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Individualized discrimination of tumor progression from treatment-related changes in different types of adult-type diffuse gliomas using [11C]methionine PET

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Abstract

Purpose

This study aimed to assess the ability of [11C]methionine (MET) PET in distinguishing between tumor progression (TP) and treatment-related changes (TRCs) among different types of adult-type diffuse gliomas according to the 2021 World Health Organization classification and predict overall survival (OS).

Methods

We retrospectively selected 113 patients with adult-type diffuse gliomas with suspected TP who underwent MET PET imaging. Maximum and mean tumor-to-background ratios (TBRmax, TBRmean) and metabolic tumor volume (MTV) were calculated. Diagnoses were verified by histopathology (n = 50) or by clinical/radiological follow-up (n = 63). The diagnostic performance of MET PET parameters was evaluated through receiver operating characteristic (ROC) analysis and area under the curve (AUC) calculation. Survival analysis employed the Kaplan–Meier method and Cox proportional-hazards regression.

Results

TP and TRCs were diagnosed in 76 (67%) and 37 (33%) patients, respectively. ROC analysis revealed TBRmax had the best performance in differentiating TP from TRCs with a cut-off of 1.96 in IDH-mutant astrocytoma (AUC, 0.87; sensitivity, 93%; specificity 69%), 1.80 in IDH-mutant and 1p/19q-codeleted oligodendroglioma (AUC, 0.96; sensitivity, 100%; specificity, 89%), and 2.13 in IDH wild-type glioblastoma (AUC, 0.89; sensitivity, 89%; specificity, 78%), respectively. On multivariate analysis, higher TBRmean and MTV were significantly correlated with shorter OS in all IDH-mutant gliomas, as well as in IDH-mutant astrocytoma subgroup.

Conclusion

This work confirms that MET PET has varying diagnostic performances in distinguishing TP from TRCs within three types of adult-type diffuse gliomas, and highlights its high diagnostic accuracy in IDH-mutant and 1p/19q-codeleted oligodendroglioma and potential prognostic value for IDH-mutant gliomas, particularly IDH-mutant astrocytoma.

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Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank Yongzhong Zhang for the efforts of radiopharmaceuticals synthesis; Wei Zhang, Qingsong Long, and Tong Wu for the image data acquisition.

Funding

This study was supported by the National Natural Science Foundation of China (82001769 to K.W.).

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Author notes

  1. Qiang Chen and Kai Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, 119 West Road of South 4th Ring, Fengtai District, Beijing, China

    Qiang Chen, Kai Wang, Xiaobin Zhao, Qian Chen, Di Fan, Shu Zhang, Xiaotong Li & Lin Ai

  2. Department of Neurosurgical Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Xiaohui Ren

  3. Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China

    Xiaohui Ren

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Contributions

Study Design: L.A. and Q.C. Manuscript writing and editing: Q.C., K.W. and L.A. Data collection: Q.C., K.W., X.R., X.Z., D.F., S.Z., and X.L. Image processing and analysis: Q.C., K.W., L.A., S.Z., and Q.C. Statistical analyses: Q.C. and K.W. Pathological analysis: X.R. All the authors reviewed the manuscript.

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Correspondence to Lin Ai.

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This retrospective study was approved by the Institutional Review Board of the Ethics Committee of Beijing Tiantan Hospital, Capital Medical University and the requirement for written informed consent was waived.

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Chen, Q., Wang, K., Ren, X. et al. Individualized discrimination of tumor progression from treatment-related changes in different types of adult-type diffuse gliomas using [11C]methionine PET. J Neurooncol 165, 547–559 (2023). https://doi.org/10.1007/s11060-023-04529-7

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