磁共振成像（MRI）和氟代乙基酪氨酸正电子发射断层扫描（FET PET）在高级别胶质瘤中对区分复发与放射性坏死的互补作用。

The complementary role of MRI and FET PET in high-grade gliomas to differentiate recurrence from radionecrosis.

作者信息

Sahu Arpita, Mathew Ronny, Ashtekar Renuka, Dasgupta Archya, Puranik Ameya, Mahajan Abhishek, Janu Amit, Choudhari Amitkumar, Desai Subhash, Patnam Nandakumar G, Chatterjee Abhishek, Patil Vijay, Menon Nandini, Jain Yash, Rangarajan Venkatesh, Dev Indraja, Epari Sridhar, Sahay Ayushi, Shetty Prakash, Goda Jayant, Moiyadi Aliasgar, Gupta Tejpal

机构信息

Department of Radiodiagnosis, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India.

Department of Radiation Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India.

出版信息

Front Nucl Med. 2023 Apr 27;3:1040998. doi: 10.3389/fnume.2023.1040998. eCollection 2023.

DOI:10.3389/fnume.2023.1040998

PMID:39355021

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11440952/

Abstract

INTRODUCTION

Conventional magnetic resonance imaging (MRI) has limitations in differentiating tumor recurrence (TR) from radionecrosis (RN) in high-grade gliomas (HGG), which can present with morphologically similar appearances. Multiparametric advanced MR sequences and Positron Emission Tomography (PET) with amino acid tracers can aid in diagnosing tumor metabolism. The role of both modalities on an individual basis and combined performances were investigated in the current study.

MATERIALS AND METHODS

Patients with HGG with MRI and PET within three weeks were included in the retrospective analysis. The multiparametric MRI included T1-contrast, T2-weighted sequences, perfusion, diffusion, and spectroscopy. MRI was interpreted by a neuroradiologist without using information from PET imaging. 18F-Fluoroethyl-Tyrosine (FET) uptake was calculated from the areas of maximum enhancement/suspicion, which was assessed by a nuclear medicine physician (having access to MRI to determine tumor-to-white matter ratio over a specific region). A definitive diagnosis of TR or RN was made based on the combination of multidisciplinary joint clinic decisions, histopathological examination, and clinic-radiological follow-up as applicable.

RESULTS

62 patients were included in the study between July 2018 and August 2021. The histology during initial diagnosis was glioblastoma, oligodendroglioma, and astrocytoma in 43, 7, and 6 patients, respectively, while in 6, no definitive histological characterization was available. The median time from radiation (RT) was 23 months. 46 and 16 patients had TR and RN recurrence, respectively. Sensitivity, specificity, and accuracy using MRI were 98, 77, and 94%, respectively. Using PET imaging with T/W cut-off of 2.65, sensitivity, specificity, and accuracy were 79, 84, and 80%, respectively. The best results were obtained using both imaging combined with sensitivity, specificity, and accuracy of 98, 100, and 98%, respectively.

CONCLUSION

Combined imaging with MRI and FET-PET offers multiparametric assessment of glioma recurrence that is correlative and complimentary, with higher accuracy and clinical value.

摘要

引言

传统磁共振成像（MRI）在鉴别高级别胶质瘤（HGG）中的肿瘤复发（TR）与放射性坏死（RN）方面存在局限性，二者在形态学上表现相似。多参数先进磁共振序列和氨基酸示踪剂正电子发射断层扫描（PET）有助于诊断肿瘤代谢。本研究调查了这两种检查方式各自的作用以及联合应用的表现。

材料与方法

对在三周内进行了MRI和PET检查的HGG患者进行回顾性分析。多参数MRI包括T1加权增强、T2加权序列、灌注、弥散和波谱分析。由神经放射科医生解读MRI，不使用PET成像的信息。从最大强化/可疑区域计算18F-氟乙基酪氨酸（FET）摄取量，由核医学医生评估（可获取MRI以确定特定区域的肿瘤与白质比值）。根据多学科联合临床决策、组织病理学检查以及适用的临床放射学随访结果做出TR或RN的明确诊断。

结果

2018年7月至2021年8月期间，62例患者纳入研究。初始诊断时的组织学类型分别为胶质母细胞瘤43例、少突胶质细胞瘤7例、星形细胞瘤6例，6例未获得明确的组织学特征。放疗后的中位时间为23个月。分别有46例和16例患者出现TR和RN复发。MRI的敏感性、特异性和准确性分别为98%、77%和94%。使用PET成像，T/W截止值为2.65时，敏感性、特异性和准确性分别为79%、84%和80%。两种成像联合使用时效果最佳，敏感性、特异性和准确性分别为98%、100%和98%。