Dynamic O-(2-[18F]fluoroethyl)-L-tyrosine (F-18 FET) PET for Glioma Grading

Calcagni, Maria Lucia; Galli, G; Giordano, Alessandro; Taralli, Silvia; Anile, Carmelo; Niesen, A.; Baüm, Richard

doi:10.1097/rlu.0b013e3182291b40

Cited by 117 publications

(126 citation statements)

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“…10 With respect to differentiation between lowand high-grade histology, it has been become clear, however, that conventional analyses of 18 F-FET PET with determination of static values such as the ratio of maximal 18 F-FET uptake within the tumor as compared to the background (SUV max /BG) lack specificity and sensitivity; this is explained by the marked overlap of the distributions of the uptake ratios in low-and high-grade tumors. 11 In contrast, dynamic analysis of 18 F-FET uptake over a period of 40 min has been shown to enable noninvasive tumor grading with high diagnostic power 12,13 : "Increasing" time-activity curves (TAC) of 18 F-FET uptake, with standard uptake values (SUV) constantly ascending or reaching a peak followed by a plateau has been demonstrated to indicate low-grade histology. "Decreasing" TAC, with SUVs exhibiting an early peak followed by a constant descend, correlate with a high-grade phenotype.…”

Section: O-(2-[mentioning

confidence: 99%

Dynamic ¹⁸F‐FET PET in suspected WHO grade II gliomas defines distinct biological subgroups with different clinical courses

Thon

Kunz

Lemke

et al. 2014

Intl Journal of Cancer

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In suspected grade II gliomas, three distinct patterns of time-activity curves (TAC) on O-(2-[ positron emission tomography (PET) have been delineated (i) increasing TAC homogeneously throughout the tumor, and decreasing TAC, (ii) either homogeneously throughout the tumor or (iii) only focally within otherwise increasing TAC patterns.Increasing TAC was associated with low-grade histology and decreasing TAC with high-grade histology. This prospective study analyzed whether these patterns correlate with distinct biological tumor subtypes and differential outcome. 18 F-FET PET-guided biopsies were used for stepwise histopathological evaluation. Molecular-genetic evaluation included O 6 -methylguanine-DNA methyltransferase (MGMT) promoter methylation, isocitrate dehydrogenase (IDH1/2) mutational and 1p/19q codeletion status. Progression-free survival (PFS) was estimated with the Kaplan-Meier method. Prognostic factors were obtained from multivariate regression models. 98 adult patients were included. Homogeneous increasing, focal decreasing and homogeneous decreasing TAC were seen in 51, 19 and 28 patients. The corresponding 1-year (2-years) PFS were 92% (85%), 89% (51%) and 50% (28%; p 5 0.002). IDH1/2 mutations were more frequent in tumors with homogeneous increasing (90%) and focal decreasing (79%) TAC, but were rare in those exhibiting homogeneous decreasing TAC (25%; p < 0.001). Overall, TAC patterns, IDH1/2 mutational and 1p/19q codeletion status were powerful and independent prognostic factors. Dynamic 18 F-FET PET might be an important and independent imaging biomarker for patients with suspected WHO grade II gliomas and offers perspectives for stratified diagnostic and therapeutic strategies. Tumors with focal decreasing TAC need highly targeted surgical interventions to avoid undergrading and undertreatment.

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Section: O-(2-[mentioning

confidence: 99%

Dynamic ¹⁸F‐FET PET in suspected WHO grade II gliomas defines distinct biological subgroups with different clinical courses

Thon

Kunz

Lemke

et al. 2014

Intl Journal of Cancer

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“…Time-to-peak (TTP; time in minutes from the beginning of the dynamic acquisition up to the maximum SUV of the lesion) was determined. Furthermore, as previously descibed (12,20), the TACs of each lesion were assigned to one of the following curve patterns: Constantly increasing 18 F-FET uptake without identifiable peak uptake (pattern I);…”

Section: Pet Data Analysismentioning

confidence: 99%

Late Pseudoprogression in Glioblastoma: Diagnostic Value of Dynamic O-(2-[18F]fluoroethyl)-L-Tyrosine PET

Kebir

Fimmers

Galldiks

et al. 2016

Clinical Cancer Research

111

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Purpose: Pseudoprogression (PsP) is characterized by therapyassociated but not tumor growth-associated increases of contrastenhancing glioblastoma lesions on MRI. Although typically occurring during the first 3 months after radiochemotherapy, PsP may occur later in the course of the disease and may then be particularly difficult to distinguish from true tumor progression. We explored PET using O-(2-Experimental Design: Twenty-six patients with glioblastoma that presented with increasing contrast-enhancing lesions later than 3 months after completion of radiochemotherapy underwent 18 F-FET-PET. Maximum and mean tumor/brain ratios (TBR max and TBR mean ) of 18 F-FET uptake as well as time-to-peak (TTP) and patterns of the time-activity curves were determined. The final diagnosis of true progression versus late PsP was based on follow-up MRI using RANO criteria.Results: Late PsP occurred in 7 patients with a median time from radiochemotherapy completion of 24 weeks while the remaining patients showed true tumor progression. TBR max and TBR mean were significantly higher in patients with true progression than in patients with late PsP (TBR max 2.4 AE 0.1 vs. 1.5 AE 0.2, P ¼ 0.003; TBR mean 2.1 AE 0.1 vs. 1.5 AE 0.2, P ¼ 0.012) whereas TTP was significantly shorter (mean TTP 25 AE 2 vs. 40 AE 2 min, P < 0.001). ROC analysis yielded an optimal cutoff value of 1.9 for TBR max to differentiate between true progression and late PsP (sensitivity 84%, specificity 86%, accuracy 85%, P ¼ 0.015).Conclusions: O-(2-[ 18 F]fluoroethyl)-L-tyrosine PET provides valuable information in assessing the elusive phenomenon of late PsP. Clin Cancer Res; 22(9); 2190-6. Ó2015 AACR.

