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Early static 18F-FET-PET scans have a higher accuracy for glioma grading than the standard 20–40 min scans

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Current guidelines for glioma imaging by positron emission tomography (PET) using the amino acid analogue O-(2-[18F]fluoroethyl)-L-tyrosine (18F-FET) recommend image acquisition from 20–40 min post injection (p.i.). The maximal tumour-to-background evaluation (TBRmax) obtained in these summation images does not enable reliable differentiation between low and high grade glioma (LGG and HGG), which, however, can be achieved by dynamic 18F-FET-PET. We investigated the accuracy of tumour grading using TBRmax values at different earlier time points after tracer injection.

Methods

Three hundred and fourteen patients with histologically proven primary diagnosis of glioma (131 LGG, 183 HGG) who had undergone 40-min dynamic 18F-FET-PET scans were retrospectively evaluated. TBRmax was assessed in the standard 20–40 min summation images, as well as in summation images from 0–10 min, 5–15 min, 5–20 min, and 15–30 min p.i., and kinetic analysis was performed. TBRmax values and kinetic analysis were correlated with histological classification. ROC analyses were performed for each time frame and sensitivity, specificity, and accuracy were assessed.

Results

TBRmax values in the earlier summation images were significantly better for tumour grading (P < 0.001) when compared to standard 20–40 min scans, with best results for the early 5–15 min scan. This was due to higher TBRmax in the HGG (3.9 vs. 3.3; p < 0.001), while TBRmax remained nearly stable in the LGG (2.2 vs. 2.1). Overall, accuracy increased from 70 % in the 20–40 min analysis to 77 % in the 5–15 min images, but did not reach the accuracy of dynamic analysis (80 %).

Conclusions

Early TBRmax assessment (5–15 min p.i.) is more accurate for the differentiation between LGG and HGG than the standard static scan (20–40 min p.i.) mainly caused by the characteristic high 18F-FET uptake of HGG in the initial phase. Therefore, when dynamic 18F-FET-PET cannot be performed, early TBRmax assessment can be considered as an alternative for tumour grading.

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Acknowledgment

Parts of this paper originate from the doctoral thesis of Isabel Winkelmann. We thank Dr. Markus Diemling for the technical support.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany

    Nathalie L. Albert, Isabel Winkelmann, Vera Wenter, Erik Mille, Andrei Todica, Matthias Brendel & Peter Bartenstein

  2. Department of Neurosurgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany

    Bogdana Suchorska & Jörg-Christian Tonn

  3. Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany

    Christine Schmid-Tannwald

  4. Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Otfried-Müller Str. 14, 72076, Tübingen, Germany

    Christian la Fougère

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  1. Nathalie L. Albert
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  2. Isabel Winkelmann
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Correspondence to Nathalie L. Albert.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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The authors declare that they have no conflict of interest.

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Albert, N.L., Winkelmann, I., Suchorska, B. et al. Early static 18F-FET-PET scans have a higher accuracy for glioma grading than the standard 20–40 min scans. Eur J Nucl Med Mol Imaging 43, 1105–1114 (2016). https://doi.org/10.1007/s00259-015-3276-2

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  • DOI: https://doi.org/10.1007/s00259-015-3276-2

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