Gabriele D Maurer1,2,3, Daniel P Brucker2,3, Gabriele Stoffels4, Katharina Filipski3,5,6, Christian P Filss4,7, Felix M Mottaghy7,8,9, Norbert Galldiks4,9,10, Joachim P Steinbach11,2,3, Elke Hattingen12, Karl-Josef Langen4,7,9. 1. Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Frankfurt am Main, Germany gabriele.maurer@kgu.de. 2. University Cancer Center Frankfurt, Goethe University Hospital, Frankfurt am Main, Germany. 3. German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Heidelberg, Germany. 4. Institute of Neuroscience and Medicine (INM-3 and INM-4), Research Center Juelich, Juelich, Germany. 5. German Cancer Research Center (DKFZ), Heidelberg, Germany. 6. Institute of Neurology (Edinger Institute), Goethe University Hospital, Frankfurt am Main, Germany. 7. Department of Nuclear Medicine, RWTH University Hospital, Aachen, Germany. 8. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands. 9. Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany. 10. Department of Neurology, University Hospital Cologne, Cologne, Germany; and. 11. Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Frankfurt am Main, Germany. 12. Institute of Neuroradiology, Goethe University Hospital, Frankfurt am Main, Germany.
Abstract
In glioma patients, differentiation between tumor progression (TP) and treatment-related changes (TRCs) remains challenging. Difficulties in classifying imaging alterations may result in a delay or an unnecessary discontinuation of treatment. PET using O-(2-18F-fluoroethyl)-l-tyrosine (18F-FET) has been shown to be a useful tool for detecting TP and TRCs. Methods: We retrospectively evaluated 127 consecutive patients with World Health Organization grade II-IV glioma who underwent 18F-FET PET imaging to distinguish between TP and TRCs. 18F-FET PET findings were verified by neuropathology (40 patients) or clinicoradiologic follow-up (87 patients). Maximum tumor-to-brain ratios (TBRmax) of 18F-FET uptake and the slope of the time-activity curves (20-50 min after injection) were determined. The diagnostic accuracy of 18F-FET PET parameters was evaluated by receiver-operating-characteristic analysis and χ2 testing. The prognostic value of 18F-FET PET was estimated using the Kaplan-Meier method. Results: TP was diagnosed in 94 patients (74%) and TRCs in 33 (26%). For differentiating TP from TRCs, receiver-operating-characteristic analysis yielded an optimal 18F-FET TBRmax cutoff of 1.95 (sensitivity, 70%; specificity, 71%; accuracy, 70%; area under the curve, 0.75 ± 0.05). The highest accuracy was achieved by a combination of TBRmax and slope (sensitivity, 86%; specificity, 67%; accuracy, 81%). However, accuracy was poorer when tumors harbored isocitrate dehydrogenase (IDH) mutations (91% in IDH-wild-type tumors, 67% in IDH-mutant tumors, P < 0.001). 18F-FET PET results correlated with overall survival (P < 0.001). Conclusion: In our neurooncology department, the diagnostic performance of 18F-FET PET was convincing but slightly inferior to that of previous reports.
In gliomapatients, differentiation between tumor progression (TP) and treatment-related changes (TRCs) remains challenging. Difficulties in classifying imaging alterations may result in a delay or an unnecessary discontinuation of treatment. PET using O-(2-18F-fluoroethyl)-l-tyrosine (18F-FET) has been shown to be a useful tool for detecting TP and TRCs. Methods: We retrospectively evaluated 127 consecutive patients with World Health Organization grade II-IV glioma who underwent 18F-FET PET imaging to distinguish between TP and TRCs. 18F-FET PET findings were verified by neuropathology (40 patients) or clinicoradiologic follow-up (87 patients). Maximum tumor-to-brain ratios (TBRmax) of 18F-FET uptake and the slope of the time-activity curves (20-50 min after injection) were determined. The diagnostic accuracy of 18F-FET PET parameters was evaluated by receiver-operating-characteristic analysis and χ2 testing. The prognostic value of 18F-FET PET was estimated using the Kaplan-Meier method. Results: TP was diagnosed in 94 patients (74%) and TRCs in 33 (26%). For differentiating TP from TRCs, receiver-operating-characteristic analysis yielded an optimal 18F-FETTBRmax cutoff of 1.95 (sensitivity, 70%; specificity, 71%; accuracy, 70%; area under the curve, 0.75 ± 0.05). The highest accuracy was achieved by a combination of TBRmax and slope (sensitivity, 86%; specificity, 67%; accuracy, 81%). However, accuracy was poorer when tumors harbored isocitrate dehydrogenase (IDH) mutations (91% in IDH-wild-type tumors, 67% in IDH-mutant tumors, P < 0.001). 18F-FET PET results correlated with overall survival (P < 0.001). Conclusion: In our neurooncology department, the diagnostic performance of 18F-FET PET was convincing but slightly inferior to that of previous reports.
Authors: Otto M Henriksen; Adam E Hansen; Aida Muhic; Lisbeth Marner; Karine Madsen; Søren Møller; Benedikte Hasselbalch; Michael J Lundemann; David Scheie; Jane Skjøth-Rasmussen; Hans S Poulsen; Vibeke A Larsen; Henrik B W Larsson; Ian Law Journal: Eur J Nucl Med Mol Imaging Date: 2022-07-30 Impact factor: 10.057
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