Lohmann Philipp, Piroth Marc D, Sellhaus Bernd, Weis Joachim, Geisler Stefanie, Oros-Peusquens Ana-Maria, Mohlberg Hartmut, Amunts Katrin, Shah Nadim J, Galldiks Norbert, Langen Karl-Josef
Institute of Neuroscience and Medicine (INM-1, -3, -4, -11), Forschungszentrum Juelich, Juelich, Germany.
Department of Radiation Oncology, HELIOS Hospital Wuppertal, Wuppertal, Germany; Department of Radiation Oncology, University Hospital RWTH Aachen, Aachen, Germany.
World Neurosurg. 2018 Nov;119:e653-e660. doi: 10.1016/j.wneu.2018.07.232. Epub 2018 Aug 2.
Amino acid positron emission tomography (PET) using O-(2-[F]fluoroethyl)-L-tyrosine (FET) provides important additional information on the extent of viable tumor tissue of glioblastoma compared with magnetic resonance imaging (MRI). Especially after radiochemotherapy, progression of contrast enhancement in MRI is equivocal and may represent either tumor progression or treatment-related changes. Here, the first case comparing postmortem whole-brain histology of a patient with pretreated glioblastoma with dynamic in vivo FET PET and MRI is presented.
A 61-year-old patient with glioblastoma initially underwent partial tumor resection and died 11 weeks after completion of chemoradiation with concurrent temozolomide. Three days before the patient died, a follow-up FET PET and MRI scan indicated tumor progression. Autopsy was performed 48 hours after death. After formalin fixation, a 7-cm bihemispherical segment of the brain containing the entire tumor mass was cut into 3500 consecutive 20μm coronal sections. Representative sections were stained with hematoxylin and eosin stain, cresyl violet, and glial fibrillary acidic protein immunohistochemistry. An experienced neuropathologist identified areas of dense and diffuse neoplastic infiltration, astrogliosis, and necrosis. In vivo FET PET, MRI datasets, and postmortem histology were co-registered and compared by 3 experienced physicians.
Increased uptake of FET in the area of equivocal contrast enhancement on MRI correlated very well with dense infiltration by vital tumor cells and showed tracer kinetics typical for malignant gliomas. An area of predominantly reactive astrogliosis showed only moderate uptake of FET and tracer kinetics usually observed in benign lesions.
This case report impressively documents the correct imaging of a progressive glioblastoma by FET PET.
与磁共振成像（MRI）相比，使用O-(2-[F]氟乙基)-L-酪氨酸（FET）的氨基酸正电子发射断层扫描（PET）能提供关于胶质母细胞瘤存活肿瘤组织范围的重要补充信息。特别是在放化疗后，MRI中对比增强的进展不明确，可能代表肿瘤进展或与治疗相关的变化。在此，展示了首例将经预处理的胶质母细胞瘤患者的死后全脑组织学与动态体内FET PET和MRI进行比较的病例。
一名61岁的胶质母细胞瘤患者最初接受了部分肿瘤切除术，并在同步替莫唑胺放化疗完成后11周死亡。患者死亡前3天，随访的FET PET和MRI扫描显示肿瘤进展。死后48小时进行尸检。福尔马林固定后，将包含整个肿瘤块的7厘米双半球脑段切成3500个连续的20μm冠状切片。代表性切片用苏木精和伊红染色、甲酚紫染色以及胶质纤维酸性蛋白免疫组织化学染色。一位经验丰富的神经病理学家识别出密集和弥漫性肿瘤浸润、星形胶质细胞增生和坏死区域。3位经验丰富的医生对体内FET PET、MRI数据集和死后组织学进行了配准和比较。
MRI上对比增强不明确区域的FET摄取增加与存活肿瘤细胞的密集浸润非常吻合，并显示出恶性胶质瘤典型的示踪剂动力学。主要为反应性星形胶质细胞增生的区域仅显示FET摄取中等，且示踪剂动力学通常在良性病变中观察到。
本病例报告令人印象深刻地证明了FET PET对进展性胶质母细胞瘤的正确成像。
