18F-氟代脱氧胸苷正电子发射断层扫描在胶质母细胞瘤手术和放疗期间对肿瘤体积进行系列评估的研究。

Study of 18 F-fluciclovine PET for serial assessment of glioblastoma tumor volumes during surgery and radiotherapy.

作者信息

Dagher Samir A, Johnson Jason M, Mohamed Rania M M, Ansari Shehbaz, Mawlawi Osama, Liu Ho-Ling, Wintermark Max, Schellingerhout Dawid, Flynt Lesley, Yeboa Debra N, Weinberg Jeffrey S, Ferguson Sherise D, Gule-Monroe Maria K

机构信息

Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.

Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.

出版信息

J Neurooncol. 2025 Jul 1. doi: 10.1007/s11060-025-05146-2.

DOI:10.1007/s11060-025-05146-2

PMID:40591209

Abstract

PURPOSE

Recent evidence supports incorporating 18 F-Fluciclovine PET for glioblastoma treatment planning and monitoring, as it better captures tumor infiltration compared to conventional MRI. However, the relationship between PET- and MRI-defined tumor volumes remains unclear, particularly in the post-treatment setting. This study prospectively compares tumor volumes on MRI and PET at multiple timepoints throughout the treatment course and evaluates volumetric changes with therapy.

METHODS

We prospectively enrolled 8 adults with IDH-wildtype glioblastoma treated with surgery and chemoradiation between September 2019 and 2021. Participants underwent paired 18 F-Fluciclovine PET/CT and conventional MRI at four timepoints: preoperatively, pre-radiation, and at one- and six-months post-radiation. Biological tumor volume (BTV) from PET, FLAIR, and post-contrast T1volumes (T1CV) were segmented. Volumetric changes were compared using the Friedman test.

RESULTS

Participants (5 males, median age 63 years [IQR 54,66]) showed significantly larger BTVs compared to T1CV at diagnosis (median BTV = 27.2mL vs. T1CV = 13.3mL, adjusted P =.03), pre-radiation (BTV = 25.2mL vs. T1CV = 6.9mL, adjusted P =.03), and at one-month post-radiation (BTV = 27.3mL vs. T1CV = 12.1mL, P =.04). BTVs closely approximated yet were slightly smaller than their corresponding FLAIR volumes at all timepoints. After surgery, the median decrease in BTV (-4.4%) was significantly smaller than T1CV (-66.5%, P =.046), with a similar nonsignificant trend observed post-radiation (P =.50).

CONCLUSION

Glioblastoma BTVs consistently exceed post-contrast T1 volumes and closely approximate FLAIR abnormalities throughout treatment. BTVs decline more gradually post-treatment, indicating persistent hypermetabolic tumor burden. Thus, 18 F-Fluciclovine PET can serve as an adjunct to conventional MRI in glioblastoma treatment planning and monitoring.

摘要

目的

最近有证据支持将18F-氟代脱氧胸苷正电子发射断层扫描（18F-Fluciclovine PET）用于胶质母细胞瘤的治疗计划制定和监测，因为与传统磁共振成像（MRI）相比，它能更好地显示肿瘤浸润情况。然而，PET和MRI所定义的肿瘤体积之间的关系仍不明确，尤其是在治疗后的情况下。本研究前瞻性地比较了整个治疗过程中多个时间点的MRI和PET上的肿瘤体积，并评估了治疗引起的体积变化。

方法

我们前瞻性地纳入了8例在2019年9月至2021年期间接受手术及放化疗的异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤成年患者。参与者在四个时间点接受了18F-氟代脱氧胸苷PET/CT和传统MRI检查：术前、放疗前、放疗后1个月和6个月。对PET、液体衰减反转恢复序列（FLAIR）和增强后T1加权像上的肿瘤体积（T1CV）进行分割。使用Friedman检验比较体积变化。

结果

参与者（5名男性；中位年龄63岁[四分位间距54,66]）在诊断时（中位BTV = 27.2mL vs. T1CV = 13.3mL，校正P = 0.03）、放疗前（BTV = 25.2mL vs. T1CV = 6.9mL，校正P = 0.03）和放疗后1个月（BTV = 27.3mL vs. T1CV = 12.1mL，P = 0.04）时，BTV均显著大于T1CV。在所有时间点，BTV均与相应的FLAIR体积相近但略小。手术后，BTV中位数下降幅度（-4.4%）显著小于T1CV（-66.5%，P = 0.046），放疗后也观察到类似的无显著差异趋势（P = 0.50）。