Henssen Dylan, Rullmann Michael, Arens Anne I J, Schildan Andreas, Striepe Stephan, Schürer Matti, Scherlach Cordula, Jähne Katja, Stassart Ruth, Sabri Osama, Seidel Clemens, Hesse Swen
Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany.
Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
Eur J Nucl Med Mol Imaging. 2025 Jul 24. doi: 10.1007/s00259-025-07469-8.
Single-session, multiparametric [¹⁸F]FET PET/MRI is used to detect tumor recurrence in high-grade glioma, but its prognostic value for overall survival remains uncertain. This study evaluated whether biological tumor volume, tumor-to-background ratio (TBRmax), cerebral blood volume (rCBVmax), and choline/NAA ratio (Cho/NAA) could predict survival in recurrent high-grade glioma.
Twenty-six patients with histopathologically confirmed tumor progression underwent simultaneous [¹⁸F]FET PET/MRI. PET-derived biological tumor volume and TBRmax, MRI-derived rCBVmax, and Cho/NAA ratio were analyzed. A Cox proportional hazards model assessed associations with overall survival, adjusting for the number of lesions and treatment strategy.
Biological tumor volume (hazard ratio = 2.22, 95%-CI: 1.035-4.762, p = 0.041) and the number of lesions (hazard ratio = 1.03, 95%-CI 1.00-1.06, p = 0.036) were significantly associated with survival. TBRmax (p = 0.089), rCBVmax (p = 0.088), and Cho/NAA ratio (p = 0.734) were not predictive. Treatment strategy after tumor recurrence diagnosis did not significantly impact overall-survival (HR = 0.208, p = 0.649). PET/MRI interaction terms did not enhance survival prediction.
Biological tumor volume is a significant prognostic imaging biomarker in recurrent high-grade glioma, emphasizing tumor burden over metabolic activity or perfusion of individual lesions. Volume-based PET metrics may offer better survival prediction than traditional PET or MRI parameters. Prospective multicenter studies are needed to validate these findings and explore automated segmentation and machine learning approaches for improved prognostication.
单次多参数[¹⁸F]FET PET/MRI用于检测高级别胶质瘤的肿瘤复发，但其对总生存期的预后价值仍不确定。本研究评估了生物学肿瘤体积、肿瘤与背景比值（TBRmax）、脑血容量（rCBVmax）和胆碱/ N-乙酰天门冬氨酸比值（Cho/NAA）能否预测复发性高级别胶质瘤的生存期。
26例经组织病理学证实肿瘤进展的患者接受了同步[¹⁸F]FET PET/MRI检查。分析了PET衍生的生物学肿瘤体积和TBRmax、MRI衍生的rCBVmax以及Cho/NAA比值。采用Cox比例风险模型评估与总生存期的相关性，并对病灶数量和治疗策略进行校正。
生物学肿瘤体积（风险比=2.22，95%可信区间：1.035 - 4.762，p = 0.041）和病灶数量（风险比=1.03，95%可信区间1.00 - 1.06，p = 0.036）与生存期显著相关。TBRmax（p = 0.089）、rCBVmax（p = 0.088）和Cho/NAA比值（p = 0.734）无预测价值。肿瘤复发诊断后的治疗策略对总生存期无显著影响（风险比=0.208，p = 0.649）。PET/MRI交互项未增强生存期预测。
生物学肿瘤体积是复发性高级别胶质瘤中一个重要的预后影像生物标志物，强调肿瘤负荷而非单个病灶的代谢活性或灌注。基于体积的PET指标可能比传统PET或MRI参数提供更好的生存期预测。需要进行前瞻性多中心研究来验证这些发现，并探索自动分割和机器学习方法以改善预后。
