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Rohan T, Hložanka P, Dostál M, Kopřivová T, Macek T, Vybíhal V, Martin HJ, Šprláková-Puková A, Keřkovský M. The relationship between gadolinium enhancement and [18 F]fluorothymidine uptake in brain lesions with the use of hybrid PET/MRI. Cancer Imaging 2024; 24:110. [PMID: 39160578 PMCID: PMC11331680 DOI: 10.1186/s40644-024-00761-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/13/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND To evaluate and compare the diagnostic power of [18F]FLT-PET with ceMRI in patients with brain tumours or other focal lesions. METHODS 121 patients with suspected brain tumour or those after brain tumour surgery were enroled in this retrospective study (61 females, 60 males, mean age 37.3 years, range 1-80 years). All patients underwent [18F]FLT-PET/MRI with gadolinium contrast agent application. In 118 of these patients, a final diagnosis was made, verified by histopathology or by follow-up. Agreement between ceMRI and [18F]FLT-PET of the whole study group was established. Further, sensitivity and specificity of ceMRI and [18F]FLT-PET were calculated for differentiation of high-grade vs. low-grade tumours, high-grade vs. low-grade tumours together with non-tumour lesions and for differentiation of high-grade tumours from all other verified lesions. RESULTS [18F]FLT-PET and ceMRI findings were concordant in 119 cases (98%). On closer analysis of a subset of 64 patients with verified gliomas, the sensitivity and specificity of both PET and ceMRI were identical (90% and 84%, respectively) for differentiating low-grade from high-grade tumours, if the contrast enhancement and [18F]FLT uptake were considered as hallmarks of high-grade tumour. For differentiation of high-grade tumours from low-grade tumours and lesions of nontumorous aetiology (e.g., inflammatory lesions or post-therapeutic changes) in a subgroup of 93 patients by visual evaluation, the sensitivity of both PET and ceMRI was 90%, whereas the specificity of PET was slightly higher (61%) compared to ceMRI (57%). By receiver operating characteristic analysis, the sensitivity and specificity were 82% and 74%, respectively, when the threshold of SUVmax in the tumour was set to 0.9 g/ml. CONCLUSION We demonstrated a generally very high correlation of [18F]FLT accumulation with contrast enhancement visible on ceMRI and a comparable diagnostic yield in both modalities for differentiating high-grade tumours from low-grade tumours and lesions of other aetiology.
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Affiliation(s)
- Tomáš Rohan
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Jihlavská 20, Brno, 625 00, Czech Republic
- Department of Radiology and Nuclear Medicine, Medical Faculty, Masaryk University, Brno, 625 00, Czechia
| | - Petr Hložanka
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Jihlavská 20, Brno, 625 00, Czech Republic
| | - Marek Dostál
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Jihlavská 20, Brno, 625 00, Czech Republic.
- Department of Biophysics, Medical Faculty, Masaryk University, Brno, 625 00, Czechia.
| | - Tereza Kopřivová
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Jihlavská 20, Brno, 625 00, Czech Republic
- Department of Radiology and Nuclear Medicine, Medical Faculty, Masaryk University, Brno, 625 00, Czechia
| | - Tomáš Macek
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Jihlavská 20, Brno, 625 00, Czech Republic
- Department of Radiology and Nuclear Medicine, Medical Faculty, Masaryk University, Brno, 625 00, Czechia
| | - Václav Vybíhal
- Clinic of Neurosurgery, University Hospital Brno, Brno, 625 00, Czechia
- Clinic of Neurosurgery, Medical Faculty, Masaryk University, Brno, 625 00, Czechia
| | - Hiroko Jeannette Martin
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Jihlavská 20, Brno, 625 00, Czech Republic
| | - Andrea Šprláková-Puková
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Jihlavská 20, Brno, 625 00, Czech Republic
- Department of Radiology and Nuclear Medicine, Medical Faculty, Masaryk University, Brno, 625 00, Czechia
| | - Miloš Keřkovský
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Jihlavská 20, Brno, 625 00, Czech Republic
- Department of Radiology and Nuclear Medicine, Medical Faculty, Masaryk University, Brno, 625 00, Czechia
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Galldiks N, Stoffels G, Filss C, Rapp M, Blau T, Tscherpel C, Ceccon G, Dunkl V, Weinzierl M, Stoffel M, Sabel M, Fink GR, Shah NJ, Langen KJ. The use of dynamic O-(2-18F-fluoroethyl)-l-tyrosine PET in the diagnosis of patients with progressive and recurrent glioma. Neuro Oncol 2015; 17:1293-300. [PMID: 26008606 DOI: 10.1093/neuonc/nov088] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/11/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We evaluated the diagnostic value of static and dynamic O-(2-[(18)F]fluoroethyl)-L-tyrosine ((18)F-FET) PET parameters in patients with progressive or recurrent glioma. METHODS We retrospectively analyzed 132 dynamic (18)F-FET PET and conventional MRI scans of 124 glioma patients (primary World Health Organization grade II, n = 55; grade III, n = 19; grade IV, n = 50; mean age, 52 ± 14 y). Patients had been referred for PET assessment with clinical signs and/or MRI findings suggestive of tumor progression or recurrence based on Response Assessment in Neuro-Oncology criteria. Maximum and mean tumor/brain ratios of (18)F-FET uptake were determined (20-40 min post-injection) as well as tracer uptake kinetics (ie, time to peak and patterns of the time-activity curves). Diagnoses were confirmed histologically (95%) or by clinical follow-up (5%). Diagnostic accuracies of PET and MR parameters for the detection of tumor progression or recurrence were evaluated by receiver operating characteristic analyses/chi-square test. RESULTS Tumor progression or recurrence could be diagnosed in 121 of 132 cases (92%). MRI and (18)F-FET PET findings were concordant in 84% and discordant in 16%. Compared with the diagnostic accuracy of conventional MRI to diagnose tumor progression or recurrence (85%), a higher accuracy (93%) was achieved by (18)F-FET PET when a mean tumor/brain ratio ≥2.0 or time to peak <45 min was present (sensitivity, 93%; specificity, 100%; accuracy, 93%; positive predictive value, 100%; P < .001). CONCLUSION Static and dynamic (18)F-FET PET parameters differentiate progressive or recurrent glioma from treatment-related nonneoplastic changes with higher accuracy than conventional MRI.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.)
| | - Gabriele Stoffels
- Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.)
| | - Christian Filss
- Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.)
| | - Marion Rapp
- Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.)
| | - Tobias Blau
- Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.)
| | - Caroline Tscherpel
- Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.)
| | - Garry Ceccon
- Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.)
| | - Veronika Dunkl
- Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.)
| | - Martin Weinzierl
- Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.)
| | - Michael Stoffel
- Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.)
| | - Michael Sabel
- Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.)
| | - Gereon R Fink
- Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.)
| | - Nadim J Shah
- Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.)
| | - Karl-Josef Langen
- Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.)
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