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Prospective trial evaluating the sensitivity and specificity of 3,4-dihydroxy-6-[18F]-fluoro-l-phenylalanine (18F-DOPA) PET and MRI in patients with recurrent gliomas

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Abstract

Treatment-related changes can be difficult to differentiate from progressive glioma using MRI with contrast (CE). The purpose of this study is to compare the sensitivity and specificity of 18F-DOPA-PET and MRI in patients with recurrent glioma. Thirteen patients with MRI findings suspicious for recurrent glioma were prospectively enrolled and underwent 18F-DOPA-PET and MRI for neurosurgical planning. Stereotactic biopsies were obtained from regions of concordant and discordant PET and MRI CE, all within regions of T2/FLAIR signal hyperintensity. The sensitivity and specificity of 18F-DOPA-PET and CE were calculated based on histopathologic analysis. Receiver operating characteristic curve analysis revealed optimal tumor to normal (T/N) and SUVmax thresholds. In the 37 specimens obtained, 51% exhibited MRI contrast enhancement (M+) and 78% demonstrated 18F-DOPA-PET avidity (P+). Imaging characteristics included M−P− in 16%, M−P+ in 32%, M+P+ in 46% and M+P− in 5%. Histopathologic review of biopsies revealed grade II components in 16%, grade III in 43%, grade IV in 30% and no tumor in 11%. MRI CE sensitivity for recurrent tumor was 52% and specificity was 50%. PET sensitivity for tumor was 82% and specificity was 50%. A T/N threshold > 2.0 altered sensitivity to 76% and specificity to 100% and SUVmax > 1.36 improved sensitivity and specificity to 94 and 75%, respectively. 18F-DOPA-PET can provide increased sensitivity and specificity compared with MRI CE for visualizing the spatial distribution of recurrent gliomas. Future studies will incorporate 18F-DOPA-PET into re-irradiation target volume delineation for RT planning.

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Acknowledgements

This work has been accepted for presentation at the 2017 ASTRO Annual Meeting (September 24–27, 2017) in San Diego, California.

Funding

This work was supported by a generous Grant from Brains Together for a Cure, the National Cancer Institute (CA178200) and by a Mayo Brain Tumor NIH SPORE Grant (CA108961).

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Authors and Affiliations

  1. Department of Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Ryan S. Youland, Deanna H. Pafundi, Debra H. Brinkmann & Nadia N. Laack

  2. Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Val J. Lowe & Bradley J. Kemp

  3. Division of Neuroradiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Jonathan M. Morris & Christopher H. Hunt

  4. Department of Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Caterina Giannini

  5. Department of Neurosurgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Ian F. Parney

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Correspondence to Ryan S. Youland.

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11060_2018_2750_MOESM1_ESM.tif

Supplementary material 1. Supplemental Fig. 1 Receiver operating characteristic analysis for SUVmax and the presence of tumor (A), SUVmax and the presence of high-grade disease (B), T/N ratio and the presence of tumor (C) and T/N ratio and the presence of high-grade disease (D) (TIF 62 KB)

Supplementary material 2 (DOCX 17 KB)

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Youland, R.S., Pafundi, D.H., Brinkmann, D.H. et al. Prospective trial evaluating the sensitivity and specificity of 3,4-dihydroxy-6-[18F]-fluoro-l-phenylalanine (18F-DOPA) PET and MRI in patients with recurrent gliomas. J Neurooncol 137, 583–591 (2018). https://doi.org/10.1007/s11060-018-2750-7

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  • DOI: https://doi.org/10.1007/s11060-018-2750-7

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