Dual-time-point O-(2-[18F]fluoroethyl)-L-tyrosine PET for grading of cerebral gliomas
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We aimed to evaluate the diagnostic potential of dual-time-point imaging with positron emission tomography (PET) using O-(2-[18F]fluoroethyl)-L-tyrosine (18F-FET) for non-invasive grading of cerebral gliomas compared with a dynamic approach.
Thirty-six patients with histologically confirmed cerebral gliomas (21 primary, 15 recurrent; 24 high-grade, 12 low-grade) underwent dynamic PET from 0 to 50 min post-injection (p.i.) of 18F-FET, and additionally from 70 to 90 min p.i. Mean tumour-to-brain ratios (TBRmean) of 18F-FET uptake were determined in early (20–40 min p.i.) and late (70–90 min p.i.) examinations. Time–activity curves (TAC) of the tumours from 0 to 50 min after injection were assigned to different patterns. The diagnostic accuracy of changes of 18F-FET uptake between early and late examinations for tumour grading was compared to that of curve pattern analysis from 0 to 50 min p.i. of 18F-FET.
The diagnostic accuracy of changes of the TBRmean of 18F-FET PET uptake between early and late examinations for the identification of HGG was 81 % (sensitivity 83 %; specificity 75 %; cutoff - 8 %; p < 0.001), and 83 % for curve pattern analysis (sensitivity 88 %; specificity 75 %; p < 0.001).
Dual-time-point imaging of 18F-FET uptake in gliomas achieves diagnostic accuracy for tumour grading that is similar to the more time-consuming dynamic data acquisition protocol.
• Dual-time-point imaging is equivalent to dynamic FET PET for grading of gliomas.
• Dual-time-point imaging is less time consuming than dynamic FET PET.
• Costs can be reduced due to higher patient throughput.
• Reduced imaging time increases patient comfort and sedation might be avoided.
• Quicker image interpretation is possible, as no curve evaluation is necessary.
KeywordsCerebral glioma FET PET Tracer kinetics Dual-time-point imaging Tumour grade
Area under receiver-operating-characteristic curve
Ordinary Poisson ordered subset expectation maximisation
Ordered subset expectation maximisation
Standardised uptake value
Mean standardised uptake value
Mean tumour-to-brain ratio
Time to peak
The authors thank Suzanne Schaden, Elisabeth Theelen and Kornelia Frey for assistance in the patient studies; and Johannes Ermert, Silke Grafmüller, Erika Wabbals and Sascha Rehbein for radiosynthesis of 18F-FET. The scientific guarantor of this publication is Prof. Dr. Karl-Josef Langen. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic study, performed at one institution.
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