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MRI-suspected low-grade glioma: is there a need to perform dynamic FET PET?

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

Abstract

Purpose

Since differentiation between low-grade glioma (LGG) and high-grade glioma (HGG) remains challenging according to MRI criteria alone, we investigated the discriminative value of additional dynamic FET PET in patients with MRI-suspected LGG.

Methods

Included in this retrospective study were 127 patients with newly diagnosed MRI-suspected LGG and dynamic FET PET prior to histopathological assessment. FET PET lesions were visually classified as having reduced, normal, or increased tracer uptake. Maximal tumour uptake scaled to the mean background uptake (SUVmax/BG), mean tumour uptake (SUVmean/BG), biological tumour volume and kinetics were evaluated and correlated with individual histopathological findings.

Results

Histopathological analysis revealed 71 patients with LGG, 47 patients with HGG (including 5 glioblastoma multiforme), 2 patients with low-grade ganglioglioma and 7 patients with non-neoplastic lesions. Of the 127 patients, 97 had lesions with increased FET uptake, of which 93 were neoplastic. Increased uptake was found in 49/71 LGG (69 %) and 42/47 HGG (89 %). None of the conventional uptake parameters differed significantly between the HGG and LGG groups. Kinetic analysis reliably identified HGG (sensitivity 95 %, specificity 72 %, PPV 74 %, NPV 95 %). Normal tracer uptake was observed in 19 patients (15 with LGG, 1 with HGG and 3 with non-neoplastic lesions) and reduced uptake in 11 patients (7 with LGG and 4 with HGG).

Conclusion

Among the MRI-suspected LGG, kinetic but not conventional analysis of FET uptake enabled remarkably high sensitivity for detection of HGG. This held true even for lesions with low or diffuse tracer uptake. Lesions with reduced tracer uptake must be interpreted with caution, as they can also harbour HGG tissue.

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Acknowledgments

The study was funded in part by the German Glioma Network, supported by German Cancer Aid (Deutsche Krebshilfe 70-3163-Wi 3).

Conflicts of interest

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Authors and Affiliations

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

    Nathalie L. Jansen, Vera Graute, Paul Cumming, Peter Bartenstein & Christian la Fougère

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

    Lena Armbruster, Bogdana Suchorska, Jörg-Christian Tonn & Friedrich Wilhelm Kreth

  3. Department of Neuroradiology, Ludwig-Maximilians-University Munich, 81377, Munich, Germany

    Juergen Lutz

  4. Department of Neuropathology, Ludwig-Maximilians-University Munich, 81377, Munich, Germany

    Sabina Eigenbrod

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  1. Nathalie L. Jansen
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  2. Vera Graute
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Correspondence to Christian la Fougère.

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Jansen, N.L., Graute, V., Armbruster, L. et al. MRI-suspected low-grade glioma: is there a need to perform dynamic FET PET?. Eur J Nucl Med Mol Imaging 39, 1021–1029 (2012). https://doi.org/10.1007/s00259-012-2109-9

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  • DOI: https://doi.org/10.1007/s00259-012-2109-9

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