduction of >25 as discriminator. Based on the morphologic and metabolic findings of this study a proposal for applying integrated PET/MRI for treatment response in relapsed GBM was developed, which was significantly predictive for PFS and OS (P = 0.010 respectively 0,029, log). CONCLUSIONS: This study demonstrates the potential of integrated 11C-MET-PET/MRI for response assessment of GBM and the utility of combined assessment of morphologic and metabolic information with the proposal for assessing relapsed GBM.
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