Nuclear Medicine, Humanitas Clinical and Research Hospital-IRCCS, Rozzano MI.
Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan.
Nucl Med Commun. 2020 Jul;41(7):696-705. doi: 10.1097/MNM.0000000000001202.
To compare 11C-methionine (11C-METH) PET with diffusion-weighted MRI (DWI-MRI) diagnostic accuracy and prognostic value in patients with glioma candidate to neurosurgery.
We collected and analyzed data from 124 consecutive patients (n = 124) investigated during preoperative work-up. Both visual and semiquantitative parameters were utilized for image analysis. The reference standard was based on histopathology. The median follow-up was 14.3 months.
Overall, 47 high-grade gliomas (HGG) and 77 low-grade gliomas (LGG) were diagnosed. On visual assessment, sensitivity and specificity for differentiating HGG from LGG were 80.8 and 59.7% for DWI-MRI, versus 95.7 and 41.5% for 11C-METH PET, respectively. On semiquantitative analysis, the sensitivity, specificity, and area under the curve were 78.7, 71.4, and 80.4% for SUVmax, 78.7, 70.1, and 81.1% for SUVratio, and 74.5, 61, and 76.7% for MTB (metabolic tumor burden), respectively. In patients with negative DWI-MRI and IDH-wild type, SUVmax and SUVratio were higher compared to IDH-mutated (P = 0.025 and P = 0.01, respectively). In LGG, patients with 1p/19q codeletion showed higher SUVmax (P = 0.044). In all patients with negative DWI-MRI, median PFS was longer for SUVmax <3.9 (median not reached vs 34.2 months, P = 0.004), SUVratio <2.3 (median not reached vs 21.5 months, P < 0.001), and MTB <3.1 (median not reached vs 45.7 months, P = 0.05). In LGG patients with negative DWI-MRI, only SUVratio <2.3 and MTB <3.1 were associated with longer PFS (P = 0.016 and P = 0.024, respectively).
C-METH PET was found highly sensitive for glioma differentiation and molecular characterization. In DWI-negative patients, PET parameters correlated with molecular profile were associated with clinical outcome.
比较 11C-蛋氨酸（11C-METH）PET 与扩散加权 MRI（DWI-MRI）在拟行神经外科手术的胶质瘤患者中的诊断准确性和预后价值。
我们收集并分析了 124 例连续患者（n=124）术前检查的数据。图像分析同时采用视觉和半定量参数。参考标准基于组织病理学。中位随访时间为 14.3 个月。
共诊断出 47 例高级别胶质瘤（HGG）和 77 例低级别胶质瘤（LGG）。在视觉评估中，DWI-MRI 区分 HGG 和 LGG 的敏感度和特异度分别为 80.8%和 59.7%，而 11C-METH PET 分别为 95.7%和 41.5%。在半定量分析中，SUVmax 的敏感度、特异度和曲线下面积分别为 78.7%、71.4%和 80.4%，SUVratio 为 78.7%、70.1%和 81.1%，MTB（代谢肿瘤负荷）为 74.5%、61%和 76.7%。在 DWI-MRI 阴性和 IDH 野生型患者中，SUVmax 和 SUVratio 高于 IDH 突变型（P=0.025 和 P=0.01）。在 LGG 中，1p/19q 缺失的患者 SUVmax 更高（P=0.044）。在所有 DWI-MRI 阴性的患者中，SUVmax<3.9（未达到中位值 vs 34.2 个月，P=0.004）、SUVratio<2.3（未达到中位值 vs 21.5 个月，P<0.001）和 MTB<3.1（未达到中位值 vs 45.7 个月，P=0.05）的患者中位 PFS 更长。在 DWI-MRI 阴性的 LGG 患者中，只有 SUVratio<2.3 和 MTB<3.1 与更长的 PFS 相关（P=0.016 和 P=0.024）。
11C-METH PET 对胶质瘤的鉴别和分子特征具有高度敏感性。在 DWI 阴性的患者中，与分子谱相关的 PET 参数与临床结局相关。
