Combination of MRI and dynamic FET PET for initial glioma grading

Summary

Aim: MRI and PET with ¹⁸F-fluoro-ethyl-tyro- sine (FET) have been increasingly used to evaluate patients with gliomas. Our purpose was to assess the additive value of MR spectroscopy (MRS), diffusion imaging and dynamic FET-PET for glioma grading. Patients, methods: 38 patients (42 ± 15 aged, F/M: 0.46) with untreated histologically proven brain gliomas were included. All underwent conventional MRI, MRS, diffusion sequences, and FET-PET within 3±4 weeks. Performances of tumour FET time-activity-curve, early-to-middle SUVmax ratio, choline / creatine ratio and ADC histogram distribution pattern for gliomas grading were assessed, as compared to histology. Combination of these parameters and respective odds were also evaluated. Results: Tumour time-activity- curve reached the best accuracy (67%) when taken alone to distinguish between low and high-grade gliomas, followed by ADC histogram analysis (65%). Combination of time-activity-curve and ADC histogram analysis improved the sensitivity from 67% to 86% and the specificity from 63-67% to 100% (p < 0.008). On multivariate logistic regression analysis, negative slope of the tumour FET time-activity-curve however remains the best predictor of high-grade glioma (odds 7.6, SE 6.8, p = 0.022). Conclusion: Combination of dynamic FET-PET and diffusion MRI reached good performance for gliomas grading. The use of FET-PET/MR may be highly relevant in the initial assessment of primary brain tumours.

Zusammenfassung

MR und ¹⁸F-Fluorethyltyrosin (FET) PET werden vermehrt zur Diagnostik bei Patienten mit Gliomen angewandt. Ziel unserer Studie war die Bewertung des zusätzlichen Nutzens von MR-Spektroskopie (MRS), Diffusions-MR und dynamischer FET-PET für das Grading von Gliomen. Patienten, Methoden: Insgesamt, 38 Patienten (42±15 Jahre, F/M = 0,46) mit unbehandelten histologisch gesicherten zerebralen Gliomen wurden mittels konventioneller MR, MRS, Diffusionssequenzen und FET-PET untersucht, die einzelnen Untersuchungen fanden im Zeitraum von 3±4 Wochen statt. Die tumorale FET-Zeit-Aktivi- täts-Kurve, das Verhältnis der frühen zur mittleren SUVmax-Ratio, die Choline/Kreatin- Ratio und ADC-Histogramm-Verteilungsmus- ter wurden für das Gliom-Grading evaluiert und verglichen mit der Histologie. Die Kombinationen dieser Parameter und ihre Odds- Ratio wurden ausgewertet. Ergebnisse: Die tumorale FET-Zeit-Aktivitäts-Kurve allein erreichte die beste Genauigkeit (67%) bei der Differenzierung von Low- und High-grade- Gliomen, gefolgt von der ADC-Histogramm- Analyse (65%). Die Kombination beider Faktoren verbesserte die Sensibilität von 67% auf 86% und die Spezifität von 63-67% auf 100% (p < 0,008). In der multivariaten logistischen Regressionsanalyse war ein negative Steigungsfaktor der tumoralen FET-Zeit-Akti- vitäts-Kurve der beste Indikator für high-grade Gliome (Odds 7,6, SE 6,8, p = 0,022). Schlussfolgerung: Die Kombination von dynamischer FET-PET und Diffusions-MRI ist gut zum Grading von Gliomen geeignet. Daher könnte der Kombination von FET-PET/MRT hohe Relevanz in der initialen Beurteilung primärer Hirntumoren zukommen.

Keywords

MRI - ADC histogram - ¹⁸F-fluoro-ethyl-tyrosine - glioma - grading

Schlüsselwörter

MR - ADC-Histogramm - ¹⁸F-Fluorethyltyrosin - Gliom - Grading

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