18F-Fluorocholine PET/CT in the Prediction of Molecular Subtypes and Prognosis for Gliomas

Abstract

Aim To study the association of metabolic features of 18F-fluorocholine in gliomas with histopathological and molecular parameters, progression-free survival (PFS) and overall survival (OS). Methods Prospective multicenter and nonrandomized study (Functional and Metabolic Glioma Analysis). Patients underwent a basal 18F-fluorocholine PET/CT and were included after histological confirmation of glioma. Histological and molecular profile was assessed: grade, Ki-67, isocitrate dehydrogenase status and 1p/19q codeletion. Patients underwent standard treatment after surgery or biopsy, depending on their clinical situation. Overall survival and PFS were obtained after follow-up. After tumor segmentation of PET images, SUV and volume-based variables, sphericity, surface, coefficient of variation, and multilesionality were obtained. Relations of metabolic variables with histological, molecular profile and prognosis were evaluated using Pearson χ2 and t test. Receiver operator caracteristic curves were used to obtain the cutoff of PET variables. Survival analysis was performed using Kaplan-Meier and Cox regression analysis. Results Forty-five patients were assessed; 38 were diagnosed as having high-grade gliomas. Significant differences of SUV-based variables with isocitrate dehydrogenase status, tumor grade, and Ki-67 were found. Tumor grade, Ki-67, SUVmax, and SUVmean were related to progression. Kaplan-Meier analysis revealed significant associations of SUVmax, SUVmean, and multilesionaly with OS and PFS. SUVmean, sphericity, and multilesionality were independent predictors of OS and PFS in Cox regression analysis. Conclusions Metabolic information obtained from 18F-fluorocholine PET of patients with glioma may be useful in the prediction of tumor biology and patient prognosis.

A Head-to-Head Comparison of 18F-Fluorocholine PET/CT and Conventional MRI as Predictors of Outcome in IDH Wild-Type High-Grade Gliomas

“…PET/CT scans were performed in single hybrid equipment (Discovery DSTXL-1, General Electric) located at the reference center following a previously used procedure [ 14 ].…”

“…Tumors were segmented on PET images using a semiautomatic procedure described in a previous study [ 14 ]. Morphological variables such as the maximum diameter and tumor total surface were included.…”

“…In the last decade, amino acid PET radiotracers supply constraints in Spain, have limited their use, which has promoted the tentative use of other more accessible PET radiotracers, such as choline analogues. However, although these radiotracers can be useful in the prediction of tumor molecular profiles and prognosis, the experience is limited and not focused on the group of IDH-wt high-grade gliomas [ 12 , 13 , 14 ]. Thus, the aim of our study was to assess the outcome potential of classical and novel imaging variables (radiomics) obtained from 18 F-fluorocholine PET/CT and compare their performance with the standard of imaging care CE-MRI together with other clinical factors related to prognosis in patients with IDH-wt high-grade gliomas.…”

A mesoscopic simulator to uncover heterogeneity and evolutionary dynamics in tumors

“…This biomarker has been found to have prognostic value for GBMs using both MRI [22,34] and PET [35] images.…”

“…When S reg approaches zero the tumor will be highly irregular, resembling a fractal-like structure. This parameter receives different names in the literature and has been found to have prognostic value in lung cancer [36,37], head and neck cancer [38,39], esophageal cancer [40], breast cancer [41], lymphoma [42], and glioma [23,35]. pointed out that TLA and MTV are related through a scaling law providing a surrogate for tumor aggressiveness [43].…”