Usefulness of positron emission tomography for differentiating gliomas according to the 2016 World Health Organization classification of tumors of the central nervous system

2020 ◽  
Vol 133 (4) ◽  
pp. 1010-1019 ◽  
Author(s):  
Hiroaki Takei ◽  
Jun Shinoda ◽  
Soko Ikuta ◽  
Takashi Maruyama ◽  
Yoshihiro Muragaki ◽  
...  

OBJECTIVEPositron emission tomography (PET) is important in the noninvasive diagnostic imaging of gliomas. There are many PET studies on glioma diagnosis based on the 2007 WHO classification; however, there are no studies on glioma diagnosis using the new classification (the 2016 WHO classification). Here, the authors investigated the relationship between uptake of 11C-methionine (MET), 11C-choline (CHO), and 18F-fluorodeoxyglucose (FDG) on PET imaging and isocitrate dehydrogenase (IDH) status (wild-type [IDH-wt] or mutant [IDH-mut]) in astrocytic and oligodendroglial tumors according to the 2016 WHO classification.METHODSIn total, 105 patients with newly diagnosed cerebral gliomas (6 diffuse astrocytomas [DAs] with IDH-wt, 6 DAs with IDH-mut, 7 anaplastic astrocytomas [AAs] with IDH-wt, 24 AAs with IDH-mut, 26 glioblastomas [GBMs] with IDH-wt, 5 GBMs with IDH-mut, 19 oligodendrogliomas [ODs], and 12 anaplastic oligodendrogliomas [AOs]) were included. All OD and AO patients had both IDH-mut and 1p/19q codeletion. The maximum standardized uptake value (SUV) of the tumor/mean SUV of normal cortex (T/N) ratios for MET, CHO, and FDG were calculated, and the mean T/N ratios of DA, AA, and GBM with IDH-wt and IDH-mut were compared. The diagnostic accuracy for distinguishing gliomas with IDH-wt from those with IDH-mut was assessed using receiver operating characteristic (ROC) curve analysis of the mean T/N ratios for the 3 PET tracers.RESULTSThere were significant differences in the mean T/N ratios for all 3 PET tracers between the IDH-wt and IDH-mut groups of all histological classifications (p < 0.001). Among the 27 gliomas with mean T/N ratios higher than the cutoff values for all 3 PET tracers, 23 (85.2%) were classified into the IDH-wt group using ROC analysis. In DA, there were no significant differences in the T/N ratios for MET, CHO, and FDG between the IDH-wt and IDH-mut groups. In AA, the mean T/N ratios of all 3 PET tracers in the IDH-wt group were significantly higher than those in the IDH-mut group (p < 0.01). In GBM, the mean T/N ratio in the IDH-wt group was significantly higher than that in the IDH-mut group for both MET (p = 0.034) and CHO (p = 0.01). However, there was no significant difference in the ratio for FDG.CONCLUSIONSPET imaging using MET, CHO, and FDG was suggested to be informative for preoperatively differentiating gliomas according to the 2016 WHO classification, particularly for differentiating IDH-wt and IDH-mut tumors.

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii66-iii66
Author(s):  
H Takei ◽  
J Shinoda ◽  
S Ikuta ◽  
T Maruyama ◽  
Y Muragaki ◽  
...  

