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Xiong M, Chen Z, Zhou C, Yang X, Hu W, Jiang Y, Zheng R, Fan W, Mou Y, Lin X. PSMA PET/MR is a New Imaging Option for Identifying Glioma Recurrence and Predicting Prognosis. Recent Pat Anticancer Drug Discov 2024; 19:383-395. [PMID: 38214322 DOI: 10.2174/1574892818666230519150401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Glioma is characterized by a high recurrence rate, while the results of the traditional imaging methods (including magnetic resonance imaging, MRI) to distinguish recurrence from treatment-related changes (TRCs) are poor. Prostate-specific membrane antigen (PSMA) (US10815200B2, Deutsches Krebsforschungszentrum, German Cancer Research Center) is a type II transmembrane glycoprotein overexpressed in glioma vascular endothelium, and it is a promising target for imaging and therapy. OBJECTIVE The study aimed to assess the performance of PSMA positron emission tomography/ magnetic resonance (PET/MR) for diagnosing recurrence and predicting prognosis in glioma patients. MATERIALS AND METHODS Patients suspected of glioma recurrence who underwent 18F-PSMA-1007 PET/MR were prospectively enrolled. Eight metabolic parameters and fifteen texture features of the lesion were extracted from PSMA PET/MR. The ability of PSMA PET/MR to diagnose glioma recurrence was investigated and compared with conventional MRI. The diagnostic agreement was assessed using Cohen κ scores and the predictive parameters of PSMA PET/MR were obtained. Kaplan-Meier method and Cox proportional hazard model were used to analyze recurrence- free survival (RFS) and overall survival (OS). Finally, the expression of PSMA was analyzed by immunohistochemistry (IHC). RESULTS Nineteen patients with a mean age of 48.11±15.72 were assessed. The maximum tumorto- parotid ratio (TPRmax) and texture features extracted from PET and T1-weighted contrast enhancement (T1-CE) MR showed differences between recurrence and TRCs (all p <0.05). PSMA PET/MR and conventional MRI exhibited comparable power in diagnosing recurrence with specificity and PPV of 100%. The interobserver concordance was fair between the two modalities (κ = 0.542, p = 0.072). The optimal cutoffs of metabolic parameters, including standardized uptake value (SUV, SUVmax, SUVmean, and SUVpeak) and TPRmax for predicting recurrence were 3.35, 1.73, 1.99, and 0.17 respectively, with the area under the curve (AUC) ranging from 0.767 to 0.817 (all p <0.05). In grade 4 glioblastoma (GBM) patients, SUVmax, SUVmean, SUVpeak, TBRmax, TBRmean, and TPRmax showed improved performance of AUC (0.833-0.867, p <0.05). Patients with SUVmax, SUVmean, or SUVpeak more than the cutoff value had significantly shorter RFS (all p <0.05). In addition, patients with SUVmean, SUVpeak, or TPRmax more than the cutoff value had significantly shorter OS (all p <0.05). PSMA expression of glioma vascular endothelium was observed in ten (10/11, 90.9%) patients with moderate-to-high levels in all GBM cases (n = 6/6, 100%). CONCLUSION This primitive study shows multiparameter PSMA PET/MR to be useful in identifying glioma (especially GBM) recurrence by providing excellent tumor background comparison, tumor heterogeneity, recurrence prediction and prognosis information, although it did not improve the diagnostic performance compared to conventional MRI. Further and larger studies are required to define its potential clinical application in this setting.
