Department of Nuclear Medicine, Eugène Marquis Center, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France.
Signal and Image Processing Laboratory (LTSI), INSERM-University of Rennes 1, Rennes, France.
J Neurooncol. 2021 Dec;155(3):287-295. doi: 10.1007/s11060-021-03873-w. Epub 2021 Oct 22.
We aimed to compare spatial extent of high-grade subregions detected with combined [F]-dihydroxyphenylalanine (F-DOPA) PET and MRI to the one provided by advanced multimodal MRI alone including Contrast-enhanced (CE) and Perfusion weighted imaging (PWI). Then, we compared the accuracy between imaging modalities, in a per biopsy analysis.
Participants with suspected diffuse glioma were prospectively included between June 2018 and September 2019. Volumes of high-grade subregions were delineated respectively on F-DOPA PET and MRI (CE and PWI). Up to three per-surgical neuronavigation-guided biopsies were performed per patient.
Thirty-eight biopsy samples from sixteen participants were analyzed. Six participants (38%) had grade IV IDH wild-type glioblastoma, six (38%) had grade III IDH-mutated astrocytoma and four (24%) had grade II IDH-mutated gliomas. Three patients had intratumoral heterogeneity with coexisting high- and low-grade tumor subregions. High-grade volumes determined with combined F-DOPA PET/MRI (median of 1.7 [interquartile range (IQR) 0.0, 19.1] mL) were larger than with multimodal MRI alone (median 1.3 [IQR 0.0, 12.8] mL) with low overlap (median Dice's coefficient 0.24 [IQR 0.08, 0.59]). Delineation volumes were substantially increased in five (31%) patients. In a per biopsy analysis, combined F-DOPA PET/MRI detected high-grade subregions with an accuracy of 58% compared to 42% (p = 0.03) with CE MRI alone and 50% (p = 0.25) using multimodal MRI (CE + PWI).
The addition of F-DOPA PET to multimodal MRI (CE and PWI) enlarged the delineation volumes and enhanced overall accuracy for detection of high-grade subregions. Thus, combining F-DOPA with advanced MRI may improve treatment planning in newly diagnosed gliomas.
我们旨在比较 [F]-二羟基苯丙氨酸（F-DOPA）PET 与 MRI 联合检测到的高级亚区的空间范围与单独使用先进的多模态 MRI （包括对比增强（CE）和灌注加权成像（PWI））提供的范围。然后，我们在每例活检分析中比较了成像方式的准确性。
2018 年 6 月至 2019 年 9 月期间前瞻性纳入疑似弥漫性神经胶质瘤的患者。在 F-DOPA PET 和 MRI（CE 和 PWI）上分别勾画高级亚区的容积。每位患者最多进行三次手术导航引导活检。
共分析了 16 名患者的 38 个活检样本。6 名患者（38%）为 IDH 野生型 IV 级胶质母细胞瘤，6 名（38%）为 IDH 突变型 III 级星形细胞瘤，4 名（24%）为 IDH 突变型 II 级胶质瘤。3 名患者存在肿瘤内异质性，同时存在高低级别肿瘤亚区。使用联合 F-DOPA PET/MRI 确定的高级别体积（中位数为 1.7 [四分位距（IQR）0.0，19.1] mL）大于单独使用多模态 MRI 确定的体积（中位数 1.3 [IQR 0.0，12.8] mL），两者之间重叠较小（中位数 Dice 系数为 0.24 [IQR 0.08，0.59]）。在 5 名患者（31%）中，勾画体积明显增加。在每例活检分析中，与单独使用 CE MRI 相比，联合 F-DOPA PET/MRI 检测高级别亚区的准确性为 58%，而单独使用多模态 MRI（CE+PWI）的准确性为 50%（p=0.03）。
F-DOPA PET 与多模态 MRI（CE 和 PWI）联合使用可扩大勾画范围，并提高高级别亚区检测的总体准确性。因此，在新诊断的神经胶质瘤中联合使用 F-DOPA 与先进的 MRI 可能改善治疗计划。
