Late Pseudoprogression in Glioblastoma: Diagnostic Value of Dynamic O-(2-[18F]fluoroethyl)-L-Tyrosine PET
Late Pseudoprogression in Glioblastoma: Diagnostic Value of Dynamic O-(2-[18F]fluoroethyl)-L-Tyrosine PET
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DOI：
10.1158/1078-0432.ccr-15-1334
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发表时间：
2016-05-01
影响因子：
11.5
通讯作者：
Herrlinger, Ulrich
中科院分区：
文献类型：
--
作者：
Kebir, Sied;Fimmers, Rolf;Herrlinger, Ulrich
目的：假性进展（PsP）的特征是MRI上造影剂增强的胶质母细胞瘤病变增加，与治疗相关，但与肿瘤生长无关。尽管PsP通常发生在放疗后的前3个月内，但PsP可能发生在疾病过程的后期，并且可能特别难以与真正的肿瘤进展区分。我们探讨PET使用O-（2-[F-18] fluoroethyl）-L-酪氨酸（F-18-FET-PET），以接近diagnosis dilemma.Experimental Design：26例胶质母细胞瘤患者，在完成放化疗后3个月内出现对比度增强病变。测定F-18-FET摄取的最大和平均肿瘤/脑比值（TBRmax和TBRmean）以及达峰时间（TTP）和时间-活性曲线的模式。真正的进展与晚期PsP的最终诊断是根据后续MRI使用RANO criterions.Results：晚期PsP发生在7例患者的中位时间从放化疗完成24周，而其余患者显示真正的肿瘤进展。真正进展患者的TBRmax和TBRmean显著高于晚期PsP患者（TBRmax 2.4 +/- 0.1 vs. 1.5 +/- 0.2，P = 0.003; TBR平均值2.1 ± 0.1 vs. 1.5 ± 0.2，P = 0.012），而TTP显著缩短（平均TTP 25 ± 2 vs. 40 ± 2 min，P < 0.001）。ROC分析得出TBRmax的最佳临界值为1.9，以区分真正进展和晚期PsP（敏感性84%，特异性86%，准确性85%，P = 0.015）。结论：O-（2-[F-18] fluoroethyl）-L-tyrosine PET为评估晚期PsP的难以捉摸现象提供了有价值的信息。6. (C)2015年AACR。
Purpose: Pseudoprogression (PsP) is characterized by therapy-associated but not tumor growth-associated increases of contrast-enhancing glioblastoma lesions on MRI. Although typically occurring during the first 3 months after radiochemotherapy, PsP may occur later in the course of the disease and may then be particularly difficult to distinguish from true tumor progression. We explored PET using O-(2-[F-18] fluoroethyl)-L-tyrosine (F-18-FET-PET) to approach the diagnostic dilemma.Experimental Design: Twenty-six patients with glioblastoma that presented with increasing contrast-enhancing lesions later than 3 months after completion of radiochemotherapy underwent F-18-FET-PET. Maximum and mean tumor/ brain ratios (TBRmax and TBRmean) of F-18-FET uptake as well as time-to-peak (TTP) and patterns of the time-activity curves were determined. The final diagnosis of true progression versus late PsP was based on follow-up MRI using RANO criteria.Results: Late PsP occurred in 7 patients with a median time from radiochemotherapy completion of 24 weeks while the remaining patients showed true tumor progression. TBRmax and TBRmean were significantly higher in patients with true progression than in patients with late PsP (TBRmax 2.4 +/- 0.1 vs. 1.5 +/- 0.2, P = 0.003; TBRmean 2.1 +/- 0.1 vs. 1.5 +/- 0.2, P = 0.012) whereas TTP was significantly shorter (mean TTP 25 +/- 2 vs. 40 +/- 2 min, P < 0.001). ROC analysis yielded an optimal cutoff value of 1.9 for TBRmax to differentiate between true progression and late PsP (sensitivity 84%, specificity 86%, accuracy 85%, P = 0.015).Conclusions: O-(2-[F-18] fluoroethyl)-L-tyrosine PET provides valuable information in assessing the elusive phenomenon of late PsP. 6. (C) 2015 AACR.