Thomas Pyka1, Daniela Hiob2, Christine Preibisch3, Jens Gempt4, Benedikt Wiestler3, Jürgen Schlegel5, Christoph Straube6, Claus Zimmer3. 1. Department of Neuroradiology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675 München, Germany; Department of Nuclear Medicine, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675 München, Germany. Electronic address: thomas.pyka@tum.de. 2. Department of Nuclear Medicine, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675 München, Germany. 3. Department of Neuroradiology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675 München, Germany. 4. Department of Neurosurgery, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675 München, Germany. 5. Department of Neuropathology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675 München, Germany. 6. Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675 München, Germany.
Abstract
OBJECTIVES: To investigate the value of combined 18F-fluorethyltyrosine-(FET)-PET/MRI for differentiation between recurrence and treatment-related changes in glioma patients. METHODS: 63 lesions suggestive of recurrence in 47 glioma patients were retrospectively identified. All patients had a dynamic FET scan, as well as morphologic MRI, PWI and DWI on a hybrid PET/MRI scanner. Lesions suggestive of recurrence were marked. ROC analysis was performed univariately and on parameter combination. RESULTS: 50 lesions were classified as recurrence, 13 as radiation necrosis. Diagnosis was based on histology in 23 and follow-up imaging in 40 cases. Sensitivities and specificities for static PET were 80 and 85%, 66% and 77% for PWI, 62 and 77% for DWI and 64 and 79% for PET time-to-peak. AUC was 0.86 (p < 0.001) for static PET, 0.73 (p = 0.013) for PWI, 0.70 (p = 0.030) for DWI and 0.73 (p < 0.001) for dynamic PET. Multiparametric analysis resulted in an AUC of 0.89, notably yielding sensitivity of 76% vs. 56% for PET alone at 100% specificity. CONCLUSION: Simultaneous dynamic FET-PET/MRI was reliably feasible for imaging of recurrent glioma. While all modalities were able to discriminate between recurrence and treatment-related changes, multiparametric analysis added value especially when high specificity was demanded.
OBJECTIVES: To investigate the value of combined 18F-fluorethyltyrosine-(FET)-PET/MRI for differentiation between recurrence and treatment-related changes in gliomapatients. METHODS: 63 lesions suggestive of recurrence in 47 gliomapatients were retrospectively identified. All patients had a dynamic FET scan, as well as morphologic MRI, PWI and DWI on a hybrid PET/MRI scanner. Lesions suggestive of recurrence were marked. ROC analysis was performed univariately and on parameter combination. RESULTS: 50 lesions were classified as recurrence, 13 as radiation necrosis. Diagnosis was based on histology in 23 and follow-up imaging in 40 cases. Sensitivities and specificities for static PET were 80 and 85%, 66% and 77% for PWI, 62 and 77% for DWI and 64 and 79% for PET time-to-peak. AUC was 0.86 (p < 0.001) for static PET, 0.73 (p = 0.013) for PWI, 0.70 (p = 0.030) for DWI and 0.73 (p < 0.001) for dynamic PET. Multiparametric analysis resulted in an AUC of 0.89, notably yielding sensitivity of 76% vs. 56% for PET alone at 100% specificity. CONCLUSION: Simultaneous dynamic FET-PET/MRI was reliably feasible for imaging of recurrent glioma. While all modalities were able to discriminate between recurrence and treatment-related changes, multiparametric analysis added value especially when high specificity was demanded.
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