Yonsei University College of Medicine, Seoul.
Division of Life Science, College of Life Science and Bioengineering, Incheon National University, Incheon.
Clin Nucl Med. 2022 Oct 1;47(10):863-868. doi: 10.1097/RLU.0000000000004341. Epub 2022 Jul 26.
11 C-acetate ( 11 C-ACE) uptake on PET/CT was recently discovered to represent reactive astrocytes in the tumor microenvironment. This study aimed at evaluating the role of 11 C-ACE PET/CT as an imaging biomarker of reactive astrogliosis in characterizing different types of gliomas.
In this prospective study, a total of 182 patients underwent 11 C-ACE PET/CT before surgery. The ratio of SUV max of a glioma to the SUV mean of the contralateral choroid plexus ( 11 C-ACE TCR) on PET/CT was calculated. 11 C-ACE TCRs were compared with the World Health Organization grades and isocitrate dehydrogenase 1 ( IDH1 ) mutation status. Grade 2 was considered low-grade tumor, and grades 3 and 4 were considered high-grade tumors.
The median 11 C-ACE TCR was significantly higher in IDH1 wild-type (wt) tumors (n = 91) than in IDH1 -mutant (mt) tumors (n = 91) (2.38 vs 1.30, P < 0.001). Of the 91 IDH1 -mt tumors, there were no differences in the median 11 C-ACE TCRs between oligodendrogliomas (ODs) and astrocytic tumors (1.40 vs 1.20, P > 0.05). In grading low- versus high-grade gliomas, the receiver operating characteristic curve analyses showed a higher area under the curve (0.951) in IDH1 -wt tumors than in IDH1 -mt tumors (0.783, P = 0.002). Grade 2 ODs were well differentiated from high-grade gliomas. The 11 C-ACE TCR of grade 3 ODs was significantly lower than that of IDH1 -wt glioblastomas.
High 11 C-ACE uptake is associated with high-grade IDH1 -wt tumors, thus facilitating differentiation from high-grade IDH1-mt and low-grade gliomas. In particular, low 11 C-ACE uptake in ODs is advantageous in overcoming the limitation of radiolabeled amino acid tracers.
最近发现 11 C-乙酰酸盐（11 C-ACE）在 PET/CT 上的摄取代表肿瘤微环境中的反应性星形胶质细胞。本研究旨在评估 11 C-ACE PET/CT 作为反应性星形胶质增生的成像生物标志物在不同类型胶质瘤中的作用。
在这项前瞻性研究中，共有 182 名患者在手术前接受了 11 C-ACE PET/CT 检查。计算 PET/CT 上肿瘤的最大 SUV 与对侧脉络丛的平均 SUV 比值（11 C-ACE TCR）。11 C-ACE TCR 与世界卫生组织分级和异柠檬酸脱氢酶 1（IDH1）突变状态进行了比较。2 级被认为是低级别肿瘤，3 级和 4 级被认为是高级别肿瘤。
在 IDH1 野生型（wt）肿瘤（n=91）中，11 C-ACE TCR 的中位数明显高于 IDH1 突变型（mt）肿瘤（n=91）（2.38 比 1.30，P<0.001）。在 91 例 IDH1-mt 肿瘤中，少突胶质细胞瘤（ODs）和星形细胞瘤之间 11 C-ACE TCR 的中位数无差异（1.40 比 1.20，P>0.05）。在低级别与高级别胶质瘤分级中，IDH1-wt 肿瘤的曲线下面积（AUC）分析显示出更高的 AUC（0.951），而 IDH1-mt 肿瘤的 AUC 则较低（0.783，P=0.002）。2 级 ODs 与高级别胶质瘤有很好的区别。3 级 ODs 的 11 C-ACE TCR 明显低于 IDH1-wt 胶质母细胞瘤。
高 11 C-ACE 摄取与高级别 IDH1-wt 肿瘤相关，因此有助于与高级别 IDH1-mt 和低级别胶质瘤区分。特别是，ODs 中低摄取 11 C-ACE 有利于克服放射性标记氨基酸示踪剂的局限性。
