Abstract
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Objectives The purpose of this study is to evaluate the clinical value of C-11 acetate (ACE) positron emission tomography/computed tomography (PET/CT) in predicting histologic grades and survival in patients with cerebral glioma.
Methods Fifty patients (30 Male, 20 Female, mean age 51.7 years old) with histologically confirmed cerebral gliomas who underwent C-11 acetate PET/CT before surgery were included in this study. Seven patients had grade II, 16 had grade III, and 27 had grade IV. For ACE PET/CT, 20 min emission scan was obtained at 10 min after injection of 370 MBq of ACE. Maximum standardized uptake value (SUVmax) of the tumors were compared between the three groups (Grade II, III and IV), and Bonferroni post hoc analyses were also performed. In addition, postoperative progression free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier survival analysis and Cox proportional hazard regression tests including clinical, pathological, and imaging variables.
Results SUVmax is 1.1±0.11 (mean±SD) in grade II, 2.3±0.17 in grade III and 3.3±0.22 in grade IV gliomas. Among these three groups, significant differences in SUVmax were seen in Bonferroni post hoc analysis (p<0.001). In univariate analysis, prognostic factors for PFS were histologic grades (grade II vs. grade III and IV p=0.007), SUVmax (cutoff>2.2, p<0.001), and sex (p=0.023). In multivariate analysis, SUVmax cutoff (p=0.01), and sex (p=0.01) were prognostic for PFS. For OS, histologic grades (p=0.006) and SUVmax (cutoff>2.2, p<0.001) were prognostic in univariate analyses and SUVmax cutoff (p=0.016) was the only prognostic factor for OS in multivariate analyses.
Conclusions We found a strong positive correlation between C-11 acetate uptake on PET/CT and histologic differentiation of cerebral gliomas. Furthermore, the degree of C-11 acetate uptake in the cerebral gliomas was a better prognostic factor than tumor grades in predicting progression free and overall survival.