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“…In the studies, a variety of methods were used for computing TBR: (1) a region-of-interest (ROI) manually drawn around the tumor based on T1-and/ or T2-weighted MR images [18][19][20], or (2) increased FET uptake [8,[21][22][23][24], (3) automated ROI drawing of the area with increased FET uptake [3 standard deviations of the mean standardized uptake value (SUV) of a control region [25], or (4) based on a 90 % SUV max threshold isocontour Studies without data to compute specificity (n = 10 studies, N = 261 pat.) Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Sixteen studies [8,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] with a total of N = 641 patients (Table 1) were eligible for inclusion in the present metaanalysis. Six studies had mixed populations with both primary brain tumor and recurrence (#1, 9, 11, 12, 13, and 14, Table 1) and one did not report histology results for all patients (#2, Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Similarly, for gliomas, a meanTBR C1.7 and a maxTBR C2.2 demonstrated excellent diagnostic performances, with significantly lower meanTBR and maxTBR in low-grade than in high-grade gliomas. On dynamic acquisitions, several studies [8,23,26,39] reported accurate distinction between low-grade and high-grade untreated gliomas using information from tumor time-activity curves, such as an increasing/decreasing slope uptake pattern [26,39] or early-to-middle uptake ratio [23]. Whether combining conventional MRI with MRS, diffusion imaging and dynamic FET-PET imaging could provide better performances for diagnosing glioma that has not been established in large populations [40,41].…”

Section: Study Characteristicsmentioning

confidence: 99%

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Diagnostic accuracy of F-18-fluoroethyltyrosine PET and PET/CT in patients with brain tumor

Dunet

Prior

2013

Clin Transl Imaging

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Positron emission tomography with 18 F-fluoroethyltyrosine (FET-PET) is increasingly used for the initial evaluation of patients with primary brain tumors (PBTs). This article provides an up-to-date systematic review and meta-analysis of FET-PET diagnostic performances in patients with suspected PBTs. The PubMed and EMBASE databases were searched for studies published in the period January 1977-September 2012. Inclusion criteria were: (1) use of FET-PET for assessment of newly diagnosed brain lesions; (2) no radiotherapy, surgery or chemotherapy prior to FET-PET and (3) use of histology as gold standard. A per-patient meta-analysis was performed, as well as a receiver operating characteristics (ROC) analysis of pooled patients to determine optimal tumor-tobackground ratio (TBR) of FET uptake. In total, 16 studies (641 patients) were included. . ROC analysis showed a meanTBR threshold C1.6 and a maxTBR C2.2 to have the best diagnostic value for differentiating PBTs from non-tumoral lesions. This meta-analysis confirms the excellent performances of FET-PET used for the diagnosis of PBTs. For FET-PET to become a relevant tool for improving patient management, prospective multicenter studies with standardized acquisition protocols should investigate its added value over current magnetic resonance imaging and the optimal combination of FET-PET and MRI.

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Dynamic O-(2-[18F]fluoroethyl)-L-tyrosine (F-18 FET) PET for Glioma Grading

Cited by 117 publications

References 10 publications

Dynamic ¹⁸F‐FET PET in suspected WHO grade II gliomas defines distinct biological subgroups with different clinical courses

Dynamic ¹⁸F‐FET PET in suspected WHO grade II gliomas defines distinct biological subgroups with different clinical courses

Late Pseudoprogression in Glioblastoma: Diagnostic Value of Dynamic O-(2-[18F]fluoroethyl)-L-Tyrosine PET

Diagnostic accuracy of F-18-fluoroethyltyrosine PET and PET/CT in patients with brain tumor

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Dynamic O-(2-[18F]fluoroethyl)-L-tyrosine (F-18 FET) PET for Glioma Grading

Cited by 117 publications

References 10 publications

Dynamic 18F‐FET PET in suspected WHO grade II gliomas defines distinct biological subgroups with different clinical courses

Dynamic 18F‐FET PET in suspected WHO grade II gliomas defines distinct biological subgroups with different clinical courses

Late Pseudoprogression in Glioblastoma: Diagnostic Value of Dynamic O-(2-[18F]fluoroethyl)-L-Tyrosine PET

Diagnostic accuracy of F-18-fluoroethyltyrosine PET and PET/CT in patients with brain tumor

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Dynamic ¹⁸F‐FET PET in suspected WHO grade II gliomas defines distinct biological subgroups with different clinical courses

Dynamic ¹⁸F‐FET PET in suspected WHO grade II gliomas defines distinct biological subgroups with different clinical courses