18F-FET PET Imaging in Differentiating Glioma Progression from Treatment-Related Changes: A Single-Center Experience: A Single-Center Experience

Gabriele D. Maurer*, Daniel P. Brucker, Gabriele Stoffels, Katharina Filipski, Christian P. Filss, Felix M. Mottaghy, Norbert Galldiks, Joachim P. Steinbach, Elke Hattingen, Karl-Josef Langen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

23 Citations (Web of Science)

Abstract

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.

Original languageEnglish
Pages (from-to)505-511
Number of pages7
JournalJournal of Nuclear Medicine
Volume61
Issue number4
DOIs
Publication statusPublished - 1 Apr 2020

Keywords

  • F-18-FET PET
  • glioma
  • tumor progression
  • pseudoprogression
  • treatment-related changes
  • RESPONSE ASSESSMENT CRITERIA
  • HIGH-GRADE GLIOMAS
  • PSEUDOPROGRESSION
  • DIAGNOSIS
  • NEUROONCOLOGY
  • GLIOBLASTOMA
  • RECURRENCE
  • PSEUDORESPONSE
  • TUMORS
  • MRI

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