Institute of Diagnostic and Interventional Radiology and Neuroradiology.
Institute of Neuropathology.
Clin Nucl Med. 2019 Jun;44(6):e375-e381. doi: 10.1097/RLU.0000000000002577.
Amino acid PET and magnetic resonance spectroscopy (MRS) are at the forefront of noninvasive imaging techniques used for detection and subtyping of glioma-suspicious lesions. In this pilot study, we compare L-methyl-C-methionine PET and MRS for their ability to predict glioma subtypes.
Nineteen patients with histologically, confirmed newly diagnosed glioma underwent preoperative L-methyl-C-methionine PET and MRS in 1 diagnostic session. According to the molecular portfolio and histopathologic diagnosis, patients were subdivided in isocitrate dehydrogenase (IDH) wild-type glioblastoma, IDH wild-type grade II/III glioma, IDH-mutant grade II/III glioma without 1p/19q codeletion, and with 1p/19q codeletion subgroups. Maximum tumor-to-brain ratio (TBRmax), creatine, choline, and N-acetyl aspartate peaks were correlated with postoperative histopathologic tumor diagnoses.
Maximum tumor-to-brain ratio was highest in glioblastoma patients (4.18) followed by patients with IDH wild-type grade II and III glioma (3.41). The latter TBRmax values were higher compared with those in patients with IDH-mutant grade II/III glioma without 1p/19q codeletion (1.95) and in patients with IDH-mutant 1p/19q codeleted grade II and III glioma (2.79). Magnetic resonance spectroscopy marker distribution showed no clear trend. Receiver operating characteristic analysis revealed TBRmax to be the best performing parameter in identifying IDH status (area under the curve, 0.67) and all spectroscopy markers combined in identifying glioma subgroups (area under the curve, 0.68), respectively.
L-Methyl-C-methionine PET and MRS bear limited potential in glioma subgrouping. L-Methyl-C-methionine PET appears to be superior in differentiating IDH status, whereas MRS is more helpful in glioma subgrouping.
氨基酸 PET 和磁共振波谱（MRS）是用于检测和分类可疑胶质瘤病变的无创成像技术的前沿。在这项初步研究中，我们比较了 L-甲基-C-蛋氨酸 PET 和 MRS 预测胶质瘤亚型的能力。
19 例经组织学证实的新诊断为胶质瘤的患者在 1 次诊断性检查中接受了 L-甲基-C-蛋氨酸 PET 和 MRS 检查。根据分子谱和组织病理学诊断，患者被分为异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤、IDH 野生型 2/3 级胶质瘤、IDH 突变型无 1p/19q 联合缺失的 2/3 级胶质瘤和伴有 1p/19q 联合缺失的亚型。最大肿瘤与脑比值（TBRmax）、肌酸、胆碱和 N-乙酰天冬氨酸峰与术后组织病理学肿瘤诊断相关。
胶质母细胞瘤患者的 TBRmax 最高（4.18），其次是 IDH 野生型 2/3 级胶质瘤患者（3.41）。后一组 TBRmax 值高于 IDH 突变型无 1p/19q 联合缺失的 2/3 级胶质瘤患者（1.95）和 IDH 突变型 1p/19q 联合缺失的 2/3 级胶质瘤患者（2.79）。磁共振波谱标志物分布无明显趋势。受试者工作特征分析显示，TBRmax 是识别 IDH 状态的最佳参数（曲线下面积，0.67），也是识别所有波谱标志物组合的胶质瘤亚组的最佳参数（曲线下面积，0.68）。
L-甲基-C-蛋氨酸 PET 和 MRS 在胶质瘤亚组分类中潜力有限。L-甲基-C-蛋氨酸 PET 在区分 IDH 状态方面似乎更具优势，而 MRS 在胶质瘤亚组分类方面更有帮助。
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