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Affiliation(s)
- Min Xiong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhenghe Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chao Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaochun Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wanming Hu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yongluo Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rongliang Zheng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wei Fan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yonggao Mou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaoping Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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Smith NJ, Deaton TK, Territo W, Graner B, Gauger A, Snyder SE, Schulte ML, Green MA, Hutchins GD, Veronesi MC. Hybrid 18F-Fluoroethyltyrosine PET and MRI with Perfusion to Distinguish Disease Progression from Treatment-Related Change in Malignant Brain Tumors: The Quest to Beat the Toughest Cases. J Nucl Med 2023; 64:1087-1092. [PMID: 37116915 PMCID: PMC10315704 DOI: 10.2967/jnumed.122.265149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/16/2023] [Indexed: 04/30/2023] Open
Abstract
Conventional MRI has important limitations when assessing for progression of disease (POD) versus treatment-related changes (TRC) in patients with malignant brain tumors. We describe the observed impact and pitfalls of implementing 18F-fluoroethyltyrosine (18F-FET) perfusion PET/MRI into routine clinical practice. Methods: Through expanded-access investigational new drug use of 18F-FET, hybrid 18F-FET perfusion PET/MRI was performed during clinical management of 80 patients with World Health Organization central nervous system grade 3 or 4 gliomas or brain metastases of 6 tissue origins for which the prior brain MRI results were ambiguous. The diagnostic performance with 18F-FET PET/MRI was dually evaluated within routine clinical service and for retrospective parametric evaluation. Various 18F-FET perfusion PET/MRI parameters were assessed, and patients were monitored for at least 6 mo to confirm the diagnosis using pathology, imaging, and clinical progress. Results: Hybrid 18F-FET perfusion PET/MRI had high overall accuracy (86%), sensitivity (86%), and specificity (87%) for difficult diagnostic cases for which conventional MRI accuracy was poor (66%). 18F-FET tumor-to-brain ratio static metrics were highly reliable for distinguishing POD from TRC (area under the curve, 0.90). Dynamic tumor-to-brain intercept was more accurate (85%) than SUV slope (73%) or time to peak (73%). Concordant PET/MRI findings were 89% accurate. When PET and MRI conflicted, 18F-FET PET was correct in 12 of 15 cases (80%), whereas MRI was correct in 3 of 15 cases (20%). Clinical management changed after 88% (36/41) of POD diagnoses, whereas management was maintained after 87% (34/39) of TRC diagnoses. Conclusion: Hybrid 18F-FET PET/MRI positively impacted the routine clinical care of challenging malignant brain tumor cases at a U.S. institution. The results add to a growing body of literature that 18F-FET PET complements MRI, even rescuing MRI when it fails.
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Affiliation(s)
- Nathaniel J Smith
- School of Medicine, Indiana University, Indianapolis, Indiana
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana; and
| | | | - Wendy Territo
- School of Medicine, Indiana University, Indianapolis, Indiana
| | - Brian Graner
- School of Medicine, Indiana University, Indianapolis, Indiana
| | - Andrew Gauger
- School of Medicine, Indiana University, Indianapolis, Indiana
| | - Scott E Snyder
- School of Medicine, Indiana University, Indianapolis, Indiana
| | | | - Mark A Green
- School of Medicine, Indiana University, Indianapolis, Indiana
| | - Gary D Hutchins
- School of Medicine, Indiana University, Indianapolis, Indiana
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Marik W, Cardoso PL, Springer E, Bogner W, Preusser M, Widhalm G, Hangel G, Hainfellner JA, Rausch I, Weber M, Schmidbauer V, Traub-Weidinger T, Trattnig S. Evaluation of Gliomas with Magnetic Resonance Fingerprinting with PET Correlation-A Comparative Study. Cancers (Basel) 2023; 15:2740. [PMID: 37345077 DOI: 10.3390/cancers15102740] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
OBJECTIVES Advanced MR imaging of brain tumors is still mainly based on qualitative imaging. PET imaging offers additive metabolic information, and MR fingerprinting (MRF) offers a novel approach to quantitative data acquisition. The purpose of this study was to evaluate the ability of MRF to predict tumor regions and grading in combination with PET. METHODS Seventeen patients with histologically verified infiltrating gliomas and available amino-acid PET data were enrolled. ROIs for solid tumor parts (SPo), perifocal edema (ED1), and normal-appearing white matter (NAWM) were selected on conventional MRI sequences and aligned to the MRF and PET images. The predictability of gliomas by region and grading as well as intermodal correlations were assessed. RESULTS For MRF, we calculated an overall predictability by region (SPo, ED1, and NAWM) for all of the MRF parameters of 76.5%, 47.1%, and 94.1%, respectively. The overall ability to distinguish low- from high-grade gliomas using MRF was 88.9% for LGG and 75% for HGG, with an accuracy of 82.4%, a ppV of 85.71%, and an npV of 80%. PET positivity was found in 13/17 patients for solid tumor parts, and in 3/17 patients for the edema region. However, there was no significant difference in region-specific MRF values between PET positive and PET negative patients. CONCLUSIONS MRF and PET provide quantitative measurements of the tumor tissue characteristics of gliomas, with good predictability. Nonetheless, the results are dissimilar, reflecting the different underlying mechanisms of each method.
