Individualized discrimination of tumor progression from treatment-related changes in different types of adult-type diffuse gliomas using [11C]methionine PET
Individualized discrimination of tumor progression from treatment-related changes in different types of adult-type diffuse gliomas using [11C]methionine PET
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DOI：
10.1007/s11060-023-04529-7
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发表时间：
2023-12-14
影响因子：
3.9
通讯作者：
Ai，Lin
中科院分区：
文献类型：
--
作者：
Chen，Qiang;Wang，Kai;Ai，Lin
本研究旨在评估[11 C]蛋氨酸（MET）PET在区分不同类型成人型弥漫性胶质瘤（根据2021年世界卫生组织分类）的肿瘤进展（TP）和治疗相关变化（TRC）并预测总生存期（OS）的能力。型弥漫性胶质瘤，疑似TP，行MET PET成像。计算最大和平均肿瘤背景比（TBRmax，TBRmean）和代谢肿瘤体积（MTV）。通过组织病理学（n = 50）或临床/放射学随访（n = 63）验证诊断。通过受试者工作特征（ROC）分析和曲线下面积（AUC）计算评价MET PET参数的诊断性能。生存分析采用Kaplan-Meier法和考克斯proportional-hazards regression.ResultsTP和TRCs分别诊断为76例（67%）和37例（33%）患者。ROC分析显示TBRmax在鉴别TP和TRC中具有最好的性能，其截断值为1.96 inIDH突变型星形细胞瘤（AUC，0.87;灵敏度，93%;特异性69%），1.80在IDH突变型和1 p/19 q共缺失型少突胶质细胞瘤中（AUC，0.96;灵敏度，100%;特异性，89%），在IDH野生型胶质母细胞瘤中分别为2.13（AUC，0.89;灵敏度，89%;特异性，78%）。在多变量分析中，较高的TBRmeans和MTV与所有IDH突变型胶质瘤以及IDH突变型星形细胞瘤亚组中较短的OS显著相关。并强调了其在IDH突变型和1 p/19 q共缺失型少突胶质细胞瘤中的高诊断准确性以及IDH突变型胶质细胞瘤的潜在预后价值，特别是IDH突变型星形细胞瘤。
PurposeThis study aimed to assess the ability of [11C]methionine (MET) PET in distinguishing between tumor progression (TP) and treatment-related changes (TRCs) among different types of adult-type diffuse gliomas according to the 2021 World Health Organization classification and predict overall survival (OS).MethodsWe retrospectively selected 113 patients with adult-type diffuse gliomas with suspected TP who underwent MET PET imaging. Maximum and mean tumor-to-background ratios (TBRmax, TBRmean) and metabolic tumor volume (MTV) were calculated. Diagnoses were verified by histopathology (n = 50) or by clinical/radiological follow-up (n = 63). The diagnostic performance of MET PET parameters was evaluated through receiver operating characteristic (ROC) analysis and area under the curve (AUC) calculation. Survival analysis employed the Kaplan–Meier method and Cox proportional-hazards regression.ResultsTP and TRCs were diagnosed in 76 (67%) and 37 (33%) patients, respectively. ROC analysis revealed TBRmaxhad the best performance in differentiating TP from TRCs with a cut-off of 1.96 inIDH-mutant astrocytoma (AUC, 0.87; sensitivity, 93%; specificity 69%), 1.80 inIDH-mutant and 1p/19q-codeleted oligodendroglioma (AUC, 0.96; sensitivity, 100%; specificity, 89%), and 2.13 inIDHwild-type glioblastoma (AUC, 0.89; sensitivity, 89%; specificity, 78%), respectively. On multivariate analysis, higher TBRmeanand MTV were significantly correlated with shorter OS in allIDH-mutant gliomas, as well as inIDH-mutant astrocytoma subgroup.ConclusionThis work confirms that MET PET has varying diagnostic performances in distinguishing TP from TRCs within three types of adult-type diffuse gliomas, and highlights its high diagnostic accuracy inIDH-mutant and 1p/19q-codeleted oligodendroglioma and potential prognostic value forIDH-mutant gliomas, particularlyIDH-mutant astrocytoma.