Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
Eur Radiol. 2021 Jun;31(6):4087-4096. doi: 10.1007/s00330-020-07470-9. Epub 2020 Nov 19.
To investigate the predictive value of static O-(2-F-fluoroethyl)-L-tyrosine positron emission tomography (F-FET PET) and cerebral blood volume (CBV) for glioma grading and determining isocitrate dehydrogenase (IDH) mutation and 1p/19q codeletion status.
Fifty-two patients with newly diagnosed gliomas who underwent simultaneous F-FET PET and dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) examinations on hybrid PET/MR were retrospectively enrolled. The mean and max tumor-to-brain ratio (TBR) and normalized CBV (nCBV) were calculated based on whole tumor volume segmentations with reference to PET/MR images. The predictive efficacy of FET PET and CBV in glioma according to the 2016 World Health Organization (WHO) classification was evaluated by receiver operating characteristic curve analyses with the area under the curve (AUC).
TBRmean, TBRmax, nCBVmean, and nCBVmax differed between low- and high-grade gliomas, with the highest AUC of nCBVmean (0.920). TBRmax and nCBVmean showed significant differences between gliomas with and without IDH mutation (p = 0.032 and 0.010, respectively). Furthermore, TBRmean, TBRmax, and nCBVmean discriminated between IDH-wildtype glioblastomas and IDH-mutated astrocytomas (p = 0.049, 0.034 and 0.029, respectively). The combination of TBRmax and nCBVmean showed the best predictive performance (AUC, 0.903). Only nCBVmean differentiated IDH-mutated with 1p/19q codeletion oligodendrogliomas from IDH-wildtype glioblastomas (p < 0.001) (AUC, 0.829), but none of the parameters discriminated between oligodendrogliomas and astrocytomas.
Both FET PET and DSC-PWI might be non-invasive predictors for glioma grades and IDH mutation status. FET PET combined with CBV could improve the differentiation of IDH-mutated astrocytomas and IDH-wildtype glioblastomas. However, FET PET and CBV might be limited for identifying oligodendrogliomas.
• Static F-FET PET and DSC-PWI parameters differed between low- and high-grade gliomas, with the highest AUC of the mean value of normalized CBV. • Static F-FET PET and DSC-PWI parameters based on hybrid PET/MR showed predictive value in identifying glioma IDH mutation subtypes, which have gained importance for both determining the diagnosis and prognosis of gliomas according to the 2016 WHO classification. • Static F-FET PET and DSC-PWI parameters have limited potential in differentiating IDH-mutated with 1p/19q codeletion oligodendrogliomas from IDH-wildtype glioblastomas or IDH-mutated astrocytomas.
探讨静态 O-(2-氟乙基)-L-酪氨酸正电子发射断层扫描（F-FET PET）和脑血容量（CBV）在胶质瘤分级以及确定异柠檬酸脱氢酶（IDH）突变和 1p/19q 联合缺失状态中的预测价值。
回顾性分析 52 例经杂交 PET/MR 行 F-FET PET 和动态磁敏感对比灌注加权成像（DSC-PWI）检查的新诊断脑胶质瘤患者。根据参考 PET/MR 图像对全肿瘤体积进行分段，计算平均和最大肿瘤与脑比值（TBR）和标准化 CBV（nCBV）。采用受试者工作特征曲线分析（AUC）评估 FET PET 和 CBV 对 2016 年世界卫生组织（WHO）分类的胶质瘤的预测效能。
低级别和高级别胶质瘤之间的 TBRmean、TBRmax、nCBVmean 和 nCBVmax 存在差异，其中 nCBVmean 的 AUC 最高（0.920）。TBRmax 和 nCBVmean 在 IDH 突变型和野生型胶质瘤之间存在显著差异（p=0.032 和 0.010）。此外，TBRmean、TBRmax 和 nCBVmean 可区分 IDH 野生型胶质母细胞瘤和 IDH 突变型星形细胞瘤（p=0.049、0.034 和 0.029）。TBRmax 和 nCBVmean 的组合具有最佳的预测性能（AUC，0.903）。仅 nCBVmean 可区分 IDH 突变型伴 1p/19q 联合缺失的少突胶质细胞瘤与 IDH 野生型胶质母细胞瘤（p<0.001）（AUC，0.829），但无任何参数可区分少突胶质细胞瘤和星形细胞瘤。
FET PET 和 DSC-PWI 均可能成为胶质瘤分级和 IDH 突变状态的非侵入性预测指标。FET PET 结合 CBV 可改善 IDH 突变型星形细胞瘤和 IDH 野生型胶质母细胞瘤的鉴别。然而，FET PET 和 CBV 可能在识别少突胶质细胞瘤方面存在局限性。
静态 F-FET PET 和 DSC-PWI 参数在低级别和高级别胶质瘤之间存在差异，其中标准化 CBV 的平均值的 AUC 最高。
基于杂交 PET/MR 的静态 F-FET PET 和 DSC-PWI 参数在识别胶质瘤 IDH 突变亚型方面具有预测价值，根据 2016 年 WHO 分类，这对确定胶质瘤的诊断和预后都具有重要意义。
静态 F-FET PET 和 DSC-PWI 参数在区分 IDH 突变伴 1p/19q 联合缺失的少突胶质细胞瘤与 IDH 野生型胶质母细胞瘤或 IDH 突变型星形细胞瘤方面的潜力有限。
