The combination of ¹³N-ammonia and ¹⁸F-FDG PET/CT in the identification of metabolic phenotype of primary human brain tumors

Abstract

Aim This pilot study made a preliminary attempt to distinguish different metabolic phenotypes of primary human brain tumors with dual tracer ¹³N-ammonia and ¹⁸F-FDG.

Methods 74 patients were included in this study including 12 benign meningiomas (B-MEN), 4 malignant meningiomas (M-MEN), 15 low-grade gliomas (LGG), 32 high-grade gliomas (HGG) and 11 primary central nervous system lymphomas (PCNSL). All patients underwent ¹³N-ammonia and ¹⁸F-FDG PET imaging. Semi-quantification analysis by tumor-to-gray matter (T/G) ratios was used for the evaluation of tracer uptakes. After the calculation of canonical discriminant functions, cross validation was done for all cases to evaluate the differential efficacy of dual tracers.

Results According to the visual analysis, B-MEN were characterized by lower uptake of ¹⁸F-FDG and higher uptake of ¹³N-ammonia, while PCNSLs displayed contrary results. Both M-MEN and HGG had higher uptake of ¹⁸F-FDG and ¹³N-ammonia, while LGG displayed negative results for both tracers. According to the T/G ratios analysis, the accuracy of predicted tumor classification by means of canonical discriminant analysis for B-MEN, LGG, HGG and PCNSL was 91.7 %, 100 %, 84.4 % and 93.3 % respectively; the overall accuracy was 90.5 %.

Conclusion The combination of dual tracer ¹³N-ammonia and ¹⁸F-FDG has a certain potential in distinguishing different types of brain tumors (meningiomas, gliomas and PCNSL). However, an advantage of the additional use of ¹³N-ammonia PET compared to a combined diagnosis with MRI and ¹⁸F-FDG PET could not be demonstrated and requires further studies.

Zusammenfassung

Ziel In dieser Pilotstudie wurde ein erster Versuch unternommen, verschiedene metabolische Phänotypen von primären humanen Gehirntumoren mit dem dualen Tracer ¹³N-Ammoniak und ¹⁸F-FDG zu unterscheiden.

Methoden In diese Studie wurden 74 Patienten eingeschlossen, davon hatten 12 benigne Meningeome (B-MEN), 4 maligne Meningeome (M-MEN), 15 niedriggradige Gliome (LGG), 32 hochgradige Gliome (HGG) und 11 primäre ZNS-Lymphome (PCNSL). Bei allen Patienten wurden PET-Aufnahmen mit ¹³N-Ammoniak- und ¹⁸F-FDG durchgeführt. Für die Bewertung der Tracer-Aufnahmen wurde eine semi-quantitative Analyse mittels Ratio des Tumors zur grauen Substanz (T/G) verwendet. Nach der Berechnung der kanonischen Diskriminanzfunktionen wurde für alle Fälle eine Kreuzvalidierung durchgeführt, um die unterschiedliche Leistungsfähigkeit von dualen Tracern zu bewerten.

Ergebnisse Gemäß der visuellen Analyse wurden B-MEN durch eine geringere Aufnahme von ¹⁸F-FDG und eine höhere Aufnahme von ¹³N-Ammoniak charakterisiert, während PCNSL konträre Ergebnisse zeigten. Sowohl M-MEN als auch HGG hatten eine höhere Aufnahme von ¹⁸F-FDG und ¹³N-Ammoniak, während LGG für beide Tracer negative Resultate zeigten. Gemäß der T/G-Ratio-Analyse betrug die Genauigkeit der vorhergesagten Tumorklassifikation mittels kanonischer Diskriminanzanalyse für B-MEN 91,7 %, für LGG 100 %, für HGG 84,4 % und für PCNSL 93,3 %. Die Gesamtgenauigkeit betrug 90,5 %.

Schlussfolgerung Die Kombination von dualem Tracer ¹³N-Ammoniak und ¹⁸F-FDG hat ein gewisses Leistungsvermögen hinsichtlich der Unterscheidung verschiedener Arten von Gehirntumoren (Meningeome, Gliome und PCNSL). Ein Vorteil des zusätzlichen Einsatzes von ¹³N-Ammoniak-PET gegenüber der kombinierten Diagnose mittels MRI und ¹⁸F-FDG-PET konnte jedoch nicht gezeigt werden und erfordert weitere Untersuchungen.

Key words

¹³N-ammonia - ¹⁸F-FDG - brain tumor - dual tracer

Schlüsselwörter

¹³N-Ammoniak - ¹⁸F-FDG - Gehirntumor - dualer Tracer

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