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Comparing the diagnostic performance of DSC-MRI and FAPI PET in differentiating tumor progression from
Hasan Önner1, Halil Özer2, Burak Gezer3
1Selcuk University, Faculty of Medicine, Department of Nuclear Medicine, Konya, Turkey.
Objectives:
This pilot study compared the diagnostic performances of DSC-MRI and FAPI PET in differentiating tumor progression (TP) and treatment-related change (TRC) in isocitrate dehydrogenase (IDH) wild-type glioblastoma during follow-up.
Methods:
IDH wild-type glioblastoma patients who underwent DSC-MRI and FAPI PET were analyzed retrospectively. TP and TRC lesions were confirmed through radiological and clinical follow-up, with a median follow-up period of 8 months (2-12 months). The differences in DSC-MRI (CBVmax, CBVmean, and rCBVmean) and FAPI PET (SUVmax, SUVmean, and TBR SUVmean) parameters between TP and TRC were compared. ROC curve analyses were performed to assess the diagnostic performance. DeLong's test evaluated the differences in AUCs.
Results:
Twelve patients (6 men and 6 women, aged 33-70) with IDH wild-type glioblastoma were enrolled. Totally 18 lesions (8 TRC and 10 TP) were detected. All DSC-MRI and FAPI PET parameters were significantly higher in the TP than in the TRC. CBVmean showed the highest diagnostic performance among all parameters. However, the DeLong test revealed no significant difference in diagnostic performance between DSC-MRI and FAPI PET parameters.
Conclusions:
Although the CBVmean has excellent diagnostic performance in differentiating TP from TRC, FAPI PET parameters were statistically found to have similar diagnostic performance. FAPI PET may be an alternative modality for patients with IDH wild-type glioblastoma who are unable to undergo DSC-MRI. However, further prospective large cohort studies and clinical validation are necessary.
Insights
Dynamic contrast-enhanced MRI (DSC-MRI) and fibroblast activation protein inhibitor (FAPI) PET show similar performance in distinguishing tumor progression from treatment effects in glioblastoma. CBVmean on DSC-MRI was highly effective, but FAPI PET offers a viable alternative when DSC-MRI is not feasible.
Area of Science:
- Neuro-oncology
- Radiology
- Nuclear Medicine
Background:
- Distinguishing tumor progression (TP) from treatment-related changes (TRC) is critical for managing isocitrate dehydrogenase (IDH) wild-type glioblastoma.
- Dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) and fibroblast activation protein inhibitor positron emission tomography (FAPI PET) are advanced imaging techniques used in oncology.
Purpose of the Study:
- To compare the diagnostic performance of DSC-MRI and FAPI PET in differentiating TP from TRC in IDH wild-type glioblastoma during follow-up.
- To evaluate specific imaging parameters from both modalities for their efficacy in lesion characterization.
Main Methods:
- Retrospective analysis of IDH wild-type glioblastoma patients who underwent both DSC-MRI and FAPI PET.
- Lesion confirmation through radiological and clinical follow-up (median 8 months).
- Comparison of DSC-MRI (CBVmax, CBVmean, rCBVmean) and FAPI PET (SUVmax, SUVmean, TBR SUVmean) parameters between TP and TRC groups using ROC curve analysis and DeLong's test.
Main Results:
- Twelve patients with 18 lesions (8 TRC, 10 TP) were analyzed.
- All DSC-MRI and FAPI PET parameters were significantly higher in TP compared to TRC.
- CBVmean demonstrated the highest diagnostic performance among all assessed parameters.
- No significant difference in diagnostic performance was found between DSC-MRI and FAPI PET parameters.
Conclusions:
- CBVmean on DSC-MRI exhibits excellent performance in differentiating TP from TRC.
- FAPI PET parameters showed statistically similar diagnostic performance to DSC-MRI parameters.
- FAPI PET may serve as an alternative imaging modality for IDH wild-type glioblastoma patients unable to undergo DSC-MRI.
- Further prospective, large-scale studies are required for clinical validation.
