[en] In the follow-up of patients treated for high grade glioma, differentiation between progressive disease (PD) and treatment-induced necrosis (TIN) is challenging. The purpose of this study is to evaluate the diagnostic accuracy of FDG PET for the differentiation between TIN and PD after high grade glioma treatment. We retrospectively identified patients between January 2011 and July 2013 that met the following criteria: age >18; glioma grade 3 or 4; treatment with radiotherapy or chemoradiotherapy; new or progressive enhancement on post treatment MRI; FDG PET within 4 weeks of MRI. Absolute and relative (to contralateral white matter) values of SUVmax and SUVpeak were determined in new enhancing lesions on MRI. The outcome of PD or TIN was determined by neurosurgical biopsy/resection, follow-up MRI, or clinical deterioration. The association between FDG PET and outcome was analyzed with univariate logistic regression and ROC analysis for: all lesions, lesions >10, >15, and >20 mm. We included 30 patients (5 grade 3 and 25 grade 4), with 39 enhancing lesions on MRI. Twenty-nine lesions represented PD and 10 TIN. Absolute and relative values of SUVmax and SUVpeak showed no significant differences between PD and TIN. ROC analysis showed highest AUCs for relative SUVpeak in all lesion sizes. Relative SUVpeak for lesions >20 mm showed reasonable discriminative properties [AUC 0.69 (0.41-0.96)]. FDG PET has reasonable discriminative properties for differentiation of PD from TIN in high grade gliomas larger than 20 mm. Overall diagnostic performance is insufficient to guide clinical decision-making.
Disciplines :
Genetics & genetic processes
Author, co-author :
Dankbaar, J. W.
Snijders, T. J.
Robe, Pierre ; Université de Liège > Département des sciences biomédicales et précliniques > Département des sciences biomédicales et précliniques
Seute, T.
Eppinga, W.
Hendrikse, J.
De Keizer, B.
Language :
English
Title :
The use of (18)F-FDG PET to differentiate progressive disease from treatment induced necrosis in high grade glioma.
Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, Ludwin SK, Allgeier A, Fisher B, Belanger K et al (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10(5):459–466
Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352(10):987–996
Weller M, van den Bent M, Hopkins K, Tonn JC, Stupp R, Falini A, Cohen-Jonathan-Moyal E, Frappaz D, Henriksson R, Balana C et al (2014) EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol 15(9):e395–e403
Hygino da Cruz LC Jr, Rodriguez I, Domingues RC, Gasparetto EL, Sorensen AG (2011) Pseudoprogression and pseudoresponse: imaging challenges in the assessment of posttreatment glioma. AJNR Am J Neuroradiol 32(11):1978–1985
Brandes AA, Tosoni A, Spagnolli F, Frezza G, Leonardi M, Calbucci F, Franceschi E (2008) Disease progression or pseudoprogression after concomitant radiochemotherapy treatment: pitfalls in neurooncology. Neuro-oncology 10(3):361–367
Taal W, Brandsma D, de Bruin HG, Bromberg JE, Swaak-Kragten AT, Smitt PA, van Es CA, van den Bent MJ (2008) Incidence of early pseudo-progression in a cohort of malignant glioma patients treated with chemoirradiation with temozolomide. Cancer 113(2):405–410
Verma N, Cowperthwaite MC, Burnett MG, Markey MK (2013) Differentiating tumor recurrence from treatment necrosis: a review of neuro-oncologic imaging strategies. Neuro-oncology 15(5):515–534
Delbeke D, Meyerowitz C, Lapidus RL, Maciunas RJ, Jennings MT, Moots PL, Kessler RM (1995) Optimal cutoff levels of F-18 fluorodeoxyglucose uptake in the differentiation of low-grade from high-grade brain tumors with PET. Radiology 195(1):47–52
Goldman S, Levivier M, Pirotte B, Brucher JM, Wikler D, Damhaut P, Stanus E, Brotchi J, Hildebrand J (1996) Regional glucose metabolism and histopathology of gliomas. A study based on positron emission tomography-guided stereotactic biopsy. Cancer 78(5):1098–1106
Bal H, Guerin L, Casey ME, Conti M, Eriksson L, Michel C, Fanti S, Pettinato C, Adler S, Choyke P (2014) Improving PET spatial resolution and detectability for prostate cancer imaging. Phys Med Biol 59(15):4411–4426
Jambor I, Borra R, Kemppainen J, Lepomaki V, Parkkola R, Dean K, Alanen K, Arponen E, Nurmi M, Aronen HJ et al (2012) Improved detection of localized prostate cancer using co-registered MRI and 11C-acetate PET/CT. Eur J Radiol 81(11):2966–2972
