RT Journal Article
SR Electronic
T1 Diagnostic Accuracy of MR Spectroscopic Imaging and <sup>18</sup>F-FET PET for Identifying Glioma: A Biopsy-Controlled Hybrid PET/MRI Study
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP jnumed.123.265868
DO 10.2967/jnumed.123.265868
A1 Mauler, Jörg
A1 Lohmann, Philipp
A1 Maudsley, Andrew A.
A1 Sheriff, Sulaiman
A1 Hoevels, Moritz
A1 Meissner, Anna-Katharina
A1 Hamisch, Christina
A1 Brunn, Anna
A1 Deckert, Martina
A1 Filss, Christian P.
A1 Stoffels, Gabriele
A1 Dammers, Jürgen
A1 Ruge, Maximillian I.
A1 Galldiks, Norbert
A1 Mottaghy, Felix M.
A1 Langen, Karl-Josef
A1 Shah, N. Jon
YR 2023
UL http://jnm.snmjournals.org/content/early/2023/10/26/jnumed.123.265868.abstract
AB Contrast-enhanced MRI is the method of choice for brain tumor diagnostics, despite its low specificity for tumor tissue. This study compared the contribution of MR spectroscopic imaging (MRSI) and amino acid PET to improve the detection of tumor tissue. Methods: In 30 untreated patients with suspected glioma, O-(2-[18F]fluoroethyl)-l-tyrosine (18F-FET) PET; 3-T MRSI with a short echo time; and fluid-attenuated inversion recovery, T2-weighted, and contrast-enhanced T1-weighted MRI were performed for stereotactic biopsy planning. Serial samples were taken along the needle trajectory, and their masks were projected to the preoperative imaging data. Each sample was individually evaluated neuropathologically. 18F-FET uptake and the MRSI signals choline (Cho), N-acetyl-aspartate (NAA), creatine, myoinositol, and derived ratios were evaluated for each sample and classified using logistic regression. The diagnostic accuracy was evaluated by receiver operating characteristic analysis. Results: On the basis of the neuropathologic evaluation of tissue from 88 stereotactic biopsies, supplemented with 18F-FET PET and MRSI metrics from 20 areas on the healthy-appearing contralateral hemisphere to balance the glioma/nonglioma groups, 18F-FET PET identified glioma with the highest accuracy (area under the receiver operating characteristic curve, 0.89; 95% CI, 0.81–0.93; threshold, 1.4 × background uptake). Among the MR spectroscopic metabolites, Cho/NAA normalized to normal brain tissue showed the highest diagnostic accuracy (area under the receiver operating characteristic curve, 0.81; 95% CI, 0.71–0.88; threshold, 2.2). The combination of 18F-FET PET and normalized Cho/NAA did not improve the diagnostic performance. Conclusion: MRI-based delineation of gliomas should preferably be supplemented by 18F-FET PET.