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Diagnostic yield of simultaneous dynamic contrast-enhanced magnetic resonance perfusion measurements and [F-18]FET PET in patients with suspected recurrent anaplastic astrocytoma and glioblastoma

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Purpose: Both amino acid positron emission tomography (PET) and magnetic resonance imaging (MRI) blood volume (BV) measurements are used in suspected recurrent high-grade gliomas. We compared the separate and combined diagnostic yield of simultaneously acquired dynamic contrast-enhanced (DCE) perfusion MRI and O-(2-[ 18F]-fluoroethyl)-L-tyrosine ([ 18F]FET) PET in patients with anaplastic astrocytoma and glioblastoma following standard therapy. Methods: A total of 76 lesions in 60 hybrid [ 18F]FET PET/MRI scans with DCE MRI from patients with suspected recurrence of anaplastic astrocytoma and glioblastoma were included retrospectively. BV was measured from DCE MRI employing a 2-compartment exchange model (2CXM). Diagnostic performances of maximal tumour-to-background [ 18F]FET uptake (TBR max), maximal BV (BV max) and normalised BV max (nBV max) were determined by ROC analysis using 6-month histopathological (n = 28) or clinical/radiographical follow-up (n = 48) as reference. Sensitivity and specificity at optimal cut-offs were determined separately for enhancing and non-enhancing lesions. Results: In progressive lesions, all BV and [ 18F]FET metrics were higher than in non-progressive lesions. ROC analyses showed higher overall ROC AUCs for TBR max than both BV max and nBV max in both lesion-wise (all lesions, p = 0.04) and in patient-wise analysis (p < 0.01). Combining TBR max with BV metrics did not increase ROC AUC. Lesion-wise positive fraction/sensitivity/specificity at optimal cut-offs were 55%/91%/84% for TBR max, 45%/77%/84% for BV max and 59%/84%/72% for nBV max. Combining TBR max and best-performing BV cut-offs yielded lesion-wise sensitivity/specificity of 75/97%. The fraction of progressive lesions was 11% in concordant negative lesions, 33% in lesions only BV positive, 64% in lesions only [ 18F]FET positive and 97% in concordant positive lesions. Conclusion: The overall diagnostic accuracy of DCE BV imaging is good, but lower than that of [ 18F]FET PET. Adding DCE BV imaging did not improve the overall diagnostic accuracy of [ 18F]FET PET, but may improve specificity and allow better lesion-wise risk stratification than [ 18F]FET PET alone.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Nuclear Medicine and Molecular Imaging
Vol/bind49
Udgave nummer13
Sider (fra-til)4677-4691
Antal sider15
ISSN1619-7070
DOI
StatusUdgivet - nov. 2022

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© 2022. The Author(s).

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