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Metabolic delineation of IDH1 wild-type glioblastoma surgical anatomy: how to plan the tumor extent of resection

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Abstract

Purpose

Magnetic resonance imaging (MRI) is the current standard for preoperative planning of glioblastoma (GBM) surgery. However, recent data on the use of 11 C-methionine positron emission tomography (11[C]-MET PET) suggest its role in providing additional information beyond MRI. The purpose of this study is to establish if there is a correlation between anatomical and metabolic data.

Methods

We retrieved all GBM cases treated from 2014 to January 2021. Preoperative MRI (Enhancing Nodule -EN-, FLAIR and Total Tumor Volume -TTV-), PET volumes and histological samples obtained from the different tumor regions were evaluated to analyze potential correlations between anatomical, metabolic and pathological data.

Results

150 patients underwent surgery for GBM and 49 of these were also studied preoperatively with 11[C]-MET PET; PET volume was evaluated in 47 patients. In 33 patients (70.21%) preoperative 11[C]-MET PET volume > preoperative EN volume and in 11 (23.4%) preoperative 11[C]-MET PET volume > preoperative TTV. We found a significant correlation between preoperative TTVs and PET volumes (p = 0.016) as well as between preoperative EN volumes and PET volumes (p = < 0.001). Histologically, 109 samples were evaluated. ENs samples exhibited the conventional GBM morphology while samples from the FLAIR regions showed white matter tissue, with focal to diffuse tumor cells infiltration and areas of reactive astrogliosis.

Conclusion

We submit that 11[C]-MET PET volume generally overcome EN. The presence of neoplastic cells confirm these metabolic data. It should be considered in the surgical planning to achieve a Supra Total Resection (SupTR).

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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

We thank the Ginetta Ferraguti Association and the Scientific Bureau of the University of Catania for language support.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Neurological Surgery, Policlinico “G. Rodolico-S. Marco” University Hospital, Catania, Italy

    Roberto Altieri, Francesco Certo, Giacomo Cammarata, Marco Garozzo & Giuseppe Barbagallo

  2. Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy

    Roberto Altieri, Francesco Certo & Giuseppe Barbagallo

  3. Department of Public Health, University of Naples Federico II, Naples, Italy

    Daniela Pacella

  4. Department of Medical and Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Anatomic Pathology, University of Catania, Catania, Italy

    Giuseppe Broggi, Rosario Caltabiano & Gaetano Magro

  5. Institute of Molecular Bioimaging and Physiology, National Research Council (CNR), Cefalù, PA, Italy

    Giorgio Russo

  6. Nuclear Medicine Department, Cannizzaro Hospital, Catania, Italy

    Sebastiano Cosentino & Massimo Ippolito

Authors
  1. Roberto Altieri
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  2. Francesco Certo
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Contributions

Study conception was performed by RA and FC. Material preparation and data collection were performed by RA, FC, GA, MG, GB, GR and SC. Data analysis and interpretation was performed by DP and GC. The first draft of the manuscript was written by RA, FC, GC and GB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Roberto Altieri.

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Competing Interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University of Catania (CE 165/2015/PO).

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Altieri, R., Certo, F., Pacella, D. et al. Metabolic delineation of IDH1 wild-type glioblastoma surgical anatomy: how to plan the tumor extent of resection. J Neurooncol 162, 417–423 (2023). https://doi.org/10.1007/s11060-023-04305-7

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