Furtak Jacek, Rakowska Józefina, Szylberg Tadeusz, Harat Marek, Małkowski Bogdan, Harat Maciej
Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland.
Department of Pathomorphology, 10th Military Research Hospital, Bydgoszcz, Poland.
Front Neurol. 2021 May 11;12:634609. doi: 10.3389/fneur.2021.634609. eCollection 2021.
Neuroimaging based on O-[2-(18F)fluoroethyl]-l-tyrosine (FET)-PET provides additional information on tumor grade and extent compared with MRI. Dynamic PET for biopsy target selection further improves results but is often clinically impractical. Static FET-PET performed at two time-points may be a good compromise, but data on this approach are limited. The aim of this study was to compare the histology of lesions obtained from two challenging glioma patients with targets selected based on hybrid dual time-point FET-PET/MRI. Five neuronavigated tumor biopsies were performed in two difficult cases of suspected glioma. Lesions with (T1-CE) and without contrast enhancement (T1 and T2-FLAIR) on MRI were selected. Dual time-point FET-PET imaging was performed 5-15 min (PET10) and 45-60 min (PET60) after radionuclide injection. The most informative FET-PET/MRI images were coregistered with MRI in time of biopsy planning. Five biopsy targets (three from high uptake and two from moderate uptake FET areas) thought to represent the most malignant sites and tumor extent were selected. Histopathological findings were compared with FET-PET and MRI images. Increased FET uptake in the area of non-CE locations on MRI correlated well with high-grade gliomas localized as far as 3 cm from T1-CE foci. Selecting a target in the motor cortex based on FET kinetics defined by dual time-point PET resulted in a grade IV diagnosis after previous negative biopsies based on MRI. An additional grade III diagnosis was obtained from an area of glioma infiltration with moderate FET uptake (between 1 and 1.25 SUV). These findings seem to show that dual time-point FET-PET-based biopsies can provide additional and clinically useful information for glioma diagnosis. Selection of targets based on dual time-point images may be useful for determining the most malignant tumor areas and may therefore be useful for resection and radiotherapy planning.
与磁共振成像（MRI）相比，基于O-[2-(18F)氟乙基]-L-酪氨酸（FET）的正电子发射断层扫描（PET）神经成像可提供有关肿瘤分级和范围的更多信息。用于活检靶点选择的动态PET可进一步改善结果，但在临床上往往不实用。在两个时间点进行的静态FET-PET可能是一个不错的折衷方案，但关于这种方法的数据有限。本研究的目的是比较从两名具有挑战性的胶质瘤患者获得的病变组织学，这些患者的靶点是基于混合双时间点FET-PET/MRI选择的。在两例疑似胶质瘤的困难病例中进行了五次神经导航肿瘤活检。选择了MRI上有（T1增强）和无对比增强（T1和T2液体衰减反转恢复序列）的病变。在放射性核素注射后5-15分钟（PET10）和45-60分钟（PET60）进行双时间点FET-PET成像。在活检计划时，将最具信息性的FET-PET/MRI图像与MRI进行配准。选择了五个活检靶点（三个来自高摄取和两个来自中等摄取FET区域），认为它们代表了最恶性的部位和肿瘤范围。将组织病理学结果与FET-PET和MRI图像进行比较。MRI上非增强部位区域的FET摄取增加与距T1增强灶达3厘米的高级别胶质瘤密切相关。基于双时间点PET定义的FET动力学在运动皮层选择靶点，导致在先前基于MRI的活检为阴性后诊断为IV级。从FET摄取中等（1至1.25标准化摄取值之间）的胶质瘤浸润区域获得了另外一个III级诊断。这些发现似乎表明，基于双时间点FET-PET的活检可为胶质瘤诊断提供额外的临床有用信息。基于双时间点图像选择靶点可能有助于确定最恶性的肿瘤区域，因此可能有助于切除和放射治疗计划。
