[ 18 F]-fluoro- l -thymidine PET and advanced MRI for preoperative grading of gliomas

Abstract

PurposeConventional MRI based on contrast enhancement is often not sufficient in differentiating grade II from grade III and grade III from grade IV diffuse gliomas. We assessed advanced MRI, MR spectroscopy and [18F]-fluoro-l-thymidine ([18F]-FLT) PET as tools to overcome these limitations.MethodsIn this prospective study, thirty-nine patients with diffuse gliomas of grades II, III or IV underwent conventional MRI, perfusion, diffusion, proton MR spectroscopy (1H-MRS) and [18F]-FLT-PET imaging before surgery. Relative cerebral blood volume (rCBV), apparent diffusion coefficient (ADC), Cho/Cr, NAA/Cr, Cho/NAA and FLT-SUV were compared between grades.ResultsCho/Cr showed significant differences between grade II and grade III gliomas (p = 0.03). To discriminate grade II from grade IV and grade III from grade IV gliomas, the most relevant parameter was the maximum value of [18F]-FLT uptake FLTmax (respectively, p < 0.001 and p < 0.0001). The parameter showing the best correlation with the grade was the mean value of [18F]-FLT uptake FLTmean (R2 = 0.36, p < 0.0001) and FLTmax (R2 = 0.5, p < 0.0001).ConclusionWhereas advanced MRI parameters give indications for the grading of gliomas, the addition of [18F]-FLT-PET could be of interest for the accurate preoperative classification of diffuse gliomas, particularly for identification of doubtful grade III and IV gliomas.

In Vivo Relationship Between Hypoxia and Angiogenesis in Human Glioblastoma: A Multimodal Imaging Study

“…Then a 3-dimensional T1-weighted sequence was used to evaluate gadolinium enhancement (T1Gd sequence) as a reflection of vessel permeability. The cerebral blood volume (CBV) maps were computed with ImageJ software (National Institutes of Health, 2013), according to the method published by Collet et al (20).…”

Diagnostic value of PET/CT with 11C-methionine (MET) and 18F-fluorothymidine (FLT) in newly diagnosed glioma based on the 2016 WHO classification

“…trapping is a representation of thymidine incorporation into DNA [11,12]. FLT-PET has been found useful for noninvasive grading and assessment of proliferative activity especially in newly diagnosed gliomas [13,14,15]. Moreover, FLT-PET can provide valuable information regarding treatment response and patient prognosis and regarding the recognition of tumour recurrence in gliomas [25,26].…”

“…This number means that one in 4 gliomas with low FLT uptake below the cutoff value (T/N ratio of 6.74) was an IHD1-wildtype tumour that could harbour an aggressive nature in the tumour. Our previous study showed that FLT uptake in tumours without an observed contrast enhancement effect on MR images was low even if the tumours were high-grade gliomas [15]. Later studies, including from our laboratory, have shown that the major portion of FLT uptake is due to increased transport and influx through the disrupted blood-brain barrier (BBB) [16,17].…”

“…FLT-PET has been found to be useful for assessing the proliferative activity of gliomas in vivo [13,14,15]. However, several studies have shown that the major portion of FLT uptake is dependent on the influx through the disrupted blood-brain barrier (BBB) and non-enhancing tumours with an intact BBB showed limited transport of FLT [16,17,18].…”

Aminosäure-PET bei Hirntumoren

“…Die Anreicherung des Proliferationsmarkers [ 18 F]-3′-deoxy-3′fluo rothymidin (FLT) korreliert mit dem Malignitätsgrad und Prognose von Hirntumoren [10], jedoch reichert sich FLT nur in Tumorregionen mit defekter BHS an und ist nicht geeignet, die Ausdehnung von zerebralen Gliomen korrekt wiederzugeben [29,57]. Des Weiteren wurden die Phospholipid-Vorläufer 11 C-Choline und 18 F-Fluorcholine als Marker des Zellmembranenumsatzes in Hirntumoren eingesetzt [25].…”