Additive Value of Dynamic FDOPA PET/CT for Glioma Grading

Abstract

Purpose: The aim of this study was to assess the value of the FDOPA PET kinetic parameters extracted using full kinetic analysis for tumor grading with neuronavigation-guided biopsies as reference in patients with newly-diagnosed gliomas.Methods: Fourteen patients with untreated gliomas were investigated. Twenty minutes of dynamic positron-emission tomography (PET) imaging and a 20-min static image 10 min after injection were reconstructed from a 40-min list-mode acquisition immediately after FDOPA injection. Tumors volume-of-interest (VOI) were generated based on the MRI-guided brain biopsies. Static parameters (TBRmax and TBRmean) and kinetic parameters [K1 and k2 using full kinetic analysis with the reversible single-tissue compartment model with blood volume parameter and the time-to-peak (TTP)] were extracted. Performances of each parameter for differentiating low-grade gliomas (LGG) from high-grade gliomas (HGG) were evaluated by receiver-operating characteristic analyses (area under the curve; AUC).Results: Thirty-two tumoral VOI were analyzed. K1, k2, and TTP were significantly higher for HGG than for LGG (median K1-value = 0.124 vs. 0.074 ml/ccm/min, p = 0.025, median k2-value = 0.093 vs. 0.063 min−1, p = 0.025, and median TTP-value = 10.0 vs. 15.0 min, p = 0.025). No significant difference was observed for the static parameters. The AUC for the kinetic parameters was higher than the AUC for the static parameters (respectively, AUCK1 = 0.787, AUCk2 = 0.785, AUCTTP = 0.775, AUCTBRmax = 0.551, AUCTBRmean = 0.575), significantly compared to TBRmax (respectively, p = 0.001 for K1, p = 0.031 for k2, and p = 0.029 for TTP).Conclusion: The present study suggests an additive value of FDOPA PET/CT kinetic parameters for newly-diagnosed gliomas grading.

A case of Kernohan-Woltman notch phenomenon caused by an epidural hematoma: the diagnostic and prognostic value of PET/CT imaging

“…It is urgent to develop advanced imaging modalities to detect and better understand KWNP. PET/CT is a radiographic technique primarily used for diagnosis and staging of glioma [8,9]. In our case no brain tumor was found.…”

“…PET/CT is a radiographic technique primarily used for diagnosis and staging of glioma [ 8 , 9 ]. In our case no brain tumor was found.…”

Effects of Carbidopa Premedication on 18F-FDOPA PET Imaging of Glioma: A Multiparametric Analysis

“…Plasma 18 F-FDOPA input functions were computed after metabolite correction, according to the methodology described by Wardak et al [ 22 ] and by using previously published values of metabolite proportions of hematocrit, as follows: (i) proportions of each of the 18 F-labeled metabolites determined by Melega et al [ 23 ] were used as they included the proportions for no premedication as well as for premedication with 100 mg of carbidopa (similarly to ours) (respectively C0 and C100 in Figure 1 A) and (ii) a mean 40% hematocrit value was selected for each patient, as previously reported [ 8 ]. The compartmental model used for tumors was a two-tissue compartmental model validated for compartmental analysis of 18 F-FDOPA PET imaging in gliomas [ 22 ], as it satisfied the minimum Akaike information criterion when compared to a simpler one-tissue compartmental model [ 24 ] or to a two-tissue compartmental model with fewer parameters (V b fixed at 5% [ 8 ] or k 4 set to 0).…”

What Does PET Imaging Bring to Neuro-Oncology in 2022? A Review

“…A recent meta-analysis found a pooled sensitivity of 0.88 and a pooled specificity and 0.73 for glioma grading [ 20 ], making it a valuable clinical tool [ 21 ]. The dynamic analysis also seems to be an interesting tool to integrate [ 22 , 23 , 24 ]. At diagnosis [ 18 F]FDOPA uptake also has an independent prognostic value [ 25 ].…”