Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Frankfurt am Main, Germany
University Cancer Center Frankfurt, Goethe University Hospital, Frankfurt am Main, Germany.
J Nucl Med. 2020 Apr;61(4):505-511. doi: 10.2967/jnumed.119.234757. Epub 2019 Sep 13.
In glioma patients, differentiation between tumor progression (TP) and treatment-related changes (TRCs) remains challenging. Difficulties in classifying imaging alterations may result in a delay or an unnecessary discontinuation of treatment. PET using -(2-F-fluoroethyl)-l-tyrosine (F-FET) has been shown to be a useful tool for detecting TP and TRCs. We retrospectively evaluated 127 consecutive patients with World Health Organization grade II-IV glioma who underwent F-FET PET imaging to distinguish between TP and TRCs. F-FET PET findings were verified by neuropathology (40 patients) or clinicoradiologic follow-up (87 patients). Maximum tumor-to-brain ratios (TBR) of F-FET uptake and the slope of the time-activity curves (20-50 min after injection) were determined. The diagnostic accuracy of F-FET PET parameters was evaluated by receiver-operating-characteristic analysis and χ testing. The prognostic value of F-FET PET was estimated using the Kaplan-Meier method. TP was diagnosed in 94 patients (74%) and TRCs in 33 (26%). For differentiating TP from TRCs, receiver-operating-characteristic analysis yielded an optimal F-FET TBR cutoff of 1.95 (sensitivity, 70%; specificity, 71%; accuracy, 70%; area under the curve, 0.75 ± 0.05). The highest accuracy was achieved by a combination of TBR and slope (sensitivity, 86%; specificity, 67%; accuracy, 81%). However, accuracy was poorer when tumors harbored isocitrate dehydrogenase () mutations (91% in -wild-type tumors, 67% in -mutant tumors, < 0.001). F-FET PET results correlated with overall survival ( < 0.001). In our neurooncology department, the diagnostic performance of F-FET PET was convincing but slightly inferior to that of previous reports.
在脑胶质瘤患者中，区分肿瘤进展（TP）和治疗相关变化（TRCs）仍然具有挑战性。由于难以对影像学改变进行分类，可能会导致治疗的延迟或不必要的中断。使用（2-氟乙基）-L-酪氨酸（F-FET）的 PET 已被证明是一种有用的工具，可用于检测 TP 和 TRCs。我们回顾性评估了 127 例连续接受 F-FET PET 成像以区分 TP 和 TRCs 的世界卫生组织（WHO）分级 II-IV 级脑胶质瘤患者。F-FET PET 结果通过神经病理学（40 例）或临床影像学随访（87 例）进行验证。测定 F-FET 摄取的最大肿瘤与脑比值（TBR）和时间-活性曲线的斜率（注射后 20-50 分钟）。通过接收者操作特征分析和 χ 检验评估 F-FET PET 参数的诊断准确性。使用 Kaplan-Meier 方法估计 F-FET PET 的预后价值。94 例（74%）患者诊断为 TP，33 例（26%）患者诊断为 TRCs。为了区分 TP 和 TRCs，接收者操作特征分析得出 F-FET TBR 最佳截断值为 1.95（敏感性，70%；特异性，71%；准确性，70%；曲线下面积，0.75±0.05）。TBR 和斜率的组合获得了最高的准确性（敏感性，86%；特异性，67%；准确性，81%）。然而，当肿瘤携带异柠檬酸脱氢酶（IDH）突变时，准确性较差（野生型肿瘤中为 91%，突变型肿瘤中为 67%， < 0.001）。F-FET PET 结果与总生存期相关（ < 0.001）。在我们的神经肿瘤学部门，F-FET PET 的诊断性能令人信服，但略低于以前的报告。
