Sequential implementation of DSC-MR perfusion and dynamic [(18)F]FET PET allows efficient differentiation of glioma progression from treatment-related changes.
Sequential implementation of DSC-MR perfusion and dynamic [(18)F]FET PET allows efficient differentiation of glioma progression from treatment-related changes.
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顺序实施DSC-MR灌注和动态[(18)F]FET PET可以有效区分胶质瘤进展与治疗相关的变化。
DOI：
10.1007/s00259-020-05114-0
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发表时间：
2021-06
影响因子：
9.1
通讯作者：
Maurer GD
中科院分区：
文献类型：
--
作者：
Steidl E;Langen KJ;Hmeidan SA;Polomac N;Filss CP;Galldiks N;Lohmann P;Keil F;Filipski K;Mottaghy FM;Shah NJ;Steinbach JP;Hattingen E;Maurer GD
磁共振灌注成像(PWI)和O-(2-[18F]氟乙基)-L酪氨酸([18F]FET)PET均可用于鉴别可疑复发胶质瘤患者的肿瘤进展(TP)和治疗相关改变(TRC)。虽然这两种方法的结合已被报道可提高诊断准确率，但顺序实施的性能尚未得到进一步研究。因此，我们回顾分析了连续的PWI和[18F]FET PET的诊断价值。我们使用PWI和动态[18F]FET PET对104例WHO II-IV级胶质瘤和疑似TP的患者进行了常规MRI检查。动态磁化率对比PWI测量最大相对脑血容量(RCBVmax)。此外，我们还计算了静态(即最大肿瘤与脑比率；TBRmax)和动态[18F]FET PET参数(即斜率)。最终诊断基于组织病理学(n=42)或临床放射学随访(n=62)。通过分析受试者的工作特性和曲线下面积(AUC)，评价PWI和[18F]FET PET参数鉴别TP和TRC的诊断性能。在所有患者中，使用rCBVmax或[18F]FET PET参数对TP和TRC的区分是中等的(AUC=0.69-0.75；p<；0.01)。RCBVmax临界值2.85对TP的阳性预测值为100%，使44例患者能够正确诊断TP。在其余60名患者中，结合静态和动态[18F]FET PET参数(TBRmax、SLOPE)在78%的患者中正确区分TP和TRC，将总体准确率提高到87%。对异柠檬酸脱氢酶(IDH)突变肿瘤的亚群分析表明，PWI的性能优于[18F]FETPET(AUC=0.8/<；0.62，p<；0.01/≥0.3)。虽然PWI上有明显的高灌注提示TP，但当PWI仍不确定时，[18F]FET PET被证明有助于区分TP和TRC。因此，我们的结果强调了顺序使用PWI和[18F]FET PET的临床价值，从而允许经济地使用诊断方法。IDH突变的影响需要进一步研究。网上版载有补充材料，可在10.1007/s00259-020-05114-0查阅。
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. 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). 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). 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. The online version contains supplementary material available at 10.1007/s00259-020-05114-0.
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3.5
作者：
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