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Affiliation(s)
- Wolfgang Marik
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Pedro Lima Cardoso
- High-Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Elisabeth Springer
- High-Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
- Institute of Radiology, Hietzing Hospital, 1130 Vienna, Austria
| | - Wolfgang Bogner
- High-Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Gilbert Hangel
- High-Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Johannes A Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria
| | - Ivo Rausch
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Michael Weber
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Victor Schmidbauer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Siegfried Trattnig
- High-Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
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Horowitz T, Tabouret E, Graillon T, Salgues B, Chinot O, Verger A, Guedj E. Contribution of nuclear medicine to the diagnosis and management of primary brain tumours. Rev Neurol (Paris) 2023; 179:394-404. [PMID: 36934021 DOI: 10.1016/j.neurol.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
Positron emission tomography (PET) is a powerful tool that can help physicians manage primary brain tumours at diagnosis and follow-up. In this context, PET imaging is used with three main types of radiotracers: 18F-FDG, amino acid radiotracers, and 68Ga conjugated to somatostatin receptor ligands (SSTRs). At initial diagnosis, 18F-FDG helps to characterize primary central nervous system (PCNS) lymphomas and high-grade gliomas, amino acid radiotracers are indicated for gliomas, and SSTR PET ligands are indicated for meningiomas. Such radiotracers provide information on tumour grade or type, assist in directing biopsies and help with treatment planning. During follow-up, in the presence of symptoms and/or MRI modifications, the differential diagnosis between tumour recurrence and post-therapeutic changes, in particular radiation necrosis, may be challenging, and there is strong interest in using PET to evaluate therapeutic toxicity. PET may also contribute to identifying specific complications, such as postradiation therapy encephalopathy, encephalitis associated with PCNS lymphoma, and stroke-like migraine after radiation therapy (SMART) syndrome associated with glioma recurrence and temporal epilepsy, originally illustrated in this review. This review summarizes the main contribution of PET to the diagnosis, management, and follow-up of brain tumours, specifically gliomas, meningiomas, and primary central nervous system lymphomas.
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Affiliation(s)
- T Horowitz
- CNRS, CERIMED, nuclear medicine department, Centrale Marseille, Institut Fresnel, Timone hospital, Aix-Marseille university, AP-HM, Marseille, France
| | - E Tabouret
- Neuro-oncology department, Timone hospital, AP-HM, Marseille, France; Team 8 GlioME, CNRS 7051, Inst. neurophysiopathol, Aix-Marseille university, Marseille, France
| | - T Graillon
- Inserm, MMG, neurosurgery department, Timone hospital, Aix-Marseille university, AP-HM, Marseille, France
| | - B Salgues
- CNRS, CERIMED, nuclear medicine department, Centrale Marseille, Institut Fresnel, Timone hospital, Aix-Marseille university, AP-HM, Marseille, France
| | - O Chinot
- Neuro-oncology department, Timone hospital, AP-HM, Marseille, France
| | - A Verger
- IADI, Inserm, UMR 1254, department of nuclear medicine & nancyclotep imaging platform, université de Lorraine, CHRU-Nancy, Nancy, France
| | - E Guedj
- CNRS, CERIMED, nuclear medicine department, Centrale Marseille, Institut Fresnel, Timone hospital, Aix-Marseille university, AP-HM, Marseille, France.
