Sequential implementation of DSC-MR perfusion and dynamic [18F]FET PET allows efficient differentiation of glioma progression from treatment-related changes
European Journal of Nuclear Medicine and Molecular Imaging, vol. 48, pp. 1956–1965
Abstract
Abstract 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.
Authors 14
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Eike Steidl corresponding
Goethe University Frankfurt · German Cancer Research Center · University Hospital Frankfurt · Deutsches Konsortium für Translationale Krebsforschung
Affiliation as printed
German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, and German Cancer Research Center (DKFZ), Heidelberg, Germany. eike.steidl@kgu.de
Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Schleusenweg 2-16, Frankfurt am Main, 60528, Germany. eike.steidl@kgu.de
University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany. eike.steidl@kgu.de
Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Schleusenweg 2-16, Frankfurt am Main, 60528, Germany
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Forschungszentrum Jülich · Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Aachen, Germany
Dept. of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
Inst. of Neuroscience and Medicine, Medical Imaging Physics (INM-4), Research Center Juelich, Juelich, Germany
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Goethe University Frankfurt · University Hospital Frankfurt
Affiliation as printed
Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Schleusenweg 2-16, Frankfurt am Main, 60528, Germany
University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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Goethe University Frankfurt · University Hospital Frankfurt
Affiliation as printed
Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Schleusenweg 2-16, Frankfurt am Main, 60528, Germany
University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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Forschungszentrum Jülich · Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Dept. of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
Inst. of Neuroscience and Medicine, Medical Imaging Physics (INM-4), Research Center Juelich, Juelich, Germany
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Forschungszentrum Jülich · University of Cologne · University Hospital Cologne
Affiliation as printed
Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany
Dept. of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
Inst. of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Research Center Juelich, Juelich, Germany
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Forschungszentrum Jülich · University of Cologne · University Hospital Cologne
Affiliation as printed
Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
Inst. of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Research Center Juelich, Juelich, Germany
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Goethe University Frankfurt · University Hospital Frankfurt
Affiliation as printed
Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Schleusenweg 2-16, Frankfurt am Main, 60528, Germany
University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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Goethe University Frankfurt · German Cancer Research Center · University Hospital Frankfurt · Deutsches Konsortium für Translationale Krebsforschung
Affiliation as printed
German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, and German Cancer Research Center (DKFZ), Heidelberg, Germany
Institute of Neurology (Edinger Institute), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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Maastricht University Medical Centre · Maastricht University · Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Aachen, Germany
Dept. of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
Dept. of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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Forschungszentrum Jülich · Universitätsklinikum Aachen · Jülich Aachen Research Alliance · RWTH Aachen University
Affiliation as printed
Dept. of Neurology, University Hospital RWTH Aachen, Aachen, Germany
Inst. of Neuroscience and Medicine, Medical Imaging Physics (INM-4), Research Center Juelich, Juelich, Germany
Inst. of Neuroscience and Medicine, Molecular Neuroscience and Neuroimaging (INM-11), JARA, Research Center Juelich, Juelich, Germany
JARA - BRAIN - Translational Medicine, Aachen, Germany
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Goethe University Frankfurt · German Cancer Research Center · University Hospital Frankfurt · Deutsches Konsortium für Translationale Krebsforschung
Affiliation as printed
Dr. Senckenberg Institute of Neurooncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, and German Cancer Research Center (DKFZ), Heidelberg, Germany
University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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Goethe University Frankfurt · German Cancer Research Center · University Hospital Frankfurt · Deutsches Konsortium für Translationale Krebsforschung
Affiliation as printed
German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, and German Cancer Research Center (DKFZ), Heidelberg, Germany
Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Schleusenweg 2-16, Frankfurt am Main, 60528, Germany
University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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Goethe University Frankfurt · German Cancer Research Center · University Hospital Frankfurt · Deutsches Konsortium für Translationale Krebsforschung
Affiliation as printed
Dr. Senckenberg Institute of Neurooncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, and German Cancer Research Center (DKFZ), Heidelberg, Germany
University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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