TY  - JOUR
A1  - Steidl, Eike
A1  - Langen, Karl-Josef
A1  - Abu Hmeidan, Sarah
A1  - Polomac, Nenad
A1  - Filß, Christian
A1  - Galldiks, Norbert
A1  - Lohmann, Philipp
A1  - Keil, Fee
A1  - Filipski, Katharina Johanna
A1  - Mottaghy, Felix
A1  - Shah, N. Jon
A1  - Steinbach, Joachim Peter
A1  - Hattingen, Elke
A1  - Maurer, Gabriele D.
T1  - Sequential implementation of DSC-MR perfusion and dynamic [18F]FET PET allows efficient differentiation of glioma progression from treatment-related changes
T2  - European journal of nuclear medicine and molecular imaging
N2  - Purpose: Perfusion-weighted MRI (PWI) and O-(2-[18F]fluoroethyl-)-l-tyrosine ([18F]FET) PET are both applied to discriminate tumor progression (TP) from treatment-related changes (TRC) in patients with suspected recurrent glioma. While the combination of both methods has been reported to improve the diagnostic accuracy, the performance of a sequential implementation has not been further investigated. Therefore, we retrospectively analyzed the diagnostic value of consecutive PWI and [18F]FET PET.
Methods: We evaluated 104 patients with WHO grade II–IV glioma and suspected TP on conventional MRI using PWI and dynamic [18F]FET PET. Leakage corrected maximum relative cerebral blood volumes (rCBVmax) were obtained from dynamic susceptibility contrast PWI. Furthermore, we calculated static (i.e., maximum tumor to brain ratios; TBRmax) and dynamic [18F]FET PET parameters (i.e., Slope). Definitive diagnoses were based on histopathology (n = 42) or clinico-radiological follow-up (n = 62). The diagnostic performance of PWI and [18F]FET PET parameters to differentiate TP from TRC was evaluated by analyzing receiver operating characteristic and area under the curve (AUC).
Results: Across all patients, the differentiation of TP from TRC using rCBVmax or [18F]FET PET parameters was moderate (AUC = 0.69–0.75; p < 0.01). A rCBVmax cutoff > 2.85 had a positive predictive value for TP of 100%, enabling a correct TP diagnosis in 44 patients. In the remaining 60 patients, combined static and dynamic [18F]FET PET parameters (TBRmax, Slope) correctly discriminated TP and TRC in a significant 78% of patients, increasing the overall accuracy to 87%. A subgroup analysis of isocitrate dehydrogenase (IDH) mutant tumors indicated a superior performance of PWI to [18F]FET PET (AUC = 0.8/< 0.62, p < 0.01/≥ 0.3).
Conclusion: While marked hyperperfusion on PWI indicated TP, [18F]FET PET proved beneficial to discriminate TP from TRC when PWI remained inconclusive. Thus, our results highlight the clinical value of sequential use of PWI and [18F]FET PET, allowing an economical use of diagnostic methods. The impact of an IDH mutation needs further investigation.
KW  - Glioma
KW  - PWI
KW  - [18F]FET PET
KW  - Pseudoprogression
KW  - Isocitrate dehydrogenase
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/69232
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-692323
SN  - 1619-7089
N1  - Open Access funding enabled and organized by Projekt DEAL. E.S. was funded by the Else Kröner-Fresenius-Stiftung. The Dr. Senckenberg Institute of Neurooncology is supported by the Dr. Senckenberg foundation (grant number 2014/SIN-02).
VL  - 48
IS  - 6
SP  - 1956
EP  - 1965
PB  - Springer-Verl.
CY  - Heidelberg [u.a.]
ER  -