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Simultaneously acquired PET and ASL imaging biomarkers may be helpful in differentiating progression from pseudo-progression in treated gliomas

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Abstract

Objectives

The aim of this work was investigating the methods based on coupling cerebral perfusion (ASL) and amino acid metabolism ([18F]DOPA-PET) measurements to evaluate the diagnostic performance of PET/MRI in glioma follow-up.

Methods

Images were acquired using a 3-T PET/MR system, on a prospective cohort of patients addressed for possible glioma progression. Data were preprocessed with statistical parametric mapping (SPM), including registration on T1-weighted images, spatial and intensity normalization, and tumor segmentation. As index tests, tumor isocontour maps of [18F]DOPA-PET and ASL T-maps were created and metabolic/perfusion abnormalities were evaluated with the asymmetry index z-score. SPM map analysis of significant size clusters and semi-quantitative PET and ASL map evaluation were performed and compared to the gold standard diagnosis. Lastly, ASL and PET topography of significant clusters was compared to that of the initial tumor.

Results

Fifty-eight patients with unilateral treated glioma were included (34 progressions and 24 pseudo-progressions). The tumor isocontour maps and T-maps showed the highest specificity (100%) and sensitivity (94.1%) for ASL and [18F]DOPA analysis, respectively. The sensitivity of qualitative SPM maps and semi-quantitative rCBF and rSUV analyses were the highest for glioblastoma.

Conclusion

Tumor isocontour T-maps and combined analysis of CBF and [18F]DOPA-PET uptake allow achieving high diagnostic performance in differentiating between progression and pseudo-progression in treated gliomas. The sensitivity is particularly high for glioblastomas.

Key Points

• Applied separately, MRI and PET imaging modalities may be insufficient to characterize the brain glioma post-therapeutic profile.

• Combined ASL and [18F]DOPA-PET map analysis allows differentiating between tumor progression and pseudo-progression.

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Abbreviations

[18F]DOPA:

18F-Fluoro-3.4-dihydroxy-l-phenylalanine

[18F]FDG:

18F-Fluoro-deoxy-glucose

ASL:

Arterial spin labeling

CBF:

Cerebral blood flow

CBV:

Cerebral blood volume

DSC:

Dynamic susceptibility contrast

FLAIR:

Fluid-attenuated inversion recovery

FN:

False negative

FP:

False positive

MRI:

Magnetic resonance imaging

pCASL:

Pseudo-continuous spin-echo ASL

PET:

Positron emission tomography

PWI:

Perfusion-weighted imaging

rCBF:

Cerebral blood flow ratio

rSUV:

Standardized uptake value ratio

SE:

Spin-echo

SPM:

Statistical parametric mapping

SUV:

Standardized uptake value

TN:

True negative

TP:

True positive

VOI:

Volume of interest

WHO:

World Health Organization

zAI:

Z-score of the asymmetry index

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Maya Khalifé

    Present address: Arterys, 34 av. des Champs-Elysées, 75008, Paris, France

Authors and Affiliations

  1. Service de Neuroradiologie Diagnostique et Interventionnelle, Centre Hospitalier Universitaire de Nantes, Hôpital Nord Laennec, Rez-de-chaussée Bas Aile Est, Boulevard Jacques-Monod, Saint-Herblain, 44093, Nantes Cedex 1, France

    Arnaud Pellerin

  2. Service de Neuroradiologie Diagnostique et Fonctionnelle, Groupe Hospitalier Pitié-Salpêtrière C. Foix, 47-83 Boulevard de l’Hôpital, 75651, Paris Cedex 13, France

    Arnaud Pellerin, Damien Galanaud, Didier Dormont & Nadya Pyatigorskaya

  3. Centre de NeuroImagerie de Recherche (CENIR), Institut du Cerveau et de la Moelle épinière (ICM), CNRS UMR 7225 – Inserm U1127 – Sorbonne Université – UMR S1127, 47-83 Boulevard de l’Hôpital, 75651, Paris Cedex 13, France

    Maya Khalifé, Damien Galanaud & Nadya Pyatigorskaya

  4. Service de Neurologie, Groupe Hospitalier Pitié-Salpêtrière C. Foix, 47-83 Boulevard de l’Hôpital, 75651, Paris Cedex 13, France

    Marc Sanson

  5. Service de Médecine Nucléaire, Groupe Hospitalier Pitié-Salpêtrière C. Foix, 47-83 Boulevard de l’Hôpital, 75651, Paris Cedex 13, France

    Laura Rozenblum-Beddok, Marc Bertaux, Marine Soret & Aurélie Kas

  6. Université Paris 6 UPMC, LIB Inserm U1146, 91-105 Boulevard de l’Hôpital, 75013, Paris, France

    Aurélie Kas

Authors
  1. Arnaud Pellerin
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Corresponding author

Correspondence to Arnaud Pellerin.

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Guarantor

The scientific guarantor of this publication is Arnaud Pellerin, the corresponding author.

Conflict of interest

The authors of this manuscript declare relationships with the following company:

Maya Khalifé received a research grant from General Electric Healthcare. No other financial relationships that might lead to a perceived conflict of interest relevant to this article were reported.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study. All data were extracted from the local database of PET/MR studies, which was approved by the French authority for the protection of privacy and personal data in clinical research (CNIL, No. 2111722). This study was performed according to the principles of the Declaration of Helsinki.

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Institutional Review Board approval was obtained.

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• prospective

• case-control study/observational

• performed at one institution

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Pellerin, A., Khalifé, M., Sanson, M. et al. Simultaneously acquired PET and ASL imaging biomarkers may be helpful in differentiating progression from pseudo-progression in treated gliomas. Eur Radiol 31, 7395–7405 (2021). https://doi.org/10.1007/s00330-021-07732-0

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  • DOI: https://doi.org/10.1007/s00330-021-07732-0

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