Antoine Verger1, Christian P Filss2, Philipp Lohmann3, Gabriele Stoffels3, Michael Sabel4, Hans-J Wittsack5, Elena Rota Kops3, Norbert Galldiks6, Gereon R Fink7, Nadim J Shah8, Karl-Josef Langen9. 1. Institute of Neuroscience and Medicine (INM-3, -4), Forschungszentrum Jülich, Jülich, Germany; Department of Nuclear Medicine & Nancyclotep Imaging Platform, CHRU Nancy, Lorraine University, Nancy, France; IADI, INSERM, UMR 947, Lorraine University, Nancy, France. Electronic address: a.verger@chru-nancy.fr. 2. Institute of Neuroscience and Medicine (INM-3, -4), Forschungszentrum Jülich, Jülich, Germany; Department of Nuclear Medicine, RWTH Aachen University Hospital, Aachen, Germany. 3. Institute of Neuroscience and Medicine (INM-3, -4), Forschungszentrum Jülich, Jülich, Germany. 4. Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany. 5. Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany. 6. Institute of Neuroscience and Medicine (INM-3, -4), Forschungszentrum Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology (CIO), University of Cologne and Bonn, Cologne and Bonn, Germany. 7. Institute of Neuroscience and Medicine (INM-3, -4), Forschungszentrum Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany. 8. Institute of Neuroscience and Medicine (INM-3, -4), Forschungszentrum Jülich, Jülich, Germany; Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany; Section JARA-Brain, Jülich-Aachen Research Alliance (JARA), Jülich, Germany. 9. Institute of Neuroscience and Medicine (INM-3, -4), Forschungszentrum Jülich, Jülich, Germany; Department of Nuclear Medicine, RWTH Aachen University Hospital, Aachen, Germany; Section JARA-Brain, Jülich-Aachen Research Alliance (JARA), Jülich, Germany.
Abstract
OBJECTIVE: To compare the diagnostic performance of O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) positron emission tomography (PET) and perfusion-weighted magnetic resonance imaging (PWI) for the diagnosis of progressive or recurrent glioma. METHODS: Thirty-two pretreated gliomas (25 progressive or recurrent tumors, 7 treatment-related changes) were investigated with 18F-FET PET and PWI via a hybrid PET/magnetic resonance scanner. Volumes of interest with a diameter of 16 mm were centered on the maximum of abnormality in the tumor area in PET and PWI maps (relative cerebral blood volume, relative cerebral blood flow, mean transit time) and the contralateral unaffected hemisphere. Mean and maximum tumor-to-brain ratios as well as dynamic data for 18F-FET uptake were calculated. Diagnostic accuracies were evaluated by receiver operating characteristic analyses, calculating the area under the curve. RESULTS: 18F-FET PET showed a significant greater sensitivity to detect abnormalities in pretreated gliomas than PWI (76% vs. 52%, P = 0.03). The maximum tumor-to-brain ratio of 18F-FET PET was the only parameter that discriminated treatment-related changes from progressive or recurrent gliomas (area under the curve, 0.78; P = 0.03, best cut-off 2.61; sensitivity 80%, specificity 86%, accuracy 81%). Among patients with signal abnormality in both modalities, 75% revealed spatially incongruent local hot spots. CONCLUSIONS: This pilot study suggests that 18F-FET PET is superior to PWI to diagnose progressive or recurrent glioma.
OBJECTIVE: To compare the diagnostic performance of O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) positron emission tomography (PET) and perfusion-weighted magnetic resonance imaging (PWI) for the diagnosis of progressive or recurrent glioma. METHODS: Thirty-two pretreated gliomas (25 progressive or recurrent tumors, 7 treatment-related changes) were investigated with 18F-FET PET and PWI via a hybrid PET/magnetic resonance scanner. Volumes of interest with a diameter of 16 mm were centered on the maximum of abnormality in the tumor area in PET and PWI maps (relative cerebral blood volume, relative cerebral blood flow, mean transit time) and the contralateral unaffected hemisphere. Mean and maximum tumor-to-brain ratios as well as dynamic data for 18F-FET uptake were calculated. Diagnostic accuracies were evaluated by receiver operating characteristic analyses, calculating the area under the curve. RESULTS: 18F-FET PET showed a significant greater sensitivity to detect abnormalities in pretreated gliomas than PWI (76% vs. 52%, P = 0.03). The maximum tumor-to-brain ratio of 18F-FET PET was the only parameter that discriminated treatment-related changes from progressive or recurrent gliomas (area under the curve, 0.78; P = 0.03, best cut-off 2.61; sensitivity 80%, specificity 86%, accuracy 81%). Among patients with signal abnormality in both modalities, 75% revealed spatially incongruent local hot spots. CONCLUSIONS: This pilot study suggests that 18F-FET PET is superior to PWI to diagnose progressive or recurrent glioma.
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