Diagnostic value of PET/CT with 11C-methionine (MET) and 18F-fluorothymidine (FLT) in newly diagnosed glioma based on the 2016 WHO classification
Diagnostic value of PET/CT with 11C-methionine (MET) and 18F-fluorothymidine (FLT) in newly diagnosed glioma based on the 2016 WHO classification
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DOI：
10.1186/s13550-020-00633-1
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发表时间：
2020-05-07
期刊：
影响因子：
3.2
通讯作者：
Tamiya, Takashi
中科院分区：
文献类型：
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作者：
Ogawa, Tomoya;Kawai, Nobuyuki;Tamiya, Takashi
异柠檬酸脱氢酶（IDH）突变和染色体1 p和19 q（1 p/19 q）共缺失状态的分子特征对于分化胶质瘤具有关键作用，并已于2016年纳入世界卫生组织（WHO）分类。正电子发射断层扫描（PET）与3 '-脱氧-3'-[F-18]氟胸苷（FLT）已被用于评估肿瘤分级和增殖活性，并与l-[甲基-C-11]-蛋氨酸（MET）在胶质瘤患者中进行了比较。在此，我们评估了MET-PET/CT和FLT-PET/CT的示踪剂摄取，以基于2016年WHO分类，特别是与IDH 1突变状态相关的胶质瘤。方法收集81例幕上胶质瘤患者的临床资料。他们在手术前接受了MET和FLT的PET/CT研究。使用手术标本确定基于2016年WHO分类的分子特征和组织病理学诊断。在MET-PET/CT和FLT-PET/CT图像上计算肿瘤的最大标准化摄取值（SUV）与对侧皮质的平均SUV的比值（T/N比值）。结果IDH 1野生型肿瘤的MET-PET/CT和FLT-PET/CT的T/N比值明显高于IDH 1突变型肿瘤（P < 0.001和P < 0.001）。受试者操作特征分析显示，FLT T/N比值的曲线下面积显著大于MET T/N比值（P < 0.01）。在II级和III级胶质瘤中，IDH 1野生型肿瘤中FLT-PET/CT的平均T/N比显著高于IDH 1突变型肿瘤（P = 0.005），但MET-PET/CT的情况并非如此。MET-PET/CT和FLT-PET/CT都能够区分IDH 1突变型肿瘤中的II级和III级胶质瘤（分别为P = 0.002和P < 0.001），但只有FLT-PET/CT能够区分IDH 1野生型肿瘤中的III级和IV级胶质瘤（P = 0.029）。结论FLT-PET/CT比MET-PET/CT能更准确地检测胶质瘤IDH 1基因突变情况，并能更准确地评估胶质瘤分级。根据2016年WHO分类，FLT-PET/CT可以改善胶质瘤的分化，但必须谨慎使用没有造影剂增强的肿瘤，并应在更多病例中进行进一步研究。
Background The molecular features of isocitrate dehydrogenase (IDH) mutation and chromosome 1p and 19q (1p/19q) codeletion status have pivotal role for differentiating gliomas and have been integrated in the World Health Organization (WHO) classification in 2016. Positron emission tomography (PET) with 3 '-deoxy-3 '-[F-18]fluorothymidine (FLT) has been used to evaluate tumour grade and proliferative activity and compared with l-[methyl-C-11]-methionine (MET) in glioma patients. Herein, we evaluated tracer uptakes of MET-PET/CT and FLT-PET/CT for differentiating glioma based on the 2016 WHO classification especially in relation to IDH1 mutation status. Methods In total, 81 patients with newly diagnosed supratentorial glioma were enrolled in this study. They underwent PET/CT studies with MET and FLT before surgery. The molecular features and histopathological diagnosis based on the 2016 WHO classification were determined using surgical specimens. The ratios of the maximum standardized uptake value (SUV) of the tumours to the mean SUV of the contralateral cortex (T/N ratios) were calculated on MET-PET/CT and FLT-PET/CT images. Results The mean T/N ratios of MET-PET/CT and FLT-PET/CT in IDH1-wildtype tumours were significantly higher than those in IDH1-mutant tumours (P < 0.001 and P < 0.001, respectively). Receiver operating characteristic analysis for differentiating IDH1 mutation status showed that the area under the curve of the FLT T/N ratio was significantly larger than that of the MET T/N ratio (P < 0.01). The mean T/N ratio of FLT-PET/CT in IDH1-wildtype tumours was significantly higher than that in IDH1-mutant tumours among grade II and III gliomas (P = 0.005), but this was not the case for MET-PET/CT. Both MET-PET/CT and FLT-PET/CT were able to distinguish between grade II and III gliomas in IDH1-mutant tumours (P = 0.002 and P < 0.001, respectively), but only FLT-PET/CT was able to distinguish between grade III and IV gliomas in IDH1-wildtype tumours (P = 0.029). Conclusion This study showed that FLT-PET/CT can be used to determine the IDH1 mutation status and evaluate glioma grade more accurately than MET-PET/CT. FLT-PET/CT can improve glioma differentiation based on the 2016 WHO classification, but caution must be paid for tumours without contrast enhancement and further studies should be conducted with more cases.