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The quantification of dynamic FET PET imaging and correlation with the clinical outcome in patients with glioblastoma

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Published 28 August 2009 • 2009 Institute of Physics and Engineering in Medicine
, , Citation Frank Thiele et al 2009 Phys. Med. Biol. 54 5525 DOI 10.1088/0031-9155/54/18/012

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1 Philips Research Europe, Weisshausstrasse 2, 52066 Aachen, Germany

2 Department of Biology, University of Wuerzburg, 97074 Wuerzburg, Germany

3 Department of Radiation Oncology, RWTH Aachen University Hospital, 52074 Aachen, Germany

4 Institute of Neurosciences and Biophysics—Nuclear Chemistry, Research Center Juelich, 52425 Juelich, Germany

5 Department of Nuclear Medicine, RWTH Aachen University Hospital, 52074 Aachen, Germany

6 Author to whom any correspondence should be addressed

7 Present address: Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195, USA

Dates

  1. Received 28 May 2009
  2. Published

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0031-9155/54/18/5525

Abstract

The PET tracer O-(2-[18F]Fluoroethyl)-l-tyrosine (FET) has been shown to be valuable for different roles in the management of brain tumours. The aim of this study was to evaluate several quantitative measures of dynamic FET PET imaging in patients with resected glioblastoma. We evaluated dynamic FET PET in nine patients with histologically confirmed glioblastoma. Following FET PET, all subjects had radiation and chemotherapy. Tumour ROIs were defined by a threshold-based region-growing algorithm. We compared several standard measures of tumour uptake and uptake kinetics: SUV, SUV/background, distribution volume ratio (DVR), weighted frame differences and compartment model parameters. These measures were correlated with disease-free and overall survival, and analysed for statistical significance. We found that several measures allowed robust quantification. SUV and distribution volume did not correlate with clinical outcome. Measures that are based on a background region (SUV/BG, Logan-DVR) highly correlated with disease-free survival (r = −0.95, p < 0.0001), but not overall survival. Some advanced measures also showed a prognostic value but no improvement over the simpler methods. We conclude that FET PET probably has a prognostic value in patients with resected glioblastoma. The ratio of SUV to background may provide a simple and valuable predictive measure of the clinical outcome. Further studies are needed to confirm these explorative results.

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General scientific summary. Glioblastoma is the most aggressive primary brain tumour with median survival of only one year. Quantitative imaging of tumour activity is expected to improve radiation therapy planning by maximizing the radiation dose of cancerous tissue while sparing non-cancerous brain tissue. Positron emission tomography (PET) using the tracer O-(2-[18F]Fluoroethyl)-l-tyrosine (FET) has shown promising results in brain tumour imaging, but quantitative FET imaging has not been thoroughly investigated to date. We compared several methods of quantitative FET PET imaging, including static and dynamic imaging. The results of quantitative imaging were also correlated with the clinical outcome. Our results are an important contribution to the understanding of clinical utility and quantification of FET PET. We find that FET PET is a predictive factor for disease progression, and molecular imaging with FET might thus be a valuable tool in radiation therapy planning and therapy assessment.

10.1088/0031-9155/54/18/012