Differentiation of treatment-related changes from tumour progression: a direct comparison between dynamic FET PET and ADC values obtained from DWI MRI

Background Following brain cancer treatment, the capacity of anatomical MRI to differentiate neoplastic tissue from treatment-related changes (e.g., pseudoprogression) is limited. This study compared apparent diffusion coefficients (ADC) obtained by diffusion-weighted MRI (DWI) with static and dynam...

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Published in:European journal of nuclear medicine and molecular imaging 2019-08, Vol.46 (9), p.1889-1901
Main Authors: Werner, Jan-Michael, Stoffels, Gabriele, Lichtenstein, Thorsten, Borggrefe, Jan, Lohmann, Philipp, Ceccon, Garry, Shah, Nadim J., Fink, Gereon R., Langen, Karl-Josef, Kabbasch, Christoph, Galldiks, Norbert
Format: Article
Language:English
Subjects:
Accuracy
Brain
Brain cancer
Brain tumors
Cardiology
Diagnostic systems
Differentiation
Glioma
Image contrast
Image enhancement
Imaging
Magnetic resonance imaging
Mathematical analysis
Medicine
Medicine & Public Health
Neurology
Nuclear Medicine
Oncology
Original Article
Orthopedics
Parameters
Patients
Positron emission
Positron emission tomography
Radiology
Tomography
Tumors
Tyrosine
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Summary:Background Following brain cancer treatment, the capacity of anatomical MRI to differentiate neoplastic tissue from treatment-related changes (e.g., pseudoprogression) is limited. This study compared apparent diffusion coefficients (ADC) obtained by diffusion-weighted MRI (DWI) with static and dynamic parameters of O-(2-[ 18 F]fluoroethyl)-L-tyrosine (FET) PET for the differentiation of treatment-related changes from tumour progression. Patients and methods Forty-eight pretreated high-grade glioma patients with anatomical MRI findings suspicious for progression (median time elapsed since last treatment was 16 weeks) were investigated using DWI and dynamic FET PET. Maximum and mean tumour-to-brain ratios (TBR max , TBR mean ) as well as dynamic parameters (time-to-peak and slope values) of FET uptake were calculated. For mean ADC calculation, regions-of-interest analyses were performed on ADC maps calculated from DWI coregistered with the contrast-enhanced MR image. Diagnoses were confirmed neuropathologically (21%) or clinicoradiologically. Diagnostic performance was evaluated using receiver-operating-characteristic analyses or Fisher’s exact test for a combinational approach. Results Ten of 48 patients had treatment-related changes (21%). The diagnostic performance of FET PET was significantly higher (threshold for both TBR max and TBR mean , 1.95; accuracy, 83%; AUC, 0.89 ± 0.05; P  
ISSN:1619-7070
1619-7089
DOI:10.1007/s00259-019-04384-7