Müther Michael, König Lorenz, Backhaus Philipp, Stummer Walter, Grauer Oliver M, Schäfers Michael, Schindler Philipp, Weckesser Matthias, Roll Wolfgang
Department of Neurosurgery, University Hospital Münster, Münster, Germany.
West German Cancer Center, Münster, Germany.
Eur J Nucl Med Mol Imaging. 2025 Sep 10. doi: 10.1007/s00259-025-07543-1.
Amino acid PET with [F]-fluoroethylthyrosine ([F]FET-PET) is frequently utilized in gliomas. Most studies on prognostication based on amino acid PET comprise mixed cohorts of brain tumors with low- and high-grade features. The objective of this study was to assess the potential prognostic value of [F]FET-PET-based markers in the group of grade 2 adult-type diffuse gliomas, as defined by the WHO CNS 2021 classification.
Retrospectively, all therapy-naive patients having undergone [F]FET-PET before maximal safe resection of grade II / 2 gliomas over a time of 2012-2022 were included. Diagnoses were updated according to the WHO CNS 2021 classification. [F]FET-PET were quantitatively evaluated, including dynamic PET acquisition if available. The primary outcome measure was progression-free survival (PFS), progression was defined by RANO 2.0 criteria.
In the cohort of WHO grade 2 gliomas, 57 (69%) patients were diagnosed with astrocytoma, IDH-mutant. Twenty-six (31%) patients were diagnosed with oligodendroglioma, IDH-mutant and 1p/19q-codeleted. Quantitative PET uptake parameters (TBR, TBR, BTV) were significantly higher in oligodendroglioma compared to astrocytoma (p < 0.001). In all patients, Cox regression analysis of clinical and imaging parameters did not identify any factor that significantly impacted PFS. In the subgroup of astrocytoma without adjuvant treatment, for patients with TBR above 1.9 PFS was significantly shorter (p < 0.001).
Preoperative [F]FET-PET can provide prognostic information in distinct subgroups of diffuse low-grade gliomas not having undergone adjuvant therapies. Following external validation, preoperative [F]FET-PET may possibly be employed as a decision-support tool to inform the choice of adjuvant therapies in astrocytoma.
[F] - 氟乙基酪氨酸（[F]FET - PET）氨基酸PET常用于胶质瘤。大多数基于氨基酸PET的预后研究包括具有低级别和高级别特征的脑肿瘤混合队列。本研究的目的是评估基于[F]FET - PET的标志物在世界卫生组织（WHO）2021年中枢神经系统分类所定义的2级成人型弥漫性胶质瘤组中的潜在预后价值。
回顾性纳入2012年至2022年期间在最大安全切除II / 2级胶质瘤之前接受过[F]FET - PET检查的所有未经治疗的患者。根据WHO CNS 2021分类更新诊断。对[F]FET - PET进行定量评估，如有可用数据则包括动态PET采集。主要结局指标是无进展生存期（PFS），进展根据RANO 2.0标准定义。
在WHO 2级胶质瘤队列中，57例（69%）患者被诊断为IDH突变型星形细胞瘤。26例（31%）患者被诊断为IDH突变且1p/19q共缺失的少突胶质细胞瘤。与星形细胞瘤相比，少突胶质细胞瘤的PET定量摄取参数（TBR、TBR、BTV）显著更高（p < 0.001）。在所有患者中，对临床和影像参数进行的Cox回归分析未发现任何显著影响PFS的因素。在未接受辅助治疗的星形细胞瘤亚组中，TBR高于1.9的患者PFS显著更短（p < 0.001）。
术前[F]FET - PET可为未接受辅助治疗的弥漫性低级别胶质瘤的不同亚组提供预后信息。经过外部验证后，术前[F]FET - PET可能会被用作决策支持工具，以指导星形细胞瘤辅助治疗的选择。
