Impact of (18)F-FET PET/MRI on Clinical Management of Brain Tumor Patients.
Impact of (18)F-FET PET/MRI on Clinical Management of Brain Tumor Patients.
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（18）F-FET PET/MRI对脑肿瘤患者临床管理的影响。
DOI：
10.2967/jnumed.121.262051
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发表时间：
2022-04
期刊：
影响因子：
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通讯作者：
Fougère C
中科院分区：
文献类型：
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作者：
Brendle C;Maier C;Bender B;Schittenhelm J;Paulsen F;Renovanz M;Roder C;Castaneda-Vega S;Tabatabai G;Ernemann U;Fougère C
使用氨基酸类似物 O-(2-18F-氟乙基)-l-酪氨酸 (18F-FET) 进行多参数 PET/MRI 可以同时评估脑肿瘤的分子、形态和功能特征。尽管它被认为是治疗脑肿瘤最准确的无创方法，但其与患者管理的相关性仍存在争议。在此，我们报告 18F-FET PET/MRI 的诊断性能及其对回顾性患者队列临床管理的影响。方法：我们回顾性分析了2017年至2018年间接受 18F-FET PET/MRI 的脑肿瘤患者。 18F-FET PET/MRI 检查因标准影像结果或临床病程不明确而被临床指征。组织学证实或临床和标准影像学随访作为参考标准。我们评估了 18F-FET PET/MRI 在临床环境中识别未经治疗的可疑病变（类别、新诊断）中的恶性肿瘤和辅助治疗期间的真实进展（类别、进展检测）的准确性。使用多元回归，我们还估计了单一模式对产生最佳 PET/MRI 结果的贡献。我们评估了 18F-FET PET/MRI 前后推荐和应用的疗法，并注意治疗是否根据 18F-FET PET/MRI 结果发生变化。结果：我们在研究中纳入了 189 名患者。 18F-FET PET/MRI 在新诊断时能够以 85% 的准确度识别恶性肿瘤，并以 93% 的准确度识别真正的进展。对比度增强、18F-FET PET 摄取和示踪动力学是最佳 PET/MRI 结果的主要贡献者。在之前模棱两可的患者中，18F-FET PET/MRI 改变了 33% 未治疗病变和 53% 肿瘤进展病例的临床治疗。结论：我们的结果表明 18F-FET PET/MRI 有助于澄清模棱两可的情况，并极大地支持脑肿瘤患者的临床管理。 18F-FET PET/MRI 的最佳模式设置以及同步检查的临床价值需要进一步探索。在新的诊断中，多参数 18F-FET PET/MRI 可能有助于排除恶性肿瘤，从而避免不必要的侵入性手术；然而，在现有的 MRI 检查中添加静态 18F-FET PET 似乎具有同等价值。在检测进展时，多参数 18F-FET PET/MRI 可以通过区分肿瘤进展和治疗相关的影像学改变来提高治疗效果。
Multiparametric PET/MRI with the amino-acid analog O-(2-18F-fluoroethyl)-l-tyrosine (18F-FET) enables the simultaneous assessment of molecular, morphologic, and functional brain tumor characteristics. Although it is considered the most accurate noninvasive approach in brain tumors, its relevance for patient management is still under debate. Here, we report the diagnostic performance of 18F-FET PET/MRI and its impact on clinical management in a retrospective patient cohort. Methods: We retrospectively analyzed brain tumor patients who underwent 18F-FET PET/MRI between 2017 and 2018. 18F-FET PET/MRI examinations were indicated clinically because of equivocal standard imaging results or the clinical course. Histologic confirmation or clinical and standard imaging follow-up served as the reference standard. We evaluated 18F-FET PET/MRI accuracy in identifying malignancy in untreated suspected lesions (category, new diagnosis) and true progression during adjuvant treatment (category, detection of progression) in a clinical setting. Using multiple regression, we also estimated the contribution of single modalities to produce an optimal PET/MRI outcome. We assessed the recommended and applied therapies before and after 18F-FET PET/MRI and noted whether the treatment changed on the basis of the 18F-FET PET/MRI outcome. Results: We included 189 patients in the study. 18F-FET PET/MRI allowed the identification of malignancy at new diagnosis with an accuracy of 85% and identified true progression with an accuracy of 93%. Contrast enhancement, 18F-FET PET uptake, and tracer kinetics were the major contributors to an optimal PET/MRI outcome. In the previously equivocal patients, 18F-FET PET/MRI changed the clinical management in 33% of the untreated lesions and 53% of the cases of tumor progression. Conclusion: Our results suggest that 18F-FET PET/MRI helps clarify equivocal conditions and profoundly supports the clinical management of brain tumor patients. The optimal modality setting for 18F-FET PET/MRI and the clinical value of a simultaneous examination need further exploration. At a new diagnosis, multiparametric 18F-FET PET/MRI might help prevent unnecessary invasive procedures by ruling out malignancy; however, adding static 18F-FET PET to an already existing MRI examination seems to be of equal value. At detection of progression, multiparametric 18F-FET PET/MRI may increase therapy effectiveness by distinguishing between tumor progression and therapy-related imaging alterations.