Abstract BACKGROUND Positron emission tomography (PET) is important in noninvasive diagnostic imaging of gliomas. There are many PET studies on glioma diagnosis based on the 2007 World Health Organization (WHO) classification; however, there are no studies on glioma diagnosis using the new classification (the 2016 WHO classification).Here we investigated the relationship between PET imaging using 11C-methionine (MET), 11C-choline (CHO), and 18F-fluorodeoxyglucose (FDG) and wildtype isocitrate dehydrogenase (IDH) (IDH-wt)/mutant IDH (IDH-mut) in astrocytic and oligodendroglial tumors according to the 2016 WHO classification. MATERIAL AND METHODS In total, 105 patients with newly diagnosed cerebral gliomas (six diffuse astrocytomas [DAs] with IDH-wt, six DAs with IDH-mut, seven anaplastic astrocytomas [AAs] with IDH-wt, 24 AAs with IDH-mut, 26 glioblastomas [GBMs] with IDH-wt, five GBMs with IDH-mut, 19 oligodendrogliomas [ODs], and 12 anaplastic oligodendrogliomas [AOs]) were included. All OD and AO patients had both IDH-mut and 1p/19q codeletion. The maximum standardized uptake values (SUVs) of the tumor/normal cortex mean SUV ratios (T/N ratios) for MET, CHO, and FDG were calculated; the mean T/N ratios of DA, AA, and GBM with IDH-wt/IDH-mut were compared. The diagnostic accuracy for distinguishing gliomas with IDH-wt from those with IDH-mut was assessed using receiver operating characteristic (ROC) curve analysis of the mean T/N ratios for the three PET tracers. RESULTS There were significant differences in the mean T/N ratios for all three PET tracers between the IDH-wt and IDH-mut groups including all histological classifications (p<0.001). Among the 27 gliomas with mean T/N ratios higher than the cutoff values for all three PET tracers, 23 (85.2%) were classified into the IDH-wt group using ROC analysis. In DA, there were no significant differences in the T/N ratios for MET, CHO, and FDG between the IDH-wt and IDH-mut groups. In AA, the mean T/N ratios of all three PET tracers in the IDH-wt group were significantly higher than those in the IDH-mut group (p<0.001). In GBM, the mean T/N ratio in the IDH-wt group was significantly higher than that of the IDH-mut group for both MET (p=0.034) and CHO (p=0.01). However, there was no significant difference in the ratio for FDG. CONCLUSIONS PET imaging using MET, CHO, and FDG was confirmed to be informative for preoperatively differentiating gliomas according to the 2016 WHO classification, particularly for differentiating IDH-wt and IDH-mut tumors.


2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Bernd Kasper ◽  
Antonia Dimitrakopoulou-Strauss ◽  
Lothar R. Pilz ◽  
Ludwig G. Strauss ◽  
Christos Sachpekidis ◽  
...  

We used 2-deoxy-2-[18F] fluoro-D-glucose (FDG) positron emission tomography (PET) to evaluate patients with desmoid tumors undergoing therapy with imatinib. The study included 22 patients with progressive disease (PD) of a biopsy proven desmoid tumor treated orally with imatinib 800 mg daily. Patients were examined using PET prior to onset of therapy and during treatment. Restaging was performed in parallel using computed tomography (CT) and/or magnetic resonance imaging (MRI). Outcome of 22 evaluable patients was as follows: five patients with partial response (PR); twelve patients with stable disease (SD) accounting for 77% with non-progressive disease; five patients showed PD. A 30% decrease of the mean average standardized uptake value (SUV) of sequential PET examinations could be demonstrated; no patient demonstrated a substantial increase in SUV. Patients with PR/SD were matched to a group of nonprogressive disease and tested versus PD. The initial average SUV and seem to be candidates for a response prediction with an approximate -value of0.06553and0.07785, respectively. This is the first larger series of desmoid patients monitored using PET showing that early SUV changes may help to discriminate responders from nonresponders and, thus, to decide whether imatinib therapy should be continued.


Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3133-3133
Author(s):  
Javier Munoz ◽  
Belisario Arango ◽  
Jessica Schering ◽  
James Morrison ◽  
Ishani Dalal ◽  
...  

