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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 5/2015

01-04-2015 | Original Article

Diagnosis of pseudoprogression in patients with glioblastoma using O-(2-[18F]fluoroethyl)-l-tyrosine PET

Authors: Norbert Galldiks, Veronika Dunkl, Gabriele Stoffels, Markus Hutterer, Marion Rapp, Michael Sabel, Guido Reifenberger, Sied Kebir, Franziska Dorn, Tobias Blau, Ulrich Herrlinger, Peter Hau, Maximilian I. Ruge, Martin Kocher, Roland Goldbrunner, Gereon R. Fink, Alexander Drzezga, Matthias Schmidt, Karl-Josef Langen

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 5/2015

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Abstract

Purpose

The follow-up of glioblastoma patients after radiochemotherapy with conventional MRI can be difficult since reactive alterations to the blood–brain barrier with contrast enhancement may mimic tumour progression (i.e. pseudoprogression, PsP). The aim of this study was to assess the clinical value of O-(2-18F-fluoroethyl)-l-tyrosine (18F-FET) PET in the differentiation of PsP and early tumour progression (EP) after radiochemotherapy of glioblastoma.

Methods

A group of 22 glioblastoma patients with new contrast-enhancing lesions or lesions showing increased enhancement (>25 %) on standard MRI within the first 12 weeks after completion of radiochemotherapy with concomitant temozolomide (median 7 weeks) were additionally examined using amino acid PET with 18F-FET. Maximum and mean tumour-to-brain ratios (TBRmax, TBRmean) were determined. 18F-FET uptake kinetic parameters (i.e. patterns of time–activity curves, TAC) were also evaluated. Classification as PsP or EP was based on the clinical course (no treatment change at least for 6 months), follow-up MR imaging and/or histopathological findings. Imaging results were also related to overall survival (OS).

Results

PsP was confirmed in 11 of the 22 patients. In patients with PsP, 18F-FET uptake was significantly lower than in patients with EP (TBRmax 1.9 ± 0.4 vs. 2.8 ± 0.5, TBRmean 1.8 ± 0.2 vs. 2.3 ± 0.3; both P < 0.001) and presence of MGMT promoter methylation was significantly more frequent (P = 0.05). Furthermore, a TAC type II or III was more frequently present in patients with EP (P = 0.04). Receiver operating characteristic analysis showed that the optimal 18F-FET TBRmax cut-off value for identifying PsP was 2.3 (sensitivity 100 %, specificity 91 %, accuracy 96 %, AUC 0.94 ± 0.06; P < 0.001). Univariate survival analysis showed that a TBRmax <2.3 predicted a significantly longer OS (median OS 23 vs. 12 months; P = 0.046).

Conclusion

18F-FET PET may facilitate the diagnosis of PsP following radiochemotherapy of glioblastoma.
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Metadata
Title
Diagnosis of pseudoprogression in patients with glioblastoma using O-(2-[18F]fluoroethyl)-l-tyrosine PET
Authors
Norbert Galldiks
Veronika Dunkl
Gabriele Stoffels
Markus Hutterer
Marion Rapp
Michael Sabel
Guido Reifenberger
Sied Kebir
Franziska Dorn
Tobias Blau
Ulrich Herrlinger
Peter Hau
Maximilian I. Ruge
Martin Kocher
Roland Goldbrunner
Gereon R. Fink
Alexander Drzezga
Matthias Schmidt
Karl-Josef Langen
Publication date
01-04-2015
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 5/2015
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-014-2959-4

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