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Published on: December 28, 2017
Diagnostic accuracy of anti-3-[18F]-FACBC PET/MRI in gliomas
Anna Karlberg1,2, Lars Kjelsberg Pedersen3, Benedikte Emilie Vindstad4
1Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, N-7030, Trondheim, Norway. annamka@stud.ntnu.no.
Purpose:
The primary aim was to evaluate whether anti-3-[18F]FACBC PET combined with conventional MRI correlated better with histomolecular diagnosis (reference standard) than MRI alone in glioma diagnostics. The ability of anti-3-[18F]FACBC to differentiate between molecular and histopathological entities in gliomas was also evaluated.
Methods:
In this prospective study, patients with suspected primary or recurrent gliomas were recruited from two sites in Norway and examined with PET/MRI prior to surgery. Anti-3-[18F]FACBC uptake (TBRpeak) was compared to histomolecular features in 36 patients. PET results were then added to clinical MRI readings (performed by two neuroradiologists, blinded for histomolecular results and PET data) to assess the predicted tumor characteristics with and without PET.
Results:
Histomolecular analyses revealed two CNS WHO grade 1, nine grade 2, eight grade 3, and 17 grade 4 gliomas. All tumors were visible on MRI FLAIR. The sensitivity of contrast-enhanced MRI and anti-3-[18F]FACBC PET was 61% (95%CI [45, 77]) and 72% (95%CI [58, 87]), respectively, in the detection of gliomas. Median TBRpeak was 7.1 (range: 1.4-19.2) for PET positive tumors. All CNS WHO grade 1 pilocytic astrocytomas/gangliogliomas, grade 3 oligodendrogliomas, and grade 4 glioblastomas/astrocytomas were PET positive, while 25% of grade 2-3 astrocytomas and 56% of grade 2-3 oligodendrogliomas were PET positive. Generally, TBRpeak increased with malignancy grade for diffuse gliomas. A significant difference in PET uptake between CNS WHO grade 2 and 4 gliomas (p < 0.001) and between grade 3 and 4 gliomas (p = 0.002) was observed. Diffuse IDH wildtype gliomas had significantly higher TBRpeak compared to IDH1/2 mutated gliomas (p < 0.001). Adding anti-3-[18F]FACBC PET to MRI improved the accuracy of predicted glioma grades, types, and IDH status, and yielded 13.9 and 16.7 percentage point improvement in the overall diagnoses for both readers, respectively.
Conclusion:
Anti-3-[18F]FACBC PET demonstrated high uptake in the majority of gliomas, especially in IDH wildtype gliomas, and improved the accuracy of preoperatively predicted glioma diagnoses.
Clinical Trial Registration:
ClinicalTrials.gov ID: NCT04111588, URL: https://clinicaltrials.gov/study/NCT04111588.
Insights
Adding anti-3-[18F]FACBC PET to MRI significantly improved glioma diagnosis accuracy. This novel PET tracer showed high uptake in most gliomas, particularly IDH wildtype types, enhancing preoperative diagnostic predictions.
Area of Science:
- Neuro-oncology
- Molecular imaging
- Radiopharmaceuticals
Background:
- Glioma diagnosis relies on histomolecular features, often requiring invasive procedures.
- Advanced imaging techniques are crucial for accurate preoperative assessment of glioma grade and type.
- Anti-3-[18F]FACBC PET offers a novel molecular imaging approach for brain tumor evaluation.
Purpose of the Study:
- To determine if anti-3-[18F]FACBC PET combined with MRI improves glioma diagnosis compared to MRI alone.
- To assess the capability of anti-3-[18F]FACBC PET in differentiating glioma subtypes and grades.
- To correlate anti-3-[18F]FACBC uptake with histomolecular diagnostic standards.
Main Methods:
- Prospective study involving 36 patients with suspected primary or recurrent gliomas undergoing PET/MRI.
- Measurement of anti-3-[18F]FACBC uptake (TBRpeak) and comparison with histomolecular features.
- Neuroradiologists assessed tumor characteristics with and without the addition of PET data to MRI readings.
Main Results:
- Anti-3-[18F]FACBC PET showed higher sensitivity (72%) than contrast-enhanced MRI (61%) for glioma detection.
- PET uptake (TBRpeak) generally increased with glioma malignancy grade and was significantly higher in IDH wildtype gliomas.
- Combining PET with MRI improved diagnostic accuracy for glioma grade, type, and IDH status by 13.9-16.7 percentage points.
Conclusions:
- Anti-3-[18F]FACBC PET is effective in detecting most gliomas, especially IDH wildtype.
- The addition of anti-3-[18F]FACBC PET to MRI enhances preoperative diagnostic accuracy for gliomas.
- This PET tracer shows promise for improved molecular and histopathological characterization of gliomas.
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