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<p>MRI is the preferred method for follow-up imaging of post-treatment WHO grade 3 or 4 gliomas. While positron emission tomography with O-(2-[<sup>18</sup>F]fluoroethyl)-L-tyrosine) (<sup>18</sup>F-FET PET) offers higher diagnostic accuracy, its use is limited due to low availability. We propose a sequential, threshold-based workflow to triage patients for additional <sup>18</sup>F-FET PET scans based on MRI dynamic susceptibility contrast (DSC) perfusion-derived rCBV values, to optimize <sup>18</sup>F-FET PET resource allocation. Patients with high-grade gliomas who had undergone standard-of-care treatment and developed new or enlarging contrast-enhancing post-treatment lesions on MRI were included, with a <sup>18</sup>F-FET PET study performed within 4 months of the MRI. Patients were excluded if there were significant changes in lesion size or treatment between the MRI and <sup>18</sup>F-FET PET scan. An rCBV threshold was determined and the performance of a threshold-based imaging workflow was evaluated compared to the gold standard defined here as surgical verification or long-term imaging follow-up without further intervention. Forty-one patients with a total of 49 lesions were included (tumor progression <i>n</i> = 40, treatment-related changes <i>n</i> = 9). Above the rCBV threshold of 2.4, MRI was 100% accurate (21/21 patients) in diagnosing tumor progression. Below the threshold, MRI identified 9 true negatives but produced 19 false negatives. <sup>18</sup>F-FET PET reclassified 18/19 (95%) false negatives resulting in an overall accuracy of 48/49 (98%) for the workflow. Our MRI DSC perfusion rCBV-based threshold workflow for triaging patients for additional <sup>18</sup>F-FET PET imaging in post-treatment high grade glioma has the potential to optimize <sup>18</sup>F-FET PET resource allocation.</p>

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An effective MRI perfusion threshold based workflow to triage additional 18F-FET PET in posttreatment high grade glioma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月5日

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  • Krishna Ranjith Kadali,
  • Nathalie Nierobisch,
  • Fabienne Maibach,
  • Philip Heesen,
  • Paula Alcaide-Leon,
  • Martin Hüllner,
  • Michael Weller,
  • Zsolt Kulcsar,
  • Nicolin Hainc

摘要

MRI is the preferred method for follow-up imaging of post-treatment WHO grade 3 or 4 gliomas. While positron emission tomography with O-(2-[18F]fluoroethyl)-L-tyrosine) (18F-FET PET) offers higher diagnostic accuracy, its use is limited due to low availability. We propose a sequential, threshold-based workflow to triage patients for additional 18F-FET PET scans based on MRI dynamic susceptibility contrast (DSC) perfusion-derived rCBV values, to optimize 18F-FET PET resource allocation. Patients with high-grade gliomas who had undergone standard-of-care treatment and developed new or enlarging contrast-enhancing post-treatment lesions on MRI were included, with a 18F-FET PET study performed within 4 months of the MRI. Patients were excluded if there were significant changes in lesion size or treatment between the MRI and 18F-FET PET scan. An rCBV threshold was determined and the performance of a threshold-based imaging workflow was evaluated compared to the gold standard defined here as surgical verification or long-term imaging follow-up without further intervention. Forty-one patients with a total of 49 lesions were included (tumor progression n = 40, treatment-related changes n = 9). Above the rCBV threshold of 2.4, MRI was 100% accurate (21/21 patients) in diagnosing tumor progression. Below the threshold, MRI identified 9 true negatives but produced 19 false negatives. 18F-FET PET reclassified 18/19 (95%) false negatives resulting in an overall accuracy of 48/49 (98%) for the workflow. Our MRI DSC perfusion rCBV-based threshold workflow for triaging patients for additional 18F-FET PET imaging in post-treatment high grade glioma has the potential to optimize 18F-FET PET resource allocation.