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Prognostic Value of O-(2-¹⁸F-Fluoroethyl)-L-Tyrosine PET and MRI in Low-Grade Glioma

¹ Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany; ² Institute of Medicine, Research Center Jülich, Jülich, Germany; ³ Brain Imaging Center West, Research Center Jülich, Jülich, Germany; ⁴ Department of Neuropathology, Heinrich-Heine-University, Düsseldorf, Germany; ⁵ Central Institute of Applied Mathematics, Research Center Jülich, Jülich, Germany; and ⁶ Institute of Nuclear Chemistry, Research Center Jülich, Jülich, Germany

Correspondence: For correspondence or reprints contact: Karl-Josef Langen, MD, Institute of Medicine, Research Center Jülich, D-52425 Jülich, Germany. E-mail: k.j.langen{at}fz-juelich.de

In glioma of World Health Organization (WHO) grade II (low-grade glioma), the natural course of a particular patient is not predictable and the treatment strategy is controversial. We determined prognostic factors in adult patients with untreated, nonenhancing, supratentorial low-grade glioma with special regard to PET using the amino acid O-(2-¹⁸F-fluoroethyl)-L-tyrosine (¹⁸F-FET) and MRI. Methods: In a prospective study, baseline ¹⁸F-FET PET and MRI analyses were performed on 33 consecutive patients with histologically confirmed low-grade glioma. None of the patients had radiation or chemotherapy. Clinical, histologic, therapeutic (initial cytoreduction vs. biopsy), ¹⁸F-FET uptake, and MRI morphologic parameters were analyzed for their prognostic significance. Statistical endpoints were clinical or radiologic tumor progression, malignant transformation to glioma of WHO grade III or IV (high-grade glioma), and death. Results: Baseline ¹⁸F-FET uptake and a diffuse versus circumscribed tumor pattern on MRI were highly significant predictors of prognosis (P < 0.01). By the combination of these prognostically significant variables, 3 major prognostic subgroups of low-grade glioma patients could be identified. The first of these subgroups was patients with circumscribed low-grade glioma on MRI without ¹⁸F-FET uptake (n = 11 patients, progression in 18%, no malignant transformation and no death). The second subgroup was patients with circumscribed low-grade glioma with ¹⁸F-FET uptake (n = 13 patients, progression in 46%, malignant transformation to a high-grade glioma in 15%, and death in 8%). The third subgroup was patients with diffuse low-grade glioma with ¹⁸F-FET uptake (n = 9 patients, progression in 100%, malignant transformation to a high-grade glioma in 78%, and death in 56%). Conclusion: We conclude that baseline amino acid uptake on ¹⁸F-FET PET and a diffuse versus circumscribed tumor pattern on MRI are strong predictors for the outcome of patients with low-grade glioma.

Key Words: low-grade glioma • prognosis • amino acid PET • O-(2-¹⁸F-fluoroethyl)-L-tyrosine (¹⁸F-FET) • circumscribed lesion • diffuse lesion

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.

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