Institute of Diagnostic Radiology, University Hospital Würzburg, Wurzburg, Germany.
Department of Neurosurgery, University Hospital Würzburg, Wurzburg, Germany.
Mol Imaging Biol. 2019 Dec;21(6):1174-1181. doi: 10.1007/s11307-019-01357-y.
The use of [F]fluoroethyl)-L-tyrosine ([F]FET) positron emission tomography/computed tomography (PET/CT) has proven valuable in brain tumor management. This study aimed to investigate the prognostic value of radiotracer uptake in newly diagnosed grade II or III gliomas according to the current 2016 World Health Organization (WHO) classification.
A total of 35 treatment-naive patients (mean age, 48 ± 17 years) with histologically proven WHO grade II or III gliomas as defined by the current 2016 WHO classification were included. Static PET/CT imaging was performed 20 min after intravenous [F]FET injection. Images were assessed visually and semi-quantitatively using regions of interest for both tumor (SUVmax, SUVmean) and background (BKGmean) to calculate tumor-to-background (TBR) ratios. The association among histological results, molecular markers (including isocitrate dehydrogenase enzyme and methylguanine-DNA methyltransferase status), clinical features (age), and PET findings was tested and compared with outcome (progression-free [PFS] and overall survival [OS]).
Fourteen patients presented with grade II (diffuse astrocytoma n = 10, oligodendroglioma n = 4) and 21 patients with grade III glioma (anaplastic astrocytoma n = 15, anaplastic oligodendroglioma n = 6). Twenty-seven out of the 35 patients were PET-positive (grade II n = 8/14, grade III n = 19/21), with grade III tumors exhibiting significantly higher amino acid uptake (TBR and TBR; p = 0.03 and p = 0.02, respectively). PET-negative lesions demonstrated significantly prolonged PFS (p = 0.003) as compared to PET-positive gliomas. PET-positive disease had a complementary value in prognostication in addition to patient age, glioma grade, and molecular markers.
Amino acid uptake as assessed by [F]FET-PET/CT imaging is useful as non-invasive read-out for tumor biology and prognosis in newly diagnosed, treatment-naive gliomas according to the 2016 WHO classification.
[F]氟乙基-L-酪氨酸([F]FET)正电子发射断层扫描/计算机断层扫描(PET/CT)在脑肿瘤治疗中的应用已被证明具有价值。本研究旨在根据 2016 年现行世界卫生组织(WHO)分类，探讨新诊断的 II 级或 III 级胶质瘤中放射性示踪剂摄取的预后价值。
共纳入 35 例经组织学证实为新诊断的 II 级或 III 级胶质瘤的治疗初治患者（平均年龄，48 ± 17 岁），这些患者的胶质瘤分类符合 2016 年现行 WHO 分类。在静脉注射[F]FET 后 20 分钟进行静态 PET/CT 成像。使用肿瘤（SUVmax、SUVmean）和背景（BKGmean）的感兴趣区进行视觉和半定量评估，以计算肿瘤与背景（TBR）比值。检测组织学结果、分子标志物（包括异柠檬酸脱氢酶酶和甲基鸟嘌呤-DNA 甲基转移酶状态）、临床特征（年龄）和 PET 结果之间的相关性，并与预后（无进展生存期[PFS]和总生存期[OS]）进行比较。
14 例患者表现为 II 级（弥漫性星形细胞瘤 n = 10，少突胶质细胞瘤 n = 4），21 例患者表现为 III 级胶质瘤（间变性星形细胞瘤 n = 15，间变性少突胶质细胞瘤 n = 6）。35 例患者中有 27 例为 PET 阳性（II 级 n = 8/14，III 级 n = 19/21），III 级肿瘤的氨基酸摄取明显更高（TBR 和 TBR；p = 0.03 和 p = 0.02）。与 PET 阳性胶质瘤相比，PET 阴性病变的 PFS 明显延长（p = 0.003）。除患者年龄、胶质瘤分级和分子标志物外，PET 阳性疾病在预后判断中具有补充价值。
根据 2016 年现行 WHO 分类，通过[F]FET-PET/CT 成像评估氨基酸摄取可作为新诊断、未经治疗的胶质瘤肿瘤生物学和预后的非侵入性指标。
