18F-FET PET Imaging in Differentiating Glioma Progression from Treatment-Related Changes: A Single-Center Experience
18F-FET PET Imaging in Differentiating Glioma Progression from Treatment-Related Changes: A Single-Center Experience
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DOI：
10.2967/jnumed.119.234757
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发表时间：
2020-04-01
影响因子：
9.3
通讯作者：
Langen, Karl-Josef
中科院分区：
文献类型：
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作者：
Maurer, Gabriele D.;Brucker, Daniel P.;Langen, Karl-Josef
在胶质瘤患者中，肿瘤进展(TP)和治疗相关改变(TRCs)之间的区别仍然具有挑战性。对影像改变进行分类的困难可能会导致治疗的延迟或不必要的中断。使用O-(2-F-18-氟乙基)-L酪氨酸(F-18-FET)的PET已被证明是检测TP和TRCs的有用工具。方法：我们回顾了127例连续接受F-18-FET PET成像以区分TP和TRCs的世界卫生组织II-IV级胶质瘤患者。F-18-FET的PET结果经神经病理(40例)或临床放射学随访(87例)证实。测定瘤脑摄取F-18-FET的最大比值(TBRmax)和时间-活动曲线的斜率(注射后20-50min)。通过接收器工作特性分析和CHI(2)检验评价F-18-FET PET参数诊断的准确性。用Kaplan-Meier法估计F-18-FET PET的预后价值。结果：94例(74%)诊断为TP，33例(26%)诊断为TRCS。在区分TP和TRC方面，受试者操作特征分析得出最佳F-18-FET TBRmax界值为1.95(敏感度70%；特异度71%；准确度70%；曲线下面积0.75+/-0.05)。结合TBRmax和SLOPE获得了最高的准确性(敏感性，86%；特异性，67%；准确性，81%)。然而，当肿瘤含有异柠檬酸脱氢酶(IDH)突变时，准确率较差(IDH野生型肿瘤的准确率为91%，IDH突变肿瘤的准确率为67%，P，0.001)。F-18-FETPET结果与总生存率相关(P，0.001)。结论：在我们的神经肿瘤科，F-18-FET PET的诊断性能令人信服，但略逊于以往的报道。
In glioma patients, differentiation between tumor progression (TP) and treatment-related changes (TRCs) remains challenging. Difficulties in classifying imaging alterations may result in a delay or an unnecessary discontinuation of treatment. PET using O-(2-F-18-fluoroethyl)-L-tyrosine (F-18-FET) has been shown to be a useful tool for detecting TP and TRCs. Methods: We retrospectively evaluated 127 consecutive patients with World Health Organization grade II-IV glioma who underwent F-18-FET PET imaging to distinguish between TP and TRCs. F-18-FET PET findings were verified by neuropathology (40 patients) or clinicoradiologic follow-up (87 patients). Maximum tumor-to-brain ratios (TBRmax) of F-18-FET uptake and the slope of the time-activity curves (20-50 min after injection) were determined. The diagnostic accuracy of F-18-FET PET parameters was evaluated by receiver-operating-characteristic analysis and chi(2) testing. The prognostic value of F-18-FET PET was estimated using the Kaplan-Meier method. Results: TP was diagnosed in 94 patients (74%) and TRCs in 33 (26%). For differentiating TP from TRCs, receiver-operating-characteristic analysis yielded an optimal F-18-FET TBRmax cutoff of 1.95 (sensitivity, 70%; specificity, 71%; accuracy, 70%; area under the curve, 0.75 +/- 0.05). The highest accuracy was achieved by a combination of TBRmax and slope (sensitivity, 86%; specificity, 67%; accuracy, 81%). However, accuracy was poorer when tumors harbored isocitrate dehydrogenase (IDH) mutations (91% in IDH-wild-type tumors, 67% in IDH-mutant tumors, P, 0.001). F-18-FET PET results correlated with overall survival (P, 0.001). Conclusion: In our neurooncology department, the diagnostic performance of F-18-FET PET was convincing but slightly inferior to that of previous reports.