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Hybrid [18F]-F-DOPA PET/MRI Interpretation Criteria and Scores for Glioma Follow-up After Radiotherapy

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Abstract

Objective

18F‑fluoro-L‑3,4‑dihydroxyphenylalanine positron emission tomography (F‑DOPA PET) is used in glioma follow-up after radiotherapy to discriminate treatment-related changes (TRC) from tumor progression (TP). We compared the performances of a combined PET and MRI analysis with F‑DOPA current standard of interpretation.

Methods

We included 76 consecutive patients showing at least one gadolinium-enhanced lesion on the T1‑w MRI sequence (T1G). Two nuclear medicine physicians blindly analyzed PET/MRI images. In addition to the conventional PET analysis, they looked for F‑DOPA uptake(s) outside T1G-enhanced areas (T1G/PET), in the white matter (WM/PET), for T1G-enhanced lesion(s) without sufficiently concordant F‑DOPA uptake (T1G+/PET), and F‑DOPA uptake(s) away from hemorrhagic changes as shown with a susceptibility weighted imaging sequence (SWI/PET). We measured lesions’ F‑DOPA uptake ratio using healthy brain background (TBR) and striatum (T/S) as references, and lesions’ perfusion with arterial spin labelling cerebral blood flow maps (rCBF). Scores were determined by logistic regression.

Results

53 and 23 patients were diagnosed with TP and TRC, respectively. The accuracies were 74% for T/S, 76% for TBR, and 84% for rCBF, with best cut-off values of 1.3, 3.7 and 1.25, respectively. For hybrid variables, best accuracies were obtained with conventional analysis (82%), T1G+/PET (82%) and SWI/PET (81%). T1G+/PET, SWI/PET and rCBF ≥ 1.25 were selected to construct a 3-point score. It outperformed conventional analysis and rCBF with an AUC of 0.94 and an accuracy of 87%.

Conclusions

Our scoring approach combining F‑DOPA PET and MRI provided better accuracy than conventional PET analyses for distinguishing TP from TRC in our patients after radiation therapy.

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Abbreviations

ASL:

Arterial spin-labelling

DSC:

Dynamic susceptibility contrast

F‑DOPA:

18F‑fluoro-L‑3,4‑dihydroxyphenylalanine

FET:

18F‑fluoroethyl-tyrosine

FLAIR:

Fluid-attenuated inversion recovery T2 sequence

IDH:

Isocitrate dehydrogenase

OS:

Overall survival

PET:

Positron emission tomography

RCBF:

Regional cerebral blood flow

ROC:

Receiver operating characteristic

ROI:

Region of interest

SUVmax:

Maximum standard uptake value

SWI:

Susceptibility-weighted imaging MRI sequence

T/S:

Tumor-to-striatum ratio

T1G:

MRI T1-weighted sequences after gadolinium contrast agent injection

TBR:

Tumor-to-background ratio

TP:

Tumor progression

TRC:

Treatment-related changes

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Service de médecine nucléaire, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix, 75013, Paris, France

    Marc Bertaux, Arnaud Berenbaum, Laura Rozenblum, Marine Soret, Sebastien Bergeret, Laure-Eugenie Tainturier, Brian Sgard, Marie-Odile Habert & Aurelie Kas

  2. Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix, Service de Neurologie 2-Mazarin, Sorbonne Université, 75013, Paris, France

    Anna-Luisa Di Stefano, Khé Hoang-Xuan, Jean-Yves Delattre, Caroline Dehais & Ahmed Idbaih

  3. LIB, INSERM U1146, Sorbonne Université, 75013, Paris, France

    Marine Soret, Marie-Odile Habert & Aurelie Kas

  4. Service de neuroradiologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix, 75013, Paris, France

    Nadya Pyatigorskaya

  5. INSERM U 1127, CNRS UMR 7225, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS UMR 7225, Institut du Cerveau et , de, la Moelle épinière-ICM, Paris, France

    Nadya Pyatigorskaya

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  1. Marc Bertaux
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  2. Arnaud Berenbaum
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  15. Aurelie Kas
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Contributions

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Marc Bertaux, Caroline Dehais, Laura Rozenblum, Laure-Eugenie Tainturier, and Aurelie Kas. Blind examination of images was performed by Arnaud Berenbaum and Marc Bertaux. The first draft of the manuscript was written by Marc Bertaux and all the authors have commented on the previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Marc Bertaux.

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Conflict of interest

M. Bertaux, A. Berenbaum, A.-L. Di Stefano, L. Rozenblum, M. Soret, S. Bergeret, K. Hoang-Xuan, L.-E. Tainturier, B. Sgard, M.-O. Habert, J.-Y. Delattre, C. Dehais, A. Idbaih, N. Pyatigorskaya and A. Kas declare that they have no competing interests.

Supplementary Information

62_2022_1139_MOESM1_ESM.docx

Variance inflation factor values (table S.1), a flow chart of patients (figure S.1) and logistic regressions predicted probabilities with outcome (figure S.2 and S.3) are given in supplementary materials

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Bertaux, M., Berenbaum, A., Di Stefano, AL. et al. Hybrid [18F]-F-DOPA PET/MRI Interpretation Criteria and Scores for Glioma Follow-up After Radiotherapy. Clin Neuroradiol 32, 735–747 (2022). https://doi.org/10.1007/s00062-022-01139-0

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