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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 12/2017

01-11-2017 | Original Article

Grading and outcome prediction of pediatric diffuse astrocytic tumors with diffusion and arterial spin labeling perfusion MRI in comparison with 18F–DOPA PET

Authors: Giovanni Morana, Arnoldo Piccardo, Domenico Tortora, Matteo Puntoni, Mariasavina Severino, Paolo Nozza, Marcello Ravegnani, Alessandro Consales, Samantha Mascelli, Alessandro Raso, Manlio Cabria, Antonio Verrico, Claudia Milanaccio, Andrea Rossi

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 12/2017

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Abstract

Purpose

The aim of this study was to investigate MRI-derived diffusion weighted imaging (DWI) and arterial spin labeling (ASL) perfusion imaging in comparison with 18F–dihydroxyphenylalanine (DOPA) PET with respect to diagnostic performance in tumor grading and outcome prediction in pediatric patients with diffuse astrocytic tumors (DAT).

Methods

We retrospectively analyzed 26 children with histologically proven treatment naïve low and high grade DAT who underwent ASL and DWI performed within 2 weeks of 18F–DOPA PET. Relative ASL-derived cerebral blood flow max (rCBF max) and DWI-derived minimum apparent diffusion coefficient (rADC min) were compared with 18F–DOPA uptake tumor/normal tissue (T/N) and tumor/striatum (T/S) ratios, and correlated with World Health Organization (WHO) tumor grade and progression-free survival (PFS). Statistics included Pearson’s chi-square and Mann-Whitney U tests, Spearman’s rank correlation, receiver operating characteristic (ROC) analysis, discriminant function analysis (DFA), Kaplan-Meier survival curve, and Cox analysis.

Results

A significant correlation was demonstrated between rCBF max, rADC min, and 18F–DOPA PET data (p < 0.001). Significant differences in terms of rCBF max, rADC min, and 18F–DOPA uptake were found between low- and high-grade DAT (p ≤ 0.001). ROC analysis and DFA demonstrated that T/S and T/N values were the best parameters for predicting tumor progression (AUC 0.93, p < 0.001). On univariate analysis, all diagnostic tools correlated with PFS (p ≤ 0.001); however, on multivariate analysis, only 18F–DOPA uptake remained significantly associated with outcome (p ≤ 0.03), while a trend emerged for rCBF max (p = 0.09) and rADC min (p = 0.08). The combination of MRI and PET data increased the predictive power for prognosticating tumor progression (AUC 0.97, p < 0.001).

Conclusions

DWI, ASL and 18F–DOPA PET provide useful complementary information for pediatric DAT grading. 18F–DOPA uptake better correlates with PFS prediction. Combining MRI and PET data provides the highest predictive power for prognosticating tumor progression suggesting a synergistic role of these diagnostic tools.
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Metadata
Title
Grading and outcome prediction of pediatric diffuse astrocytic tumors with diffusion and arterial spin labeling perfusion MRI in comparison with 18F–DOPA PET
Authors
Giovanni Morana
Arnoldo Piccardo
Domenico Tortora
Matteo Puntoni
Mariasavina Severino
Paolo Nozza
Marcello Ravegnani
Alessandro Consales
Samantha Mascelli
Alessandro Raso
Manlio Cabria
Antonio Verrico
Claudia Milanaccio
Andrea Rossi
Publication date
01-11-2017
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 12/2017
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-017-3777-2

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