11C-Acetate PET/CT for Reactive Astrogliosis Outperforms 11C-Methionine PET/CT in Glioma Classification and Survival Prediction

Purpose: C-11-acetate (ACE) PET/CT visualizes reactive astrogliosis in tumor microenvironment. This study compared C-11-ACE and C-11-methionine (MET) PET/CT for glioma classification and predicting patient survival.Patients and methods: In this prospective study, a total of 142 patients with cerebral gliomas underwent preoperative MRI, C-11-MET PET/CT, and C-11-ACE PET/CT. Tumor-to-contralateral cortex (TNRMET) and tumor-to-choroid plexus ratios (TNRACE) were calculated for C-11-MET and C-11-ACE. The Kruskal-Wallis test and Bonferroni post hoc analysis were used to compare the differences in( 11)C-TNRMET and C-11-TNRACE. The Cox proportional hazards regression analysis and classification and regression tree models were used to assess progression-free survival (PFS) and overall survival (OS).Results: The median C-11-TNRMET and C-11-TNRACE for oligodendrogliomas (ODs), IDH1-mutant astrocytomas, IDH1-wildtype astrocytomas, and glioblastomas were 2.75, 1.40, 2.30, and 3.70, respectively, and 1.40, 1.20, 1.77, and 2.87, respectively. The median 11C-TNRMET was significantly different among the groups, except between ODs and IDH1-wildtype astrocytomas, whereas the median( 11)C-TNRACE was significantly different among all groups. The classification and regression tree model identified 4 risk groups (IDH1-mutant with C-11-TNRACE <= 1.4, IDH1-mutant with C-11-TNRACE > 1.4, IDH1-wildtype with C-11-TNRACE <= 1.8, and IDH1-wildtype with C-11-TNRACE > 1.8), with median PFS of 52.7, 44.5, 25.9, and 8.9 months, respectively. Using a C-11-TNRACE cutoff of 1.4 for IDH1-mutant gliomas and a C-11-TNRACE cutoff of 2.0 for IDH1-wildtype gliomas, all gliomas were divided into 4 groups with median OS of 52.7, 46.8, 27.6, and 12.0 months, respectively. Significant differences in PFS and OS were observed among the 4 groups after correcting for multiple comparisons.Conclusions: C-11-ACE PET/CT is better for glioma classification and survival prediction than C-11-MET PET/CT, highlighting its potential role in cerebral glioma patients.