Diagnosis of pseudoprogression in patients with glioblastoma using O-(2-[18F]fluoroethyl)-L-tyrosine PET

被引：203

作者：

Galldiks, Norbert ^{[1
,2
,3
]}

Dunkl, Veronika ^{[1
,2
]}

Stoffels, Gabriele ^{[2
]}

Hutterer, Markus ^{[4
,5
]}

Rapp, Marion ^{[6
]}

Sabel, Michael ^{[6
]}

Reifenberger, Guido ^{[7
]}

Kebir, Sied ^{[8
]}

Dorn, Franziska ^{[9
]}

Blau, Tobias ^{[10
]}

Herrlinger, Ulrich ^{[3
,8
]}

Hau, Peter ^{[4
,5
]}

Ruge, Maximilian I. ^{[3
,11
]}

Kocher, Martin ^{[3
,12
]}

Goldbrunner, Roland ^{[3
,13
]}

Fink, Gereon R. ^{[1
,2
]}

Drzezga, Alexander ^{[14
]}

Schmidt, Matthias ^{[14
]}

Langen, Karl-Josef ^{[2
,15
]}

机构：

[1] Univ Cologne, Dept Neurol, D-50931 Cologne, Germany

[2] Forschungszentrum Julich, Inst Neurosci & Med, D-52425 Julich, Germany

[3] Univ Cologne, CIO, D-50931 Cologne, Germany

[4] Univ Regensburg, Dept Neurol, D-93053 Regensburg, Germany

[5] Univ Regensburg, Wilhelm Sander NeuroOncol Unit, D-93053 Regensburg, Germany

[6] Univ Dusseldorf, Dept Neurosurg, Dusseldorf, Germany

[7] Univ Dusseldorf, Dept Neuropathol, Dusseldorf, Germany

[8] Univ Bonn, Dept Neurol, Bonn, Germany

[9] Univ Cologne, Dept Neuroradiol, D-50931 Cologne, Germany

[10] Univ Cologne, Dept Neuropathol, D-50931 Cologne, Germany

[11] Univ Cologne, Dept Stereotaxy & Funct Neurosurg, D-50931 Cologne, Germany

[12] Univ Cologne, Dept Radiat Oncol, D-50931 Cologne, Germany

[13] Univ Cologne, Dept Neurosurg, D-50931 Cologne, Germany

[14] Univ Cologne, Dept Nucl Med, D-50931 Cologne, Germany

[15] Univ Aachen, Dept Nucl Med, Aachen, Germany

来源：

EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING | 2015年 / 42卷 / 05期

关键词：

Pseudoprogression; Tumour progression; Glioblastoma; FET PET; O-(2-F-18-FLUOROETHYL)-L-TYROSINE PET; F-18-FET PET; RESPONSE ASSESSMENT; TUMOR; DIFFERENTIATION; TEMOZOLOMIDE; RADIOCHEMOTHERAPY; PSEUDORESPONSE; PERFORMANCE; PROGRESSION;

D O I：

10.1007/s00259-014-2959-4

中图分类号：

R8 [特种医学]; R445 [影像诊断学];

学科分类号：

1002 ; 100207 ; 1009 ;

摘要：

Purpose The follow-up of glioblastoma patients after radiochemotherapy with conventional MRI can be difficult since reactive alterations to the blood-brain barrier with contrast enhancement may mimic tumour progression (i.e. pseudoprogression, PsP). The aim of this study was to assess the clinical value of O-(2-F-18-fluoroethyl)-L-tyrosine (F-18-FET) PET in the differentiation of PsP and early tumour progression (EP) after radiochemotherapy of glioblastoma. Methods A group of 22 glioblastoma patients with new contrast-enhancing lesions or lesions showing increased enhancement (>25%) on standardMRI within the first 12 weeks after completion of radiochemotherapy with concomitant temozolomide (median 7 weeks) were additionally examined using amino acid PET with F-18-FET. Maximum and mean tumour-to-brain ratios (TBRmax, TBRmean) were determined. F-18-FET uptake kinetic parameters (i.e. patterns of time-activity curves, TAC) were also evaluated. Classification as PsP or EP was based on the clinical course (no treatment change at least for 6 months), follow-up MR imaging and/or histopathological findings. Imaging results were also related to overall survival (OS). Results PsP was confirmed in 11 of the 22 patients. In patients with PsP, F-18-FET uptake was significantly lower than in patients with EP (TBRmax 1.9 +/- 0.4 vs. 2.8 +/- 0.5, TBRmean 1.8 +/- 0.2 vs. 2.3 +/- 0.3; both P<0.001) and presence of MGMT promoter methylation was significantly more frequent (P=0.05). Furthermore, a TAC type II or III was more frequently present in patients with EP (P=0.04). Receiver operating characteristic analysis showed that the optimal F-18-FET TBRmax cut-off value for identifying PsP was 2.3 (sensitivity 100 %, specificity 91 %, accuracy 96 %, AUC 0.94 +/- 0.06; P<0.001). Univariate survival analysis showed that a TBRmax <2.3 predicted a significantly longer OS (median OS 23 vs. 12 months; P=0.046). Conclusion F-18-FET PET may facilitate the diagnosis of PsP following radiochemotherapy of glioblastoma.

引用

页码：685 / 695

页数：11

共 37 条

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