Abstract Abstract 3133 Introduction: Significant tonsil uptake is sometimes observed in F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) after treatment. Some patients undergo tonsillectomy or FNA (fine needle aspiration) to rule out malignant involvement particularly when management depends on restaging (Figure 1). Our study describes the incidence and degree of tonsil FDG uptake in a large group of lymphoma patients that underwent PET scanning. Patients and Methods: Single institution, retrospective chart review by ICD code, 617 lymphoma patients that underwent PET at our institution from 2004 to 2009. Results of PET were compared to pathological diagnosis of tonsillectomy (Table 1) or FNA biopsy (Table 2) when available which was performed at physician's discretion. Patients that were diagnosed with lymphoma during restaging studies performed for a different primary malignancy were excluded. Results and Discussion: All 8 tonsillectomies and FNA biopsies performed after a restaging PET that showed increased tonsil uptake were negative for malignancy (Figure 2). All of these 8 patients had an initial previous PET that did not show increased tonsil uptake and also these 8 patients remained in remission from their lymphoma after the procedure was performed. In contrast, 6 out of 7 patients that underwent tonsillectomy or FNA at diagnosis were positive for malignancy (Table 3). Differences among tonsil FDG uptake has been thought to reflect differences in activity of “physiological” inflammation of the palatine tonsils. Increased glucose metabolism during active inflammation in the case of chronic tonsillitis or lymphocyte proliferation in the case of a patient that has received prior chemotherapy (likely experiencing compensatory extra medullar lymphoid hyperplasia) were thought to be causes of high FDG uptake in the tonsils. The significance of such increased tonsil FDG uptake is currently unknown however previous studies suggest that normal pharyngeal palatine tonsil uptake was generally symmetrical and that the difference in maximal standardized uptake value (SUVmax) between right and left tonsils (right-to-left ratio or a surrogate of symmetry) in the same patient might be helpful in detecting malignant tissue. The mean right-to-left ratio of tonsillar SUV was 4.55 in patients with confirmed malignant pathology and 1.53 in patients with documented benign tonsillar tissue (Table 4). The mean tonsillar SUVmax was 15.35 in patients with confirmed malignant pathology and 7.05 in patients with documented benign tonsillar tissue hence SUVmax seems to be useful in differentiating tumor from physiological accumulation. Younger patients with low SUV max symmetric tonsillar uptake and no other abnormal FDG areas seen during restaging PET could probably be watched non-invasively. Conclusions: At the time of initial staging PET, increased tonsil uptake showed true lymphomatous involvement in most cases. At restaging, increased tonsil uptake displayed no cases positive for lymphomatous involvement as all tonsillectomies and FNA biopsies were negative for malignancy. These findings seem to be valid irrespective of the subtype of lymphoma. Our study supports a conservative non-invasive approach because physiologic uptake is the most common cause of increased tonsil uptake when restaging lymphoma patients after treatment has been completed. Disclosures: No relevant conflicts of interest to declare.


2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15766-e15766
Author(s):  
Chad Barnes ◽  
Mohammed Aldakkak ◽  
Kathleen K. Christians ◽  
Parag Tolat ◽  
Paul S. Ritch ◽  
...  

e15766 Background: The role of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in the staging of pancreatic cancer (PC) has not been well defined. We evaluated the prognostic value of FDG-PET imaging in patients with localized PC enrolled in a prospective trial of personalized molecular-directed neoadjuvant therapy. Methods: Pretreatment FDG-PET was classified as high or low based on a standardized uptake value (SUV) cutpoint of 7.2 (population median). Carbohydrate antigen 19-9 (CA19-9) was measured after the completion of neoadjuvant therapy (preoperative) and classified as normal (≤35 U/mL) or elevated. Results: Pretreatment FDG-PET imaging was performed on 100 consecutive patients; SUV was high in 50 and low in 50. Preoperative CA19-9 values were available in 99 of 100 patients; 54 (55%) were elevated and 45 (45%) were normal. Of the 100 patients, 81 completed neoadjuvant therapy and surgery, and 19 were not resected. Among the 81 resected patients, SUV was high in 37 (46%) and low in 44 (54%); preoperative CA19-9 was elevated in 40 (49%) and normal in 41 (51%). The median overall survival (OS) for all patients was 39 months; 45 months for who completed all intended neoadjuvant therapy and surgery and 9 months for patients who were not resected. The median OS for patients with normal CA19-9/low SUV, normal CA19-9/high SUV, elevated CA19-9/low SUV, and elevated CA19-9/high SUV were not reached, 35, 24, and 18 months, respectively (p = 0.0001). Conclusions: Pretreatment FDG-PET avidity and preoperative CA19-9 are important prognostic markers and may be used to estimate the anticipated benefit of surgery; information of immediate clinical significance for both treatment sequencing and the application of surgery to patients who are frequently of advanced age or high-risk.


Lab on a Chip ◽  
2014 ◽  
Vol 14 (5) ◽  
pp. 902-910 ◽  
Author(s):  
Supin Chen ◽  
Muhammad Rashed Javed ◽  
Hee-Kwon Kim ◽  
Jack Lei ◽  
Mark Lazari ◽  
...  

Radiotracer synthesis is an ideal application for microfluidics because only nanogram quantities are needed for positron emission tomography (PET) imaging.


