Lee Dong Yun, Oh Jungsu S, Kim Jeong Won, Oh Minyoung, Oh Seung Jun, Lee Seungjoo, Kim Young-Hoon, Kim Jeong Hoon, Nam Soo Jeong, Song Sang Woo, Kim Jae Seung
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Eur J Nucl Med Mol Imaging. 2025 Jan;52(2):669-682. doi: 10.1007/s00259-024-06935-z. Epub 2024 Oct 4.
While [F]FET PET plays a complementary role in glioma imaging, it needs to be more comprehensively understood for improved characterization of glioma prior to surgery given the evolving landscape of molecular neuropathology. Thus, we investigated the utility of pre-operative dual-time-point [F]FET PET in correlation with next-generation sequencing (NGS) data in patients with adult-type diffuse glioma (ADG).
Adult patients who were suspected to have primary glioma were prospectively recruited between June 2021 and January 2024. They underwent pre-operative dual-time-point static PET/CT at 20 min (early) and 80 min (delay) after [F]FET injection. Semi-quantitative parameters of the hottest lesion (SUV) of tumour and the hottest lesion-to-normal brain ratio (TBR) were assessed from each summed image. Furthermore, the percentage changes (△) of SUV and TBR between two images were calculated. Histopathology of glioma was determined according to the 2021 WHO classification and NGS data.
This study investigated a dozen genes in 76 patients, of whom 51 had isocitrate dehydrogenase (IDH)-wild-type glioblastoma, 13 had IDH-mutant astrocytoma, and 12 had IDH-mutant oligodendroglioma. Every tumour was [F]FET-avid having TBR more than 1.6. Patients with CDKN2A/B loss had significantly higher values of SUV (5.7 ± 1.6 vs. 4.7 ± 1.3, p = 0.004; 5.0 ± 1.4 vs. 4.4 ± 1.2, p = 0.026) and TBR (6.5 ± 1.8 vs. 5.1 ± 1.7, p = 0.001; 5.3 ± 1.5 vs. 4.3 ± 1.3, p = 0.004) in both scans than patients without CDKN2A/B loss, even after adjustment for age, MRI enhancement, tumor grade and type of pathology. Furthermore, patients with PIK3CA mutation (16.2 ± 11.8 vs. 6.7 ± 11.6, p = 0.007) had significantly higher △SUV than patients without PIK3CA mutation, even after adjustment for age, MRI enhancement, tumor grade, and type of pathology.
Among the dozen genes investigated in this prospective study in patients with ADG, we found out that CDKN2A/B loss and PIK3CA mutation status could be differentiated by pre-operative dual-time-point [F]FET PET/CT.
虽然[F]FET PET在胶质瘤成像中发挥着补充作用，但鉴于分子神经病理学的不断发展，为了在手术前更好地表征胶质瘤，需要对其有更全面的了解。因此，我们研究了术前双时相[F]FET PET与成人型弥漫性胶质瘤（ADG）患者的下一代测序（NGS）数据相关的效用。
2021年6月至2024年1月前瞻性招募疑似患有原发性胶质瘤的成年患者。他们在注射[F]FET后20分钟（早期）和80分钟（延迟）进行术前双时相静态PET/CT检查。从每个总图像中评估肿瘤最热病灶的半定量参数（SUV）和最热病灶与正常脑的比值（TBR）。此外，计算两幅图像之间SUV和TBR的百分比变化（△）。根据2021年世界卫生组织分类和NGS数据确定胶质瘤的组织病理学。
本研究对76例患者的十几个基因进行了研究，其中51例患有异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤，13例患有IDH突变型星形细胞瘤，12例患有IDH突变型少突胶质细胞瘤。每个肿瘤均为[F]FET摄取阳性，TBR大于1.6。即使在调整年龄、MRI增强、肿瘤分级和病理类型后，CDKN2A/B缺失的患者在两次扫描中的SUV（5.7±1.6对4.7±1.3，p = 0.004；5.0±1.4对4.4±1.2，p = 0.026）和TBR（6.5±1.8对5.1±1.7，p = 0.001；5.3±1.5对4.3±1.3，p = 0.004）值均显著高于无CDKN2A/B缺失的患者。此外，即使在调整年龄、MRI增强、肿瘤分级和病理类型后，PIK3CA突变的患者（16.2±11.8对6.7±11.6，p = 0.007）的△SUV也显著高于无PIK3CA突变的患者。
在这项针对ADG患者的前瞻性研究中所研究的十几个基因中，我们发现术前双时相[F]FET PET/CT可以区分CDKN2A/B缺失和PIK3CA突变状态。
