Related Experiment Video
Updated: Mar 5, 2026
PET and MRI Guided Irradiation of a Glioblastoma Rat Model Using a Micro-irradiator
Published on: December 28, 2017
Multiparametric Evaluation in Differentiating Glioma Recurrence from Treatment-Induced Necrosis Using Simultaneous
Background And Purpose:
Differentiating glioma recurrence from treatment-induced necrosis can be a challenge on conventional imaging. This study aimed to assess the diagnostic performance of each functional MR imaging and PET parameter derived by using simultaneous FDG-PET/MR imaging individually and in combination in the evaluation of suspected glioma recurrence.
Materials And Methods:
Thirty-five treated glioma patients with 41 enhancing lesions (World Health Organization grade II = 9, III = 13, IV = 19) on MR imaging after an operation followed by radiation therapy and/or chemotherapy formed part of this study. Using PET/MR imaging, we calculated the normalized mean relative CBV, mean ADC, Cho/Cr, and maximum and mean target-to-background ratios. Statistical analysis was performed to determine the diagnostic performance of each parameter by receiver operating characteristic analysis individually and in combination with multivariate receiver operating characteristic analysis for the detection of glioma recurrence. Histopathology or clinicoradiologic follow-up was considered the criterion standard.
Results:
Of 35 patients, 25 (30 lesions) were classified as having a recurrence and 10 (11 lesions) patients as having treatment-induced necrosis. Parameters like rCBVmean (mean relative CBV), ADCmean, Cho/Cr, and maximum and mean target-to-background ratios were statistically significant in the detection of recurrent lesions with an accuracy of 77.5%, 78.0%, 90.9%, 87.8%, and 87.8%, respectively. On multivariate receiver operating characteristic analysis, the combination of all 3 MR imaging parameters resulted in an area under the curve of 0.913 ± 0.053. Furthermore, an area under the curve of 0.935 ± 0.046 was obtained when MR imaging parameters (ADCmean and Cho/Cr) were combined with the PET parameter (mean target-to-background ratio), demonstrating an increase in diagnostic accuracy.
Conclusions:
Simultaneous PET/MR imaging with FDG offers correlative and synergistic multiparametric assessment of glioma recurrence with increased accuracy and clinical utility.
Insights
Diagnosing glioma recurrence is challenging. Simultaneous FDG-PET/MR imaging provides multiparametric assessment, combining MR imaging and PET parameters to significantly improve the accuracy of detecting glioma recurrence.
Area of Science:
- Neuroimaging
- Oncology
- Radiology
Background:
- Differentiating glioma recurrence from treatment-induced necrosis is difficult with conventional imaging.
- Functional MR imaging and PET parameters offer potential for improved diagnostic accuracy.
Purpose of the Study:
- To assess the diagnostic performance of individual and combined functional MR imaging and PET parameters using simultaneous FDG-PET/MR imaging.
- To evaluate the utility of these parameters in detecting suspected glioma recurrence.
Main Methods:
- Thirty-five treated glioma patients with 41 enhancing lesions underwent simultaneous FDG-PET/MR imaging.
- Calculated parameters included relative cerebral blood volume (rCBV), apparent diffusion coefficient (ADC), choline to creatine ratio (Cho/Cr), and target-to-background ratios (TBR).
- Receiver operating characteristic (ROC) analysis was used to determine diagnostic performance individually and in combination.
Main Results:
- Individual parameters showed significant detection capabilities for recurrent lesions.
- The combination of MR imaging parameters (ADCmean and Cho/Cr) with a PET parameter (mean TBR) achieved the highest diagnostic accuracy with an area under the curve of 0.935 ± 0.046.
- Multivariate analysis combining all MR imaging parameters yielded an area under the curve of 0.913 ± 0.053.
Conclusions:
- Simultaneous FDG-PET/MR imaging enables a multiparametric assessment of glioma recurrence.
- This approach offers synergistic benefits, increasing diagnostic accuracy and clinical utility for suspected glioma recurrence.
![Semi-quantitative Assessment Using [18F]FDG Tracer in Patients with Severe Brain Injury](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F58641.jpg&w=3840&q=50)