2000 ◽  
Vol 18 (8) ◽  
pp. 1676-1688 ◽  
Author(s):  
Ian C. Smith ◽  
Andrew E. Welch ◽  
Andrew W. Hutcheon ◽  
Iain D. Miller ◽  
Simon Payne ◽  
...  

PURPOSE: To determine whether [18F]-fluorodeoxy-d-glucose ([18F]-FDG) positron emission tomography (PET) can predict the pathologic response of primary and metastatic breast cancer to chemotherapy.PATIENTS AND METHODS: Thirty patients with noninflammatory, large (> 3 cm), or locally advanced breast cancers received eight doses of primary chemotherapy. Dynamic PET imaging was performed immediately before the first, second, and fifth doses and after the last dose of treatment. Primary tumors and involved axillary lymph nodes were identified, and the [18F]-FDG uptake values were calculated (expressed as semiquantitative dose uptake ratio [DUR] and influx constant [K]). Pathologic response was determined after chemotherapy by evaluation of surgical resection specimens.RESULTS: Thirty-one primary breast lesions were identified. The mean pretreatment DUR values of the eight lesions that achieved a complete microscopic pathologic response were significantly (P = .037) higher than those from less responsive lesions. The mean reduction in DUR after the first pulse of chemotherapy was significantly greater in lesions that achieved a partial (P = .013), complete macroscopic (P = .003), or complete microscopic (P = .001) pathologic response. PET after a single pulse of chemotherapy was able to predict complete pathologic response with a sensitivity of 90% and a specificity of 74%. Eleven patients had pathologic evidence of lymph node metastases. Mean pretreatment DUR values in the metastatic lesions that responded did not differ significantly from those that failed to respond (P = .076). However, mean pretreatment K values were significantly higher in ultimately responsive cancers (P = .037). The mean change in DUR and K after the first pulse of chemotherapy was significantly greater in responding lesions (DUR, P = .038; K, P = .012).CONCLUSION: [18F]-FDG PET imaging of primary and metastatic breast cancer after a single pulse of chemotherapy may be of value in the prediction of pathologic treatment response.


2019 ◽  
Vol 27 (3) ◽  
pp. 230949901986892
Author(s):  
Takayuki Oishi ◽  
Naomi Kobayashi ◽  
Hyonmin Choe ◽  
Taro Tezuka ◽  
Daigo Kobayashi ◽  
...  

Background and purpose: The pathology of the posterior acetabular lesions, so-called “contrecoup regions”, in femorocacetabular impingement (FAI) has not been elucidated fully. 18F-fluoride positron emission tomography/computed tomography (PET/CT) can visualize abnormal uptake caused by impingement. Therefore, we aimed to evaluate posterior acetabular uptake on PET/CT in FAI patients. Patients and methods: Patients with FAI who underwent 18F-fluoride PET/CT between October 2014 and October 2016 were retrospectively evaluated. The maximum standardized uptake value (SUVmax) in the posterior acetabulum was evaluated. The mean SUVmax of FAI with cam morphology (the cam group) was compared with that of FAI with pincer morphology (the pincer group). In addition, the numbers of cases with SUVmax ≥ 6 and SUVmax < 6 in each group were evaluated. The entire study cohort was also grouped according to SUVmax, and the mean α and center edge angles were evaluated. Results: In total, 41 hips were analyzed (34 hips in the cam group and 7 in the pincer group). The mean SUVmax of the cam group (11.2 ± 7.4) was significantly higher than that of the pincer group (4.9 ± 1.9) ( p < 0.01). The incidence of cases with SUVmax ≥ 6 in the cam group was significantly high ( p < 0.01). In the overall cohort, the mean α angle of the SUVmax ≥ 6 group was significantly higher than that of the SUVmax < 6 group ( p < 0.01). Conclusion: Evaluation of posterior acetabular uptake suggests an association between cam morphology and increased posterior acetabular uptake.


Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 189
Author(s):  
Osamu Manabe ◽  
Shigeru Yamaguchi ◽  
Kenji Hirata ◽  
Kentaro Kobayashi ◽  
Hiroyuki Kobayashi ◽  
...  

