Nuklearmedizin 2019; 58(02): 123
DOI: 10.1055/s-0039-1683523
Vorträge
PET: FDG und neue Tracer
Georg Thieme Verlag KG Stuttgart · New York

Differentiation of treatment-related changes from high-grade glioma progression: A direct comparison between FET PET and ADC values obtained by DWI MRI

J Werner
1   University Hospital Cologne, Dept. of Neurology, Cologne
,
G Stoffels
2   Research Center Jülich, Inst. of Neuroscience and Medicine (INM-4), Jülich
,
T Lichtenstein
3   University Hospital Cologne, Dept. of Neuroradiology, Cologne
,
J Borggrefe
3   University Hospital Cologne, Dept. of Neuroradiology, Cologne
,
G Ceccon
1   University Hospital Cologne, Dept. of Neurology, Cologne
,
NJ Shah
2   Research Center Jülich, Inst. of Neuroscience and Medicine (INM-4), Jülich
,
GR Fink
1   University Hospital Cologne, Dept. of Neurology, Cologne
,
KJ Langen
2   Research Center Jülich, Inst. of Neuroscience and Medicine (INM-4), Jülich
,
C Kabbasch
3   University Hospital Cologne, Dept. of Neuroradiology, Cologne
,
N Galldiks
1   University Hospital Cologne, Dept. of Neurology, Cologne
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2019 (online)

 
 

    Ziel/Aim:

    Following brain cancer treatment, the capacity of anatomical MRI to differentiate neoplastic tissue from treatment-related changes such as pseudoprogression is limited. The aim of this study was to compare apparent diffusion coefficient (ADC) values obtained by diffusion-weighted MRI (DWI) with static parameters of O-(2-[18F]fluoroethyl)-L-tyrosine (FET) PET for the differentiation of treatment-related changes from tumor progression.

    Methodik/Methods:

    Forty-eight pretreated high-grade glioma patients (mean age, 50 ± 15 years) with anatomical MRI findings suspicious for tumor progression (median time after completion of last treatment, 16 weeks) were additionally investigated using DWI MRI and FET PET. Maximum and mean tumor-to-brain ratios (TBRmax/mean) of FET uptake were determined (20 – 40 minutes post-injection). Regions-of-Interest analyses were performed concerning the enhancing lesion on ADC maps calculated from DWI MRI. Diagnoses were confirmed neuropathologically (21%; 10 patients) or clinico-radiologically (79%; 38 patients). Diagnostic performances of TBRs and ADC values for the correct differentiation were evaluated each alone using receiver-operating-characteristic analyses, or the Fisher Exact test for a combinational approach.

    Ergebnisse/Results:

    Ten of 48 patients had treatment-related changes (21%). The diagnostic performance of FET PET was clearly higher (threshold TBRmean, 1.95; sensitivity, 100%; specificity, 79%; accuracy, 83%; AUC 0.89 ± 0.05; P-3 mm2/s; sensitivity, 60%; specificity; 79%; accuracy, 75%; AUC 0.73 ± 0.09; P = 0.05). The combination of both imaging parameters did not increase the accuracy (64%; P = 0.144).

    Schlussfolgerungen/Conclusions:

    Static FET PET seems to add valuable clinical information regarding the differentiation of early treatment-related changes from tumor progression and outperforms ADC values for this highly relevant clinical question.


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