Salamon N, Kung J, Shaw SJ, Koo J, Koh S, Wu JY, Lerner JT, Sankar R, Shields WD, Engel J Jr et al (2008) FDG-PET/MRI coregistration improves detection of cortical dysplasia in patients with epilepsy. Neurology 71(20):1594–1601
Reardon DA, Vredenburgh JJ, Desjardins A, Peters KB, Sathornsumetee S, Threatt S, Sampson JH, Herndon JE 2nd, Coan A, McSherry F et al (2012) Phase 1 trial of dasatinib plus erlotinib in adults with recurrent malignant glioma. J Neurooncol 108(3):499–506
van den Bent MJ, Brandes AA, Taphoorn MJ, Kros JM, Kouwenhoven MC, Delattre JY, Bernsen HJ, Frenay M, Tijssen CC, Grisold W et al (2013) Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951. J Clin Oncol 31(3):344–350
Ricci PE, Karis JP, Heiserman JE, Fram EK, Bice AN, Drayer BP (1998) Differentiating recurrent tumor from radiation necrosis: time for re-evaluation of positron emission tomography? AJNR Am J Neuroradiol 19(3):407–413
Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, Degroot J, Wick W, Gilbert MR, Lassman AB et al (2010) Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 28(11):1963–1972
Chinot OL, Macdonald DR, Abrey LE, Zahlmann G, Kerloeguen Y, Cloughesy TF (2013) Response assessment criteria for glioblastoma: practical adaptation and implementation in clinical trials of antiangiogenic therapy. Curr Neurol Neurosci Rep 13(5):347
Koopman D, van Dalen JA, Lagerweij MC, Arkies H, Boer J, Oostdijk AH, Slump CH, Jager PL (2015) Improving the detection of small lesions using a state-of-the-art time-of-flight PET/CT system and small voxel reconstructions. Journal of nuclear medicine technology
Jakoby BW, Bercier Y, Conti M, Casey ME, Bendriem B, Townsend DW (2011) Physical and clinical performance of the mCT time-of-flight PET/CT scanner. Phys Med Biol 56(8):2375–2389
Nihashi T, Dahabreh IJ, Terasawa T (2013) Diagnostic accuracy of PET for recurrent glioma diagnosis: a meta-analysis. AJNR Am J Neuroradiol 34(5):944–950 S941–S911
Deng SM, Zhang B, Wu YW, Zhang W, Chen YY (2013) Detection of glioma recurrence by (1)(1)C-methionine positron emission tomography and dynamic susceptibility contrast-enhanced magnetic resonance imaging: a meta-analysis. Nucl Med Commun 34(8):758–766
Galldiks N, Dunkl V, Stoffels G, Hutterer M, Rapp M, Sabel M, Reifenberger G, Kebir S, Dorn F, Blau T et al (2015) Diagnosis of pseudoprogression in patients with glioblastoma using O-(2-[(18)F]fluoroethyl)-l-tyrosine PET. Eur J Nucl Med Mol Imaging 42(5):685–695
Barajas RF Jr, Chang JS, Segal MR, Parsa AT, McDermott MW, Berger MS, Cha S (2009) Differentiation of recurrent glioblastoma multiforme from radiation necrosis after external beam radiation therapy with dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. Radiology 253(2):486–496
Gahramanov S, Raslan AM, Muldoon LL, Hamilton BE, Rooney WD, Varallyay CG, Njus JM, Haluska M, Neuwelt EA (2011) Potential for differentiation of pseudoprogression from true tumor progression with dynamic susceptibility-weighted contrast-enhanced magnetic resonance imaging using ferumoxytol vs. gadoteridol: a pilot study. Int J Radiat Oncol Biol Phys 79(2):514–523
Mangla R, Singh G, Ziegelitz D, Milano MT, Korones DN, Zhong J, Ekholm SE (2010) Changes in relative cerebral blood volume 1 month after radiation-temozolomide therapy can help predict overall survival in patients with glioblastoma. Radiology 256(2):575–584
Sundgren PC (2009) MR spectroscopy in radiation injury. AJNR Am J Neuroradiol 30(8):1469–1476
Lee WJ, Choi SH, Park CK, Yi KS, Kim TM, Lee SH, Kim JH, Sohn CH, Park SH, Kim IH (2012) Diffusion-weighted MR imaging for the differentiation of true progression from pseudoprogression following concomitant radiotherapy with temozolomide in patients with newly diagnosed high-grade gliomas. Acad Radiol 19(11):1353–1361
Zeng QS, Li CF, Liu H, Zhen JH, Feng DC (2007) Distinction between recurrent glioma and radiation injury using magnetic resonance spectroscopy in combination with diffusion-weighted imaging. Int J Radiat Oncol Biol Phys 68(1):151–158
Vos MJ, Tony BN, Hoekstra OS, Postma TJ, Heimans JJ, Hooft L (2007) Systematic review of the diagnostic accuracy of 201Tl single photon emission computed tomography in the detection of recurrent glioma. Nucl Med Commun 28(6):431–439
Jain R (2011) Perfusion CT imaging of brain tumors: an overview. AJNR Am J Neuroradiol 32(9):1570–1577
