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Histomolecular Validation of [18F]-FACBC in Gliomas Using Image-Localized Biopsies.

Benedikte Emilie Vindstad1, Anne Jarstein Skjulsvik2,3, Lars Kjelsberg Pedersen4

  • 1Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, 7030 Trondheim, Norway.

Cancers
|July 27, 2024
PubMed
Summary

This study shows that [18F]-FACBC PET imaging improves glioma classification and tumor volume delineation compared to standard MRI. It offers higher sensitivity and specificity for identifying aggressive tumor tissues.

Keywords:
MRI[18F]-FACBCamino acid PETglioma

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Area of Science:

  • Neuro-oncology
  • Medical Imaging
  • Nuclear Medicine

Background:

  • Gliomas are complex tumors requiring precise identification of aggressive areas and boundaries for effective treatment.
  • Accurate histomolecular diagnosis, surgical planning, and radiation therapy depend on precise tumor characterization.

Purpose of the Study:

  • To evaluate the utility of [18F]-FACBC Positron Emission Tomography (PET) for classifying glioma tissues.
  • To compare the diagnostic accuracy and volume delineation capabilities of [18F]-FACBC PET with conventional contrast-enhanced T1-weighted (ce-T1) Magnetic Resonance Imaging (MRI).

Main Methods:

  • Pre-surgical [18F]-FACBC PET/MR imaging was utilized for image-localized biopsy sampling in patients with high- and low-grade gliomas.
  • Tumor-to-background ratio (TBR) thresholds were optimized against histomolecular results to assess sensitivity, specificity, and Area Under the Curve (AUC).
  • PET-derived tumor volumes were calculated and compared to ce-T1 MRI volumes and biopsy-proven tumor presence.

Main Results:

  • [18F]-FACBC PET demonstrated superior sensitivity (0.63) and specificity (0.57) for tumor classification compared to ce-T1 MRI (0.24 and 0.43).
  • Tumor-to-background ratio (TBR) using [18F]-FACBC PET was a strong classifier for IDH1-wildtype gliomas (AUC: 0.83).
  • In glioblastoma, [18F]-FACBC PET volumes were approximately eight times larger than ce-T1 MRI volumes, encompassing 87.5% of tumor-positive biopsies versus 31.5% for ce-T1 MRI.

Conclusions:

  • The integration of [18F]-FACBC PET with conventional MRI significantly enhances glioma classification accuracy.
  • [18F]-FACBC PET improves the delineation of tumor boundaries, offering a more comprehensive assessment of tumor extent.