Static FET-PET and MR Imaging in Anaplastic Gliomas (WHO III)

Stefanie Bette; Patrick Peschke; Johannes Kaesmacher; Claire Delbridge; Thomas Pyka; Friederike Schmidt-Graf; Claus Zimmer; Bernhard Meyer; Florian Ringel; Jens Gempt

doi:10.1016/j.wneu.2016.02.094

Static FET-PET and MR Imaging in Anaplastic Gliomas (WHO III)

World Neurosurg. 2016 Jul:91:524-531.e1. doi: 10.1016/j.wneu.2016.02.094. Epub 2016 Mar 4.

Authors

Affiliations

¹ Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Electronic address: Stefanie.bette@tum.de.
² Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
³ Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
⁴ Department of Neuropathology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
⁵ Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
⁶ Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.

PMID: 26947726
DOI: 10.1016/j.wneu.2016.02.094

Abstract

Objective: O-(2-[18F]-fluoroethyl)-L-tyrosine-positron emission tomography (FET-PET) imaging is an additional tool for tumor grading and surgery planning. Up to now, not much is known about FET-PET imaging in anaplastic gliomas. Our objective was to assess the FET uptake in anaplastic gliomas, compared with magnetic resonance imaging (MRI), histopathologic markers, and its prognostic value.

Patients and methods: Forty-six patients (27 males/19 females) with an anaplastic glioma (WHO III) who received MRI and FET-PET imaging before surgery were retrospectively analyzed. Tumor volume was calculated in MRI and FET-PET imaging using a tumor-to-background ratio (TBR), and maximum FET uptake (TBRmax) was calculated. Overall survival (OS) and histopathologic markers (isocitrate-dehydrogenase 1/2-mutation, oligodendrial differentiation, and Ki67 proliferation index) were assessed. Univariate and multivariate analysis was performed for OS.

Results: In univariate analysis a significant correlation of TBRmax to OS was observed (P = 0.031). Tumor volume in FET-PET imaging (TBR > 2.0) (P = 0.028) showed a higher correlation to OS than the volume of the contrast-enhancing tumor part (P = 0.031). The highest correlation was observed for intersection of volume TBR > 1.3 and the volume of the contrast-enhancing tumor part (P = 0.005); fluid-attenuated inversion recovery volume showed no significant correlation to OS (P = 0.401) in the univariate analysis. Anaplastic glioma with oligodendrial differentiation showed significantly higher TBRmax values (P = 0.029), while no significant difference was observed for isocitrate hydrogenase 1/2-mutation (P = 0.752).

Conclusion: Static FET-PET provides significant prognostic information in anaplastic gliomas, which adds to the value of MRI, supporting the use of both modalities preoperatively to assess individual risks and estimate prognosis. Definition of the histopathologic subtype using static FET-PET remains challenging.

Keywords: Anaplastic gliomas; Oligodendrial differentiation; Static FET-PET.

MeSH terms

Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Astrocytoma / diagnosis
Astrocytoma / therapy
Brain Neoplasms / mortality
Brain Neoplasms / pathology*
Brain Neoplasms / therapy
Combined Modality Therapy
Female
Glioma / mortality
Glioma / pathology*
Glioma / therapy
Humans
Karnofsky Performance Status
Magnetic Resonance Imaging
Male
Middle Aged
Oligodendroglioma / diagnosis
Oligodendroglioma / therapy
Positron-Emission Tomography
Retrospective Studies
Survival Analysis
Tumor Burden