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A Multi-Disciplinary Approach to Diagnosis and Treatment of Radionecrosis in Malignant Gliomas and Cerebral Metastases. Cancers (Basel) 2022; 14:cancers14246264. [PMID: 36551750 PMCID: PMC9777318 DOI: 10.3390/cancers14246264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/06/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Radiation necrosis represents a potentially devastating complication after radiation therapy in brain tumors. The establishment of the diagnosis and especially the differentiation from progression and pseudoprogression with its therapeutic implications requires interdisciplinary consent and monitoring. Herein, we want to provide an overview of the diagnostic modalities, therapeutic possibilities and an outlook on future developments to tackle this challenging topic. The aim of this report is to provide an overview of the current morphological, functional, metabolic and evolving imaging tools described in the literature in order to (I) identify the best criteria to distinguish radionecrosis from tumor recurrence after the radio-oncological treatment of malignant gliomas and cerebral metastases, (II) analyze the therapeutic possibilities and (III) give an outlook on future developments to tackle this challenging topic. Additionally, we provide the experience of a tertiary tumor center with this important issue in neuro-oncology and provide an institutional pathway dealing with this problem.
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Jackson LR, Masi MR, Selman BM, Sandusky GE, Zarrinmayeh H, Das SK, Maharjan S, Wang N, Zheng QH, Pollok KE, Snyder SE, Sun PZ, Hutchins GD, Butch ER, Veronesi MC. Use of multimodality imaging, histology, and treatment feasibility to characterize a transgenic Rag2-null rat model of glioblastoma. Front Oncol 2022; 12:939260. [PMID: 36483050 PMCID: PMC9722958 DOI: 10.3389/fonc.2022.939260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/20/2022] [Indexed: 11/23/2022] Open
Abstract
Many drugs that show potential in animal models of glioblastoma (GBM) fail to translate to the clinic, contributing to a paucity of new therapeutic options. In addition, animal model development often includes histologic assessment, but multiparametric/multimodality imaging is rarely included despite increasing utilization in patient cancer management. This study developed an intracranial recurrent, drug-resistant, human-derived glioblastoma tumor in Sprague-Dawley Rag2-Rag2 tm1Hera knockout rat and was characterized both histologically and using multiparametric/multimodality neuroimaging. Hybrid 18F-fluoroethyltyrosine positron emission tomography and magnetic resonance imaging, including chemical exchange saturation transfer (18F-FET PET/CEST MRI), was performed for full tumor viability determination and characterization. Histological analysis demonstrated human-like GBM features of the intracranially implanted tumor, with rapid tumor cell proliferation (Ki67 positivity: 30.5 ± 7.8%) and neovascular heterogeneity (von Willebrand factor VIII:1.8 to 5.0% positivity). Early serial MRI followed by simultaneous 18F-FET PET/CEST MRI demonstrated consistent, predictable tumor growth, with exponential tumor growth most evident between days 35 and 49 post-implantation. In a second, larger cohort of rats, 18F-FET PET/CEST MRI was performed in mature tumors (day 49 post-implantation) for biomarker determination, followed by evaluation of single and combination therapy as part of the model development and validation. The mean percentage of the injected dose per mL of 18F-FET PET correlated with the mean %CEST (r = 0.67, P < 0.05), but there was also a qualitative difference in hot spot location within the tumor, indicating complementary information regarding the tumor cell demand for amino acids and tumor intracellular mobile phase protein levels. Finally, the use of this glioblastoma animal model for therapy assessment was validated by its increased overall survival after treatment with combination therapy (temozolomide and idasanutlin) (P < 0.001). Our findings hold promise for a more accurate tumor viability determination and novel therapy assessment in vivo in a recently developed, reproducible, intracranial, PDX GBM.
