Sequential implementation of DSC-MR perfusion and dynamic [18F]FET PET allows efficient differentiation of glioma progression from treatment-related changes

  • 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.
Author:Eike SteidlORCiDGND, Karl-Josef LangenORCiDGND, Sarah Abu Hmeidan, Nenad PolomacORCiD, Christian FilßORCiDGND, Norbert GalldiksORCiDGND, Philipp LohmannORCiDGND, Fee KeilORCiDGND, Katharina Johanna FilipskiGND, Felix MottaghyORCiDGND, N. Jon ShahORCiDGND, Joachim Peter SteinbachORCiDGND, Elke HattingenORCiDGND, Gabriele D. MaurerORCiDGND
Parent Title (English):European journal of nuclear medicine and molecular imaging
Place of publication:Heidelberg [u.a.]
Document Type:Article
Date of Publication (online):2020/11/26
Date of first Publication:2020/11/26
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2022/10/20
Tag:Glioma; Isocitrate dehydrogenase; PWI; Pseudoprogression; [18F]FET PET
Page Number:10
First Page:1956
Last Page:1965
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).
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0