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The role of [18 F]FDOPA PET as an adjunct to conventional MRI in the diagnosis of aggressive glial lesions

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

Abstract

Background

Amino acid PET is recommended for the initial diagnosis of brain lesions, but its value for identifying aggressive lesions remains to be established. The current study therefore evaluates the added-value of dynamic [18 F]FDOPA PET as an adjunct to conventional MRI for determining the aggressiveness of presumed glial lesions at diagnosis.

Methods

Consecutive patients, with a minimal 1 year-follow-up, underwent contrast-enhanced MRI (CE MRI) and dynamic [18 F]FDOPA PET to characterize their suspected glial lesion. Lesions were classified semi-automatically by their CE MRI (MRI-/+), and PET parameters (static tumor-to-background ratio, TBR; dynamic time-to-peak ratio, TTPratio). Diagnostic accuracies of MRI and PET parameters for the differentiation of tumor aggressiveness were evaluated by chi-square test or receiver operating characteristic analyses. Aggressive lesions were either defined as lesions with dismal molecular characteristics based on the WHO 2021 classification of brain tumors or with compatible clinico-radiological profiles. Time-to-treatment failure (TTF) and overall survival (OS) were evaluated.

Results

Of the 109 patients included, 46 had aggressive lesions (45 confirmed by histo-molecular analyses). CE MRI identified aggressive lesions with an accuracy of 73%. TBRmax (threshold of 3.2), and TTPratio (threshold of 5.4 min) respectively identified aggressive lesions with an accuracy of 83% and 76% and were independent of CE MRI and clinical factors in the multivariate analysis. Among the MRI-lesions, 11/56 (20%) were aggressive and respectively 55% and 50% of these aggressive lesions showed high TBRmax and short TTPratio in PET. High TBRmax and short TTPratio in PET were significantly associated to poorer survivals (p ≤ 0.009).

Conclusion

Dynamic [18 F]FDOPA PET provides a similar diagnostic accuracy as contrast enhancement in MRI to identify the aggressiveness of suspected glial lesions at diagnosis. Both methods, however, are complementary and [18 F]FDOPA PET may be a useful additional tool in equivocal cases.

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Data availability

The data that support the findings of this study are available on a Supplemental file.

Code Availability

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Funding

The authors have nothing to disclose.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine & Nancyclotep Imaging Platform, CHRU-Nancy, Université de Lorraine, Nancy, F-54000, France

    Adeline Zinsz, Laetitia Imbert, Timothée Zaragori & Antoine Verger

  2. Department of Pathology, CHRU-Nancy, Université de Lorraine, Nancy, CP, France

    Celso Pouget

  3. INSERM U1256, Université de Lorraine, Nancy, CP, France

    Celso Pouget

  4. Department of Neurosurgery, CHRU-Nancy, Université de Lorraine, Nancy, FR, France

    Fabien Rech

  5. Centre de Recherche en Automatique de Nancy CRAN UMR 7039, CNRS, Université de Lorraine, Nancy, France

    Fabien Rech, Luc Taillandier & Marie Blonski

  6. Department of Neuro-Oncology, CHRU-Nancy, Université de Lorraine, Nancy, LT, MB, France

    Luc Taillandier & Marie Blonski

  7. Department of Neuro-Radiology, CHRU-Nancy, Université de Lorraine, Nancy, SA, France

    Samir Amlal

  8. INSERM, IADI, UMR 1254 Université de Lorraine, Nancy, F-54000, France

    Laetitia Imbert, Timothée Zaragori & Antoine Verger

  9. Médecine Nucléaire, Hôpital de Brabois, CHRU- Nancy, Allée du Morvan, Vandoeuvre-les-Nancy, 54500, France

    Antoine Verger

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  1. Adeline Zinsz
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Contributions

All authors contributed significantly to the analysis and interpretation of the data (AZ, CP, SA, TZ, AV), to the writing of the manuscript (AZ, AV) and to the revision of the manuscript (FR, LT, MB, LI, TZ, AV).

Corresponding author

Correspondence to Antoine Verger.

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Ethics approval and consent to participate

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki declaration and its latest amendments or comparable ethics standards. The institutional ethics committee (Comité d’Ethique du CHRU de Nancy) approved the evaluation of the retrospective patient data and the trial was registered at ClinicalTrials.gov (NCT04469244). The research complied with the principles of the Declaration of Helsinki. Informed consent was obtained from all individuals included in the study.

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Zinsz, A., Pouget, C., Rech, F. et al. The role of [18 F]FDOPA PET as an adjunct to conventional MRI in the diagnosis of aggressive glial lesions. Eur J Nucl Med Mol Imaging (2024). https://doi.org/10.1007/s00259-024-06720-y

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