抗 3-[F]-FACBC PET/MRI 对脑胶质瘤的诊断准确性。
Diagnostic accuracy of anti-3-[F]-FACBC PET/MRI in gliomas.
机构信息
Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, N-7030, Trondheim, Norway.
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
出版信息
Eur J Nucl Med Mol Imaging. 2024 Jan;51(2):496-509. doi: 10.1007/s00259-023-06437-4. Epub 2023 Sep 30.
PURPOSE
The primary aim was to evaluate whether anti-3-[F]FACBC PET combined with conventional MRI correlated better with histomolecular diagnosis (reference standard) than MRI alone in glioma diagnostics. The ability of anti-3-[F]FACBC to differentiate between molecular and histopathological entities in gliomas was also evaluated.
METHODS
In this prospective study, patients with suspected primary or recurrent gliomas were recruited from two sites in Norway and examined with PET/MRI prior to surgery. Anti-3-[F]FACBC uptake (TBR) was compared to histomolecular features in 36 patients. PET results were then added to clinical MRI readings (performed by two neuroradiologists, blinded for histomolecular results and PET data) to assess the predicted tumor characteristics with and without PET.
RESULTS
Histomolecular analyses revealed two CNS WHO grade 1, nine grade 2, eight grade 3, and 17 grade 4 gliomas. All tumors were visible on MRI FLAIR. The sensitivity of contrast-enhanced MRI and anti-3-[F]FACBC PET was 61% (95%CI [45, 77]) and 72% (95%CI [58, 87]), respectively, in the detection of gliomas. Median TBR was 7.1 (range: 1.4-19.2) for PET positive tumors. All CNS WHO grade 1 pilocytic astrocytomas/gangliogliomas, grade 3 oligodendrogliomas, and grade 4 glioblastomas/astrocytomas were PET positive, while 25% of grade 2-3 astrocytomas and 56% of grade 2-3 oligodendrogliomas were PET positive. Generally, TBR increased with malignancy grade for diffuse gliomas. A significant difference in PET uptake between CNS WHO grade 2 and 4 gliomas (p < 0.001) and between grade 3 and 4 gliomas (p = 0.002) was observed. Diffuse IDH wildtype gliomas had significantly higher TBR compared to IDH1/2 mutated gliomas (p < 0.001). Adding anti-3-[F]FACBC PET to MRI improved the accuracy of predicted glioma grades, types, and IDH status, and yielded 13.9 and 16.7 percentage point improvement in the overall diagnoses for both readers, respectively.
CONCLUSION
Anti-3-[F]FACBC PET demonstrated high uptake in the majority of gliomas, especially in IDH wildtype gliomas, and improved the accuracy of preoperatively predicted glioma diagnoses.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov ID: NCT04111588, URL: https://clinicaltrials.gov/study/NCT04111588.
目的
主要目的是评估抗 3-[F]FACBC PET 与常规 MRI 相结合是否比单独 MRI 更能与组织分子诊断（参考标准）相关联，用于诊断胶质瘤。还评估了抗 3-[F]FACBC 在胶质瘤中区分分子和组织病理学实体的能力。
方法
在这项前瞻性研究中，从挪威的两个地点招募了疑似原发性或复发性脑胶质瘤的患者，并在手术前进行 PET/MRI 检查。在 36 名患者中比较了抗 3-[F]FACBC 摄取（TBR）与组织分子特征。然后，将 PET 结果添加到临床 MRI 阅读中（由两名神经放射科医生进行，对组织分子结果和 PET 数据均不知情），以评估有无 PET 时预测的肿瘤特征。
结果
组织分子分析显示 2 例中枢神经系统（CNS）WHO 1 级，9 例 2 级，8 例 3 级和 17 例 4 级胶质瘤。所有肿瘤在 MRI FLAIR 上均可见。对比增强 MRI 和抗 3-[F]FACBC PET 的敏感性分别为 61%（95%CI [45,77]）和 72%（95%CI [58,87]），用于检测胶质瘤。PET 阳性肿瘤的中位 TBR 为 7.1（范围：1.4-19.2）。所有 CNS WHO 1 级毛细胞型星形细胞瘤/神经节细胞瘤、3 级少突胶质细胞瘤和 4 级胶质母细胞瘤/星形细胞瘤均为 PET 阳性，而 2 级-3 级星形细胞瘤和 2 级-3 级少突胶质细胞瘤中有 25%和 56%为 PET 阳性。通常，弥漫性胶质瘤的恶性程度越高，TBR 越高。观察到 CNS WHO 2 级和 4 级胶质瘤（p<0.001）以及 3 级和 4 级胶质瘤（p=0.002）之间的 PET 摄取存在显著差异。IDH 野生型胶质瘤的 TBR 明显高于 IDH1/2 突变型胶质瘤（p<0.001）。将抗 3-[F]FACBC PET 添加到 MRI 中可提高预测胶质瘤等级、类型和 IDH 状态的准确性，两位读者的总体诊断分别提高了 13.9%和 16.7%。
结论
抗 3-[F]FACBC PET 在大多数胶质瘤中表现出高摄取，特别是在 IDH 野生型胶质瘤中，提高了术前预测胶质瘤诊断的准确性。
临床试验注册
ClinicalTrials.gov ID：NCT04111588，网址：https://clinicaltrials.gov/study/NCT04111588。
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