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European Journal of Nuclear Medicine and Molecular Imaging

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01-11-2019 | Glioma | Original Article

Non-invasive prediction of IDH-wildtype genotype in gliomas using dynamic ¹⁸F-FET PET

Authors: Franziska Vettermann, Bogdana Suchorska, Marcus Unterrainer, Debie Nelwan, Robert Forbrig, Viktoria Ruf, Vera Wenter, Friedrich-Wilhelm Kreth, Jochen Herms, Peter Bartenstein, Jörg-Christian Tonn, Nathalie L. Albert

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 12/2019

Abstract

Purpose

According to the updated WHO classification of gliomas with its emphasis on molecular parameters, tumours with an IDH-wildtype status have a dismal prognosis. To ensure timely adjustment of treatment, demand for non-invasive prediction methods is high. ¹⁸F-FET PET has been shown to be an important diagnostic tool for glioma management. The aim of this study was to assess the value of dynamic ¹⁸F-FET PET for the non-invasive prediction of the IDH-mutation status.

Methods

Newly diagnosed WHO grade II–IV glioma patients with MRI and dynamic ¹⁸F-FET PET were included. The ¹⁸F-FET PET parameters mean and maximal tumour-to-background ratio (TBR_mean, TBR_max) and minimal time-to-peak (TTP_min) were evaluated. The diagnostic power for the prediction of the IDH genotype (positive/negative predictive value) was tested in the overall study group and in the subgroup of non-contrast enhancing gliomas.

Results

Three hundred forty-one patients were evaluated. Molecular analyses revealed 178 IDH-mutant and 163 IDH-wildtype tumours. Overall, 270/341 gliomas were classified as ¹⁸F-FET-positive (TBR_max > 1.6), 90.2% of the IDH-wildtype and 69.1% of IDH-mutant gliomas. Median TBR_max was significantly higher in IDH-wildtype compared with IDH-mutant gliomas (2.9 vs. 2.3, p < 0.001); however, ROC-analyses revealed no reliable cutoff due to a high overlap (range 1.0–7.1 vs. 1.1–7.9). Dynamic analysis revealed a significantly shorter TTP_min in IDH-wildtype gliomas; using TTP_min ≤ 12.5 min as indicator for IDH-wildtype gliomas, a positive predictive value of 87% was reached (negative predictive value 72%, AUC = 0.796, p ≤ 0.001). A total of 161/341 gliomas did not show contrast enhancement on MRI; even within this subgroup, TTP_min ≤ 12.5 min remained a good predictor of IDH-wildtype glioma (positive predictive value 83%, negative predictive value 90%; AUC = 0.868, p < 0.001).

Conclusion

A short TTP_min in dynamic ¹⁸F-FET PET serves as good predictor of highly aggressive IDH-wildtype status in gliomas. In particular, a high diagnostic power was observed in the subgroup of non-contrast enhancing gliomas, which helps to identify patients with worse prognosis.

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Title: Non-invasive prediction of IDH-wildtype genotype in gliomas using dynamic 18F-FET PET
Authors: Franziska Vettermann
Bogdana Suchorska
Marcus Unterrainer
Debie Nelwan
Robert Forbrig
Viktoria Ruf
Vera Wenter
Friedrich-Wilhelm Kreth
Jochen Herms
Peter Bartenstein
Jörg-Christian Tonn
Nathalie L. Albert
Publication date: 01-11-2019
Publisher: Springer Berlin Heidelberg
Keywords: Glioma
Glioma
Glioma
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 12/2019
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-019-04477-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Non-invasive prediction of IDH-wildtype genotype in gliomas using dynamic ¹⁸F-FET PET

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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