Department of Radiation Oncology, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center and Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Nuclear Medicine, Cleveland Clinic, Cleveland, OH, USA.
J Neurooncol. 2023 Jul;163(3):647-655. doi: 10.1007/s11060-023-04377-5. Epub 2023 Jun 21.
Distinguishing radiation necrosis from tumor progression among patients with brain metastases previously treated with stereotactic radiosurgery represents a common diagnostic challenge. We performed a prospective pilot study to determine whether PET/CT with F-fluciclovine, a widely available amino acid PET radiotracer, repurposed intracranially, can accurately diagnose equivocal lesions.
Adults with brain metastases previously treated with radiosurgery presenting with a follow-up tumor-protocol MRI brain equivocal for radiation necrosis versus tumor progression underwent an F-fluciclovine PET/CT of the brain within 30 days. The reference standard for final diagnosis consisted of clinical follow-up until multidisciplinary consensus or tissue confirmation.
Of 16 patients imaged from 7/2019 to 11/2020, 15 subjects were evaluable with 20 lesions (radiation necrosis, n = 16; tumor progression, n = 4). Higher SUV statistically significantly predicted tumor progression (AUC = 0.875; p = 0.011). Lesion SUV (AUC = 0.875; p = 0.018), SUV (AUC = 0.813; p = 0.007), and SUV-to-normal-brain (AUC = 0.859; p = 0.002) also predicted tumor progression, whereas SUV-to-normal-brain (p = 0.1) and SUV-to-normal-brain (p = 0.5) did not. Qualitative visual scores were significant predictors for readers 1 (AUC = 0.750; p < 0.001) and 3 (AUC = 0.781; p = 0.045), but not for reader 2 (p = 0.3). Visual interpretations were significant predictors for reader 1 (AUC = 0.898; p = 0.012) but not for reader 2 (p = 0.3) or 3 (p = 0.2).
In this prospective pilot study of patients with brain metastases previously treated with radiosurgery presenting with a contemporary MRI brain with a lesion equivocal for radiation necrosis versus tumor progression, F-fluciclovine PET/CT repurposed intracranially demonstrated encouraging diagnostic accuracy, supporting the pursuit of larger clinical trials which will be necessary to establish diagnostic criteria and performance.
在先前接受立体定向放射外科治疗的脑转移患者中，区分放射性坏死与肿瘤进展是一项常见的诊断挑战。我们进行了一项前瞻性试点研究，以确定重新应用于颅内的 F-氟代赖氨酸（一种广泛应用的氨基酸 PET 放射性示踪剂）是否可以准确诊断模棱两可的病变。
先前接受放射外科治疗的脑转移患者在接受随访时出现疑似放射性坏死与肿瘤进展的肿瘤方案 MRI 脑图像，在 30 天内进行 F-氟代赖氨酸脑 PET/CT 检查。最终诊断的参考标准是多学科共识或组织确认的临床随访。
在 2019 年 7 月至 2020 年 11 月期间对 16 名患者进行成像，15 名患者可评估 20 个病变（放射性坏死，n=16；肿瘤进展，n=4）。较高的 SUV 具有统计学意义地预测肿瘤进展（AUC=0.875；p=0.011）。病变 SUV（AUC=0.875；p=0.018）、SUV（AUC=0.813；p=0.007）和 SUV 与正常脑比值（AUC=0.859；p=0.002）也可预测肿瘤进展，而 SUV 与正常脑比值（p=0.1）和 SUV 与正常脑比值（p=0.5）则不能。定性视觉评分是读者 1（AUC=0.750；p<0.001）和读者 3（AUC=0.781；p=0.045）的显著预测因素，但不是读者 2（p=0.3）的预测因素。视觉解释是读者 1（AUC=0.898；p=0.012）的显著预测因素，但不是读者 2（p=0.3）或读者 3（p=0.2）的预测因素。
在这项先前接受放射外科治疗的脑转移患者的前瞻性试点研究中，出现疑似放射性坏死与肿瘤进展的当代 MRI 脑病变，重新应用于颅内的 F-氟代赖氨酸 PET/CT 显示出令人鼓舞的诊断准确性，支持开展更大规模的临床试验，以建立诊断标准和性能。