Background: Positron emission tomography with 11C-methionine (MET) is well established in the diagnostic work-up of malignant brain tumors. Texture analysis is a novel technique for extracting information regarding relationships among surrounding voxels, in order to quantify their inhomogeneity. This study evaluated whether the texture analysis of MET uptake has prognostic value for patients with glioma. Methods: We retrospectively analyzed adults with glioma who had undergone preoperative metabolic imaging at a single center. Tumors were delineated using a threshold of 1.3-fold of the mean standardized uptake value for the contralateral cortex, and then processed to calculate the texture features in glioma. Results: The study included 42 patients (median age: 56 years). The World Health Organization classifications were grade II (7 patients), grade III (17 patients), and grade IV (18 patients). Sixteen (16.1%) all-cause deaths were recorded during the median follow-up of 18.8 months. The univariate analyses revealed that overall survival (OS) was associated with age (hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.01–1.08, p = 0.0093), tumor grade (HR 3.64, 95% CI 1.63–9.63, p = 0.0010), genetic status (p < 0.0001), low gray-level run emphasis (LGRE, calculated from the gray-level run-length matrix) (HR 2.30 × 1011, 95% CI 737.11–4.23 × 1019, p = 0.0096), and correlation (calculated from the gray-level co-occurrence matrix) (HR 5.17, 95% CI 1.07–20.93, p = 0.041). The multivariate analyses revealed OS was independently associated with LGRE and correlation. The survival curves were also significantly different (both log-rank p < 0.05). Conclusion: Textural features obtained using preoperative MET positron emission tomography may compliment the semi-quantitative assessment for prognostication in glioma cases.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Benjamin B. Kasten ◽  
Hailey A. Houson ◽  
Jennifer M. Coleman ◽  
Jianmei W. Leavenworth ◽  
James M. Markert ◽  
...  

AbstractDetermination of treatment response to immunotherapy in glioblastoma multiforme (GBM) is a process which can take months. Detection of CD8+ T cell recruitment to the tumor with a noninvasive imaging modality such as positron emission tomography (PET) may allow for tumor characterization and early evaluation of therapeutic response to immunotherapy. In this study, we utilized 89Zr-labeled anti-CD8 cys-diabody-PET to provide proof-of-concept to detect CD8+ T cell immune response to oncolytic herpes simplex virus (oHSV) M002 immunotherapy in a syngeneic GBM model. Immunocompetent mice (n = 16) were implanted intracranially with GSC005 GBM tumors, and treated with intratumoral injection of oHSV M002 or saline control. An additional non-tumor bearing cohort (n = 4) receiving oHSV M002 treatment was also evaluated. Mice were injected with 89Zr-labeled anti-CD8 cys-diabody seven days post oHSV administration and imaged with a preclinical PET scanner. Standardized uptake value (SUV) was quantified. Ex vivo tissue analyses included autoradiography and immunohistochemistry. PET imaging showed significantly higher SUV in tumors which had been treated with M002 compared to those without M002 treatment (p = 0.0207) and the non-tumor bearing M002 treated group (p = 0.0021). Accumulation in target areas, especially the spleen, was significantly reduced by blocking with the non-labeled diabody (p < 0.001). Radioactive probe accumulation in brains was consistent with CD8+ cell trafficking patterns after oHSV treatment. This PET imaging strategy could aid in distinguishing responders from non-responders during immunotherapy of GBM.


2020 ◽  
Vol 22 (10) ◽  
Author(s):  
Andrej Ćorović ◽  
Christopher Wall ◽  
Justin C. Mason ◽  
James H. F. Rudd ◽  
Jason M. Tarkin

Abstract Purpose of Review To provide a focused update on recent advances in positron emission tomography (PET) imaging in vascular inflammatory diseases and consider future directions in the field. Recent Findings While PET imaging with 18F-fluorodeoxyglucose (FDG) can provide a useful marker of disease activity in several vascular inflammatory diseases, including atherosclerosis and large-vessel vasculitis, this tracer lacks inflammatory cell specificity and is not a practical solution for imaging the coronary vasculature because of avid background myocardial signal. To overcome these limitations, research is ongoing to identify novel PET tracers that can more accurately track individual components of vascular immune responses. Use of these novel PET tracers could lead to a better understanding of underlying disease mechanisms and help inform the identification and stratification of patients for newly emerging immune-modulatory therapies. Summary Future research is needed to realise the true clinical translational value of PET imaging in vascular inflammatory diseases.


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