Related Experiment Video
Updated: Nov 28, 2025
Radiotracer Administration for High Temporal Resolution Positron Emission Tomography of the Human Brain: Application to FDG-fPET
Published on: October 22, 2019
Sequential implementation of DSC-MR perfusion and dynamic [18F]FET PET allows efficient differentiation of glioma
Eike Steidl1,2,3, Karl-Josef Langen4,5,6, Sarah Abu Hmeidan7,8
1Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Schleusenweg 2-16, Frankfurt am Main, 60528, Germany. eike.steidl@kgu.de.
Purpose:
Perfusion-weighted MRI (PWI) and O-(2-[18F]fluoroethyl-)-l-tyrosine ([18F]FET) PET are both applied to discriminate tumor progression (TP) from treatment-related changes (TRC) in patients with suspected recurrent glioma. While the combination of both methods has been reported to improve the diagnostic accuracy, the performance of a sequential implementation has not been further investigated. Therefore, we retrospectively analyzed the diagnostic value of consecutive PWI and [18F]FET PET.
Methods:
We evaluated 104 patients with WHO grade II-IV glioma and suspected TP on conventional MRI using PWI and dynamic [18F]FET PET. Leakage corrected maximum relative cerebral blood volumes (rCBVmax) were obtained from dynamic susceptibility contrast PWI. Furthermore, we calculated static (i.e., maximum tumor to brain ratios; TBRmax) and dynamic [18F]FET PET parameters (i.e., Slope). Definitive diagnoses were based on histopathology (n = 42) or clinico-radiological follow-up (n = 62). The diagnostic performance of PWI and [18F]FET PET parameters to differentiate TP from TRC was evaluated by analyzing receiver operating characteristic and area under the curve (AUC).
Results:
Across all patients, the differentiation of TP from TRC using rCBVmax or [18F]FET PET parameters was moderate (AUC = 0.69-0.75; p < 0.01). A rCBVmax cutoff > 2.85 had a positive predictive value for TP of 100%, enabling a correct TP diagnosis in 44 patients. In the remaining 60 patients, combined static and dynamic [18F]FET PET parameters (TBRmax, Slope) correctly discriminated TP and TRC in a significant 78% of patients, increasing the overall accuracy to 87%. A subgroup analysis of isocitrate dehydrogenase (IDH) mutant tumors indicated a superior performance of PWI to [18F]FET PET (AUC = 0.8/< 0.62, p < 0.01/≥ 0.3).
Conclusion:
While marked hyperperfusion on PWI indicated TP, [18F]FET PET proved beneficial to discriminate TP from TRC when PWI remained inconclusive. Thus, our results highlight the clinical value of sequential use of PWI and [18F]FET PET, allowing an economical use of diagnostic methods. The impact of an IDH mutation needs further investigation.
Insights
Sequential perfusion-weighted MRI (PWI) and O-(2-[¹⁸F]fluoroethyl-)-l-tyrosine ([¹⁸F]FET) PET improve glioma recurrence diagnosis. Combining PWI and [¹⁸F]FET PET enhances accuracy in differentiating tumor progression from treatment effects.
Area of Science:
- Neuroimaging
- Oncology
- Radiology
Background:
- Distinguishing tumor progression (TP) from treatment-related changes (TRC) is crucial for managing glioma patients.
- Perfusion-weighted MRI (PWI) and O-(2-[¹⁸F]fluoroethyl-)-l-tyrosine ([¹⁸F]FET) PET are established methods for this differentiation.
- The diagnostic value of a sequential implementation of PWI followed by [¹⁸F]FET PET has not been fully explored.
Purpose of the Study:
- To retrospectively analyze the diagnostic performance of sequential PWI and [¹⁸F]FET PET in differentiating TP from TRC in patients with suspected recurrent glioma.
- To evaluate the combined diagnostic accuracy of PWI and [¹⁸F]FET PET parameters.
Main Methods:
- 104 patients with suspected recurrent glioma underwent PWI and dynamic [¹⁸F]FET PET.
- PWI analysis included leakage-corrected maximum relative cerebral blood volume (rCBVmax).
- [¹⁸F]FET PET analysis involved static (TBRmax) and dynamic (Slope) parameters. Diagnoses were confirmed by histopathology or follow-up.
Main Results:
- Both PWI (rCBVmax) and [¹⁸F]FET PET parameters showed moderate diagnostic performance (AUC 0.69-0.75).
- A rCBVmax cutoff > 2.85 accurately identified TP in 44 patients.
- In remaining cases, combined [¹⁸F]FET PET parameters (TBRmax, Slope) achieved 78% accuracy, increasing overall diagnostic accuracy to 87%.
Conclusions:
- Sequential PWI and [¹⁸F]FET PET offer significant clinical value for diagnosing glioma recurrence.
- PWI is effective for detecting hyperperfusion indicative of TP.
- [¹⁸F]FET PET is beneficial when PWI results are inconclusive, enabling economical and accurate diagnostic workflows.