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Affiliation(s)
- Luke R. Jackson
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Megan R. Masi
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Bryce M. Selman
- Department of Pathology and Laboratory Medicine, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - George E. Sandusky
- Department of Pathology and Laboratory Medicine, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Hamideh Zarrinmayeh
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Sudip K. Das
- Department of Pharmaceutical Sciences, Butler University, Indianapolis, IN, United States
| | - Surendra Maharjan
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Nian Wang
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Qi-Huang Zheng
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Karen E. Pollok
- Department of Pediatrics, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Scott E. Snyder
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Phillip Zhe Sun
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Atlanta, GA, United States
| | - Gary D. Hutchins
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Elizabeth R. Butch
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Michael C. Veronesi
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States,*Correspondence: Michael C. Veronesi,
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7T HR FID-MRSI Compared to Amino Acid PET: Glutamine and Glycine as Promising Biomarkers in Brain Tumors. Cancers (Basel) 2022; 14:cancers14092163. [PMID: 35565293 PMCID: PMC9101868 DOI: 10.3390/cancers14092163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Magnetic resonance spectroscopic imaging is an imaging method that can map the distribution of multiple biochemicals in the human brain in one scan. Using stronger magnetic fields, such as 7 Tesla, allows for higher resolution images and more biochemical maps. To test these results, we compared it to positron emission tomography, the established clinical standard for metabolic imaging. This comparison mainly looked at the overlap between regions with increased signal between both methods. We found that the molecules glutamine and glycine, only mappable at 7 Tesla, corresponded better to positron emission tomography than the commonly used choline. Abstract (1) Background: Recent developments in 7T magnetic resonance spectroscopic imaging (MRSI) made the acquisition of high-resolution metabolic images in clinically feasible measurement times possible. The amino acids glutamine (Gln) and glycine (Gly) were identified as potential neuro-oncological markers of importance. For the first time, we compared 7T MRSI to amino acid PET in a cohort of glioma patients. (2) Methods: In 24 patients, we co-registered 7T MRSI and routine PET and compared hotspot volumes of interest (VOI). We evaluated dice similarity coefficients (DSC), volume, center of intensity distance (CoI), median and threshold values for VOIs of PET and ratios of total choline (tCho), Gln, Gly, myo-inositol (Ins) to total N-acetylaspartate (tNAA) or total creatine (tCr). (3) Results: We found that Gln and Gly ratios generally resulted in a higher correspondence to PET than tCho. Using cutoffs of 1.6-times median values of a control region, DSCs to PET were 0.53 ± 0.36 for tCho/tNAA, 0.66 ± 0.40 for Gln/tNAA, 0.57 ± 0.36 for Gly/tNAA, and 0.38 ± 0.31 for Ins/tNAA. (4) Conclusions: Our 7T MRSI data corresponded better to PET than previous studies at lower fields. Our results for Gln and Gly highlight the importance of future research (e.g., using Gln PET tracers) into the role of both amino acids.
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Prostate-Specific Membrane Antigen as Target for Neuroimaging of Central Nervous System Tumors. Mol Imaging 2022; 2022:5358545. [PMID: 35517711 PMCID: PMC9042374 DOI: 10.1155/2022/5358545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/24/2022] [Indexed: 12/18/2022] Open
Abstract
Introduction. Positron emission tomography (PET) imaging with prostate-specific membrane antigen- (PSMA-) binding tracers has been found incidentally to demonstrate uptake in CNS tumors. Following the encouraging findings of several such case reports, there is a growing interest in the potential application of PSMA-targeted PET imaging for diagnostics, theranostics, and monitoring of CNS tumors. This is a systematic literature review on PSMA-binding tracers in CNS tumors. Methods. A PubMed search was conducted, including preclinical and clinical reports. One hundred and twelve records were identified, and after screening, 56 were included in the final report. Results. Tissue studies demonstrated PSMA expression in tumor vascular endothelial cells, without expression in normal brain tissue, though the extent and intensity of staining varied by anti-PSMA antibody and methodology. Most included studies reported on gliomas, which showed strong PSMA ligand uptake and more favorable tumor to background ratios than other PET tracers. There are also case reports demonstrating PSMA ligand uptake in prostate cancer brain metastases, nonprostate cancer brain metastases, and meningiomas. We also review the properties of the various PSMA-binding radiotracers available. Therapeutic and theranostic applications of PSMA-binding tracers have been studied, including labeled alpha- and beta-ray emitting isotopes, as well as PSMA targeting in directing MRI-guided focused ultrasound. Conclusions. There is a potential application for PSMA-targeted PET in neuro-oncology as a combination of diagnostic and therapeutic use, as a theranostic modality for managing CNS tumors. Further research is needed regarding the mechanism(s) of PSMA expression in CNS tumors and its differential performance by tumor type.
