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Differentiating high-grade glioma progression from treatment-related changes with dynamic [18F]FDOPA PET: a multicentric study

  • Nuclear Medicine
  • Published:
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Abstract

Objectives

Diagnostic accuracy of amino-acid PET for distinguishing progression from treatment-related changes (TRC) is currently based on single-center non-homogeneous glioma populations. Our study assesses the diagnostic value of static and dynamic [18F]FDOPA PET acquisitions to differentiate between high-grade glioma (HGG) recurrence and TRC in a large cohort sourced from two independent nuclear medicine centers.

Methods

We retrospectively identified 106 patients with suspected glioma recurrences (WHO GIII, n = 38; GIV, n = 68; IDH-mutant, n = 35, IDH-wildtype, n = 71). Patients underwent dynamic [18F]FDOPA PET/CT (n = 83) or PET/MRI (n = 23), and static tumor-to-background ratios (TBRs), metabolic tumor volumes and dynamic parameters (time to peak and slope) were determined. The final diagnosis was either defined by histopathology or a clinical-radiological follow-up at 6 months. Optimal [18F]FDOPA PET parameter cut-offs were obtained by receiver operating characteristic analysis. Predictive factors and clinical parameters were assessed using univariate and multivariate Cox regression survival analyses.

Results

Surgery or the clinical-radiological 6-month follow-up identified 71 progressions and 35 treatment-related changes. TBRmean, with a threshold of 1.8, best-differentiated glioma recurrence/progression from post-treatment changes in the whole population (sensitivity 82%, specificity 71%, p < 0.0001) whereas curve slope was only significantly different in IDH-mutant HGGs (n = 25). In survival analyses, MTV was a clinical independent predictor of progression-free and overall survival on the multivariate analysis (p ≤ 0.01). A curve slope > −0.12/h was an independent predictor for longer PFS in IDH-mutant HGGs

Conclusion

Our multicentric study confirms the high accuracy of [18F]FDOPA PET to differentiate recurrent malignant gliomas from TRC and emphasizes the diagnostic and prognostic value of dynamic acquisitions for IDH-mutant HGGs.

Key Points

• The diagnostic accuracy of dynamic amino-acid PET, for distinguishing progression from treatment-related changes, is currently based on single-center non-homogeneous glioma populations.

• This multicentric study confirms the high accuracy of static [ 18 F]FDOPA PET images for differentiating progression from treatment-related changes in a homogeneous population of high-grade gliomas and highlights the diagnostic and prognostic value of dynamic acquisitions for IDH-mutant high-grade gliomas.

• Dynamic acquisitions should be performed in IDH-mutant glioma patients to provide valuable information for the differential diagnosis of recurrence and treatment-related changes.

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Abbreviations

ASL:

Arterial spin labelling

DCE:

Dynamic contrast-enhanced

FLAIR:

Fluid attenuation inversion recovery

G:

Grade

HGG:

High-grade glioma

LGG:

Low-grade glioma

MTV:

Metabolic tumor volume

OS:

Overall survival

PFS:

Progression-free survival

RANO:

Response assessment in neuro-oncology

rCBV:

Relative cerebral blood volumes

ROC:

Receiver operating characteristic

TAC:

Time-activity-curve

TTP:

Time-to-peak

WHO:

World health organization

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Funding

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

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Authors and Affiliations

  1. Department of Nuclear Medicine and LIB, INSERM U1146, Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, 47-83 boulevard de l’hôpital, 75013, Paris, France

    Laura Rozenblum & Aurélie Kas

  2. Department of Nuclear Medicine & Nancyclotep Imaging platform, Université de Lorraine, CHRU-Nancy, F-54000, Nancy, France

    Timothée Zaragori & Antoine Verger

  3. IADI, INSERM, UMR 1254, Université de Lorraine, F-54000, Nancy, France

    Timothée Zaragori & Antoine Verger

  4. Department of Neuropathology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France

    Suzanne Tran

  5. Department of Neuro-Oncology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France

    Andrea Morales-Martinez

  6. Department of Neuro-Oncology, Université de Lorraine, CHRU-Nancy and CRAN, CNRS UMR 7039, F-54000, Nancy, France

    Luc Taillandier & Marie Blonski

  7. Department of Neurosurgery, Université de Lorraine, CHRU-Nancy, F-54000, Nancy, France

    Fabien Rech

  8. Neuroradiology Department, Hôpital Pitié-Salpêtrière, Pitié-Salpêtrière Hospital, AP-HP Sorbonne Université, Sorbonne Université, Paris, France

    Damien Galanaud

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  1. Laura Rozenblum
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  2. Timothée Zaragori
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  9. Aurélie Kas
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  10. Antoine Verger
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Corresponding author

Correspondence to Laura Rozenblum.

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The scientific guarantor of this publication is Pr. Verger.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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• diagnostic or prognostic study

• multicenter study

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Rozenblum, L., Zaragori, T., Tran, S. et al. Differentiating high-grade glioma progression from treatment-related changes with dynamic [18F]FDOPA PET: a multicentric study. Eur Radiol 33, 2548–2560 (2023). https://doi.org/10.1007/s00330-022-09221-4

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