Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK.
Department of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK.
Eur J Nucl Med Mol Imaging. 2023 Nov;50(13):3982-3995. doi: 10.1007/s00259-023-06330-0. Epub 2023 Jul 25.
MRI and PET are used in neuro-oncology for the detection and characterisation of lesions for malignancy to target surgical biopsy and to plan surgical resections or stereotactic radiosurgery. The critical role of short-chain fatty acids (SCFAs) in brain tumour biology has come to the forefront. The non-metabolised SCFA radiotracer, [F]fluoropivalate (FPIA), shows low background signal in most tissues except eliminating organs and has appropriate human dosimetry. Tumour uptake of the radiotracer is, however, unknown. We investigated the uptake characteristics of FPIA in this pilot PET/MRI study.
Ten adult glioma subjects were identified based on radiological features using standard-of-care MRI prior to any surgical intervention, with subsequent histopathological confirmation of glioma subtype and grade (lower-grade - LGG - and higher-grade - HGG - patients). FPIA was injected as an intravenous bolus injection (range 342-368 MBq), and dynamic PET and MRI data were acquired simultaneously over 66 min.
All patients tolerated the PET/MRI protocol. Three patients were reclassified following resection and histology. Tumour maximum standardised uptake value (SUV) increased in the order LGG (WHO grade 2) < HGG (WHO grade 3) < HGG (WHO grade 4). The net irreversible solute transfer, Ki, and influx rate constant, K1, were significantly higher in HGG (p < 0.05). Of the MRI variables studied, DCE-MRI-derived extravascular-and-extracellular volume fraction (v) was high in tumours of WHO grade 4 compared with other grades (p < 0.05). SLC25A20 protein expression was higher in HGG compared with LGG.
Tumoural FPIA PET uptake is higher in HGG compared to LGG. This study supports further investigation of FPIA PET/MRI for brain tumour imaging in a larger patient population.
Clinicaltrials.gov, NCT04097535.
磁共振成像（MRI）和正电子发射断层扫描（PET）用于神经肿瘤学中，以检测和描述病变的恶性程度，从而确定外科活检的目标，并计划进行外科切除或立体定向放射手术。短链脂肪酸（SCFA）在脑肿瘤生物学中的关键作用已经成为研究的重点。未代谢的 SCFA 放射性示踪剂[F]氟戊酸盐（FPIA）在大多数组织中除了消除器官外显示出低背景信号，并且具有适当的人体剂量学。然而，肿瘤对放射性示踪剂的摄取情况尚不清楚。我们在这项初步的 PET/MRI 研究中研究了 FPIA 的摄取特征。
根据标准 MRI 影像学特征，在进行任何手术干预之前，从 10 名成人胶质瘤患者中识别出肿瘤，并对胶质瘤亚型和分级（低级别胶质瘤[LGG]和高级别胶质瘤[HGG]患者）进行随后的组织病理学确认。FPIA 作为静脉内推注（范围 342-368MBq）注入，同时在 66 分钟内采集动态 PET 和 MRI 数据。
所有患者均耐受 PET/MRI 方案。在切除和组织学检查后，有 3 名患者重新分类。肿瘤最大标准化摄取值（SUV）的顺序为 LGG（WHO 分级 2）<HGG（WHO 分级 3）<HGG（WHO 分级 4）。在 HGG 中，净不可逆转的溶质转移率 Ki 和流入速率常数 K1 显著更高（p<0.05）。在研究的 MRI 变量中，与其他分级相比，DCE-MRI 衍生的血管外-细胞外容积分数（v）在 WHO 分级 4 的肿瘤中较高（p<0.05）。与 LGG 相比，HGG 中 SLC25A20 蛋白表达更高。
与 LGG 相比，HGG 中的肿瘤 FPIA PET 摄取更高。这项研究支持在更大的患者人群中进一步研究 FPIA PET/MRI 用于脑肿瘤成像。
Clinicaltrials.gov，NCT04097535。
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