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PET Imaging in Neuro-Oncology: An Update and Overview of a Rapidly Growing Area. Cancers (Basel) 2022; 14:cancers14051103. [PMID: 35267411 PMCID: PMC8909369 DOI: 10.3390/cancers14051103] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/08/2022] [Accepted: 02/19/2022] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Positron emission tomography (PET) is a functional imaging technique which plays an increasingly important role in the management of brain tumors. Owing different radiotracers, PET allows to image different metabolic aspects of the brain tumors. This review outlines currently available PET radiotracers and their respective indications in neuro-oncology. It specifically focuses on the investigation of gliomas, meningiomas, primary central nervous system lymphomas as well as brain metastases. Recent advances in the production of PET radiotracers, image analyses and translational applications to peptide radionuclide receptor therapy, which allow to treat brain tumors with radiotracers, are also discussed. The objective of this review is to provide a comprehensive overview of PET imaging’s potential in neuro-oncology as an adjunct to brain magnetic resonance imaging (MRI). Abstract PET plays an increasingly important role in the management of brain tumors. This review outlines currently available PET radiotracers and their respective indications. It specifically focuses on 18F-FDG, amino acid and somatostatin receptor radiotracers, for imaging gliomas, meningiomas, primary central nervous system lymphomas as well as brain metastases. Recent advances in radiopharmaceuticals, image analyses and translational applications to therapy are also discussed. The objective of this review is to provide a comprehensive overview of PET imaging’s potential in neuro-oncology as an adjunct to brain MRI for all medical professionals implicated in brain tumor diagnosis and care.
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Mangalore S, Vankayalapati S, Jabeen S, Kumar Gupta A, Kumar P. Can High b Value Diffusion Be a Surrogate Marker for PET-A MR/PET Study in Neurooncology Set Up. Front Neurol 2021; 12:627247. [PMID: 34630267 PMCID: PMC8497703 DOI: 10.3389/fneur.2021.627247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Hybrid whole-body magnetic resonance/positron emission tomography (MR/PET) systems are new diagnostic tools enabling the simultaneous acquisition of morphologic and multiparametric functional data, which allow for a diversified characterization of oncological diseases. This study aimed to compare the diagnostic ability of MRI with the diffusion-weighted image (DWI), and simultaneous integrated positron emission tomography MR/PET to detect malignant lesions and elucidate the utility and limitations of these imaging modalities in preoperative and postoperative follow up in cancer patients. Material and Methods: A total of 45 patients undergoing simultaneous MR/PET for CNS ICSOL in our institution between January 2016 and July 2020 were considered in this study. Post-processing was done in Siemens syngo software to generate a b2000 image. This image was then inverted to grayscale and compared with the NAC image of PET. Results: The lesion-based sensitivity, specificity, positive predictive value, and negative predictive value for DWI were 92.3, 83.3, 97.3, and 62.5%, respectively (at 95% CI and p was 0.000). The lesion-based sensitivity, specificity, positive predictive value, and negative predictive value for PET were 97.4, 71.4, 94.9, and 83.3%, respectively (at 95% CI and p was 0.000). The lesion-based sensitivity and specificity of DWI were comparable with those of PET. Conclusions: Although DWI and FDG-PET reflect different tissue properties, there is an association between the measures of both methods in CNS tumors probably because of the coupling of cellularity with tumor metabolism as seen on FDG and other PET tracers. Our study shows that DWI acts as a surrogate biomarker for FDG PET and other tracers in tumors. The method of DWI image generation is simple, radiation-free, and cost-effective in a clinical setup. The simultaneous DWI-PET study provides evidence and confirms the role of DWI in surveillance imaging of tumors.
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Affiliation(s)
- Sandhya Mangalore
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
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