O-(2-18F-氟乙基)-L-酪氨酸PET与MRI在低级别胶质瘤中的预后价值
Prognostic value of O-(2-18F-fluoroethyl)-L-tyrosine PET and MRI in low-grade glioma.
作者信息
Floeth Frank W, Pauleit Dirk, Sabel Michael, Stoffels Gabriele, Reifenberger Guido, Riemenschneider Markus J, Jansen Paul, Coenen Heinz H, Steiger Hans-Jakob, Langen Karl-Josef
机构信息
Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany.
出版信息
J Nucl Med. 2007 Apr;48(4):519-27. doi: 10.2967/jnumed.106.037895.
UNLABELLED
In glioma of World Health Organization (WHO) grade II (low-grade glioma), the natural course of a particular patient is not predictable and the treatment strategy is controversial. We determined prognostic factors in adult patients with untreated, nonenhancing, supratentorial low-grade glioma with special regard to PET using the amino acid O-(2-(18)F-fluoroethyl)-L-tyrosine ((18)F-FET) and MRI.
METHODS
In a prospective study, baseline (18)F-FET PET and MRI analyses were performed on 33 consecutive patients with histologically confirmed low-grade glioma. None of the patients had radiation or chemotherapy. Clinical, histologic, therapeutic (initial cytoreduction vs. biopsy), (18)F-FET uptake, and MRI morphologic parameters were analyzed for their prognostic significance. Statistical endpoints were clinical or radiologic tumor progression, malignant transformation to glioma of WHO grade III or IV (high-grade glioma), and death.
RESULTS
Baseline (18)F-FET uptake and a diffuse versus circumscribed tumor pattern on MRI were highly significant predictors of prognosis (P < 0.01). By the combination of these prognostically significant variables, 3 major prognostic subgroups of low-grade glioma patients could be identified. The first of these subgroups was patients with circumscribed low-grade glioma on MRI without (18)F-FET uptake (n = 11 patients, progression in 18%, no malignant transformation and no death). The second subgroup was patients with circumscribed low-grade glioma with (18)F-FET uptake (n = 13 patients, progression in 46%, malignant transformation to a high-grade glioma in 15%, and death in 8%). The third subgroup was patients with diffuse low-grade glioma with (18)F-FET uptake (n = 9 patients, progression in 100%, malignant transformation to a high-grade glioma in 78%, and death in 56%).
CONCLUSION
We conclude that baseline amino acid uptake on (18)F-FET PET and a diffuse versus circumscribed tumor pattern on MRI are strong predictors for the outcome of patients with low-grade glioma.
未标记
在世界卫生组织（WHO）二级胶质瘤（低级别胶质瘤）中，特定患者的自然病程不可预测，治疗策略也存在争议。我们确定了未经治疗、无强化、幕上低级别胶质瘤成年患者的预后因素，特别关注使用氨基酸O-(2-(18)F-氟乙基)-L-酪氨酸((18)F-FET)的PET和MRI。
方法
在一项前瞻性研究中，对33例经组织学证实为低级别胶质瘤的连续患者进行了基线(18)F-FET PET和MRI分析。所有患者均未接受放疗或化疗。分析临床、组织学、治疗（初始减瘤术与活检）、(18)F-FET摄取及MRI形态学参数的预后意义。统计终点为临床或影像学肿瘤进展、恶性转化为WHO三级或四级胶质瘤（高级别胶质瘤）及死亡。
结果
基线(18)F-FET摄取以及MRI上肿瘤的弥漫性与局限性模式是预后的高度显著预测因素（P<0.01）。通过结合这些具有预后意义的变量，可识别出低级别胶质瘤患者的3个主要预后亚组。第一亚组为MRI上表现为局限性低级别胶质瘤且无(18)F-FET摄取的患者（n = 11例，进展率为18%，无恶性转化且无死亡）。第二亚组为MRI上表现为局限性低级别胶质瘤且有(18)F-FET摄取的患者（n = 13例，进展率为46%，15%恶性转化为高级别胶质瘤，8%死亡）。第三亚组为MRI上表现为弥漫性低级别胶质瘤且有(18)F-FET摄取的患者（n = 9例，进展率为100%，78%恶性转化为高级别胶质瘤，56%死亡）。
结论
我们得出结论，基线(18)F-FET PET上的氨基酸摄取以及MRI上肿瘤的弥漫性与局限性模式是低级别胶质瘤患者预后的有力预测因素。
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