Research ArticleClinical Investigation

Diagnostic Accuracy of MR Spectroscopic Imaging and 18F-FET PET for Identifying Glioma: A Biopsy-Controlled Hybrid PET/MRI Study

Jörg Mauler, Philipp Lohmann, Andrew A. Maudsley, Sulaiman Sheriff, Moritz Hoevels, Anna-Katharina Meissner, Christina Hamisch, Anna Brunn, Martina Deckert, Christian P. Filss, Gabriele Stoffels, Jürgen Dammers, Maximillian I. Ruge, Norbert Galldiks, Felix M. Mottaghy, Karl-Josef Langen and N. Jon Shah
Journal of Nuclear Medicine January 2024, 65 (1) 16-21; DOI: https://doi.org/10.2967/jnumed.123.265868

Article Figures & Data

Figures

  • Figure
  • FIGURE 1.
    FIGURE 1.

    Example of registered contrast-enhanced T1-weighted MRI (top; arbitrary units), corresponding Cho/NAA spectroscopic image (middle), and 18F-FET PET (bottom) of patient 18, who was diagnosed with glioblastoma, IDH wild-type, central nervous system WHO grade 4. 18F-FETn data were resliced and resampled to resolution of MRSI data. Position of crosshairs marks location of biopsy.

  • FIGURE 2.
    FIGURE 2.

    Contrast-enhanced T1-weighted MRI (top; arbitrary units), registered Cho/NAA spectroscopic signals (middle), and 18F-FET PET (bottom) from patient 1, diagnosed with astrocytoma, IDH1-mutant, central nervous system WHO grade 3. Biopsy positions were based on 18F-FET enhancement and therefore did not necessarily coincide with sites of maximum Cho/NAA ratios. Position of crosshairs marks location of biopsy.

  • FIGURE 3.
    FIGURE 3.

    Receiver operating characteristic curves of 18F-FETn PET and MRSI metabolic markers Cho/NAAn, NAA/Crn, Chon, and NAAn based on analysis of 88 biopsies and 20 imaging data points from normal-appearing brain tissue.

Tables

  • TABLE 1.

    Results Depending on Different Model Terms in Logistic Regression Analysis

    MarkerAUC95% CIThresholdP interceptP slope
    FETn*0.890.81–0.931.43.7 e−063.4 e−06
    Cho/NAAn*0.810.71–0.882.165 e−042 e−04
    Cho/NAA*0.790.68–0.860.650.00144.8 e−04
    Cho/Crn*0.720.61–0.801.657.5 e−046.9 e−04
    Cho/Cr*0.710.60–0.800.398.6 e−048 e−04
    NAA/Crn*0.780.68–0.860.764.8 e−051.8 e−05
    NAA/Cr*0.750.65–0.840.861.1 e−042.9 e−05
    mIno/Crn*0.700.59–0.790.990.0060.004
    Chon*0.770.67–0.851.370.0010.001
    Cho*0.710.60–0.8010,5940.0370.024
    NAAn*0.740.64–0.830.662.4 e−049 e−05
    NAA*0.720.61–0.8122,1290.0030.001
    mInon*0.700.59–0.790.870.010.01
    FETn, Cho/NAAn0.900.82–0.94NA2.6 e−066.2 e−05; 0.305
    FETn, Cho/NAA0.890.81–0.94NA2.4 e−063.5 e−05; 0.563

    • ↵* P < 0.05 in all terms of model.

    • NA = not applicable.

    • All models contain constant and 1 or 2 linear terms, which represent level of markers 18F-FET, Cho, NAA, Cr, mIno, and ratios thereof. Table is limited to results in which normalized metabolite signal reached AUC of 0.70 or more.

  • TABLE 2.

    Results of Leave-One-Out Cross-Validation

    Parameter18F-FETCho/NAA
    Mean AUC ± SD0.89 ± 0.0030.81 ± 0.004
    Mean threshold ± SD1.4 ± 0.012.16 ± 0.04
    Accuracy0.780.71
    Sensitivity0.760.59
    Specificity0.800.83
    Positive predictive value0.790.78
    Negative predictive value0.770.67

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