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Background <p>Approximately 30–36% of gliomas presented with [<sup>18</sup>F]fluoroethyl-<span>l</span>-tyrosine ([<sup>18</sup>F]FET) PET-negative at primary diagnosis, which interferes with the differentiation of gliomas from other isolated brain lesions. Preoperative noninvasive identification of [<sup>18</sup>F]FET PET-negative gliomas to aggressive surgical treatment could reduce ineffective treatment and improve prognosis. This study aimed to assess the potential utility of multiparametric MRI with <sup>1</sup>H-magnetic resonance spectroscopy (<sup>1</sup>H-MRS) in the diagnosis of gliomas within [<sup>18</sup>F]FET PET-negative isolated cerebral lesions.</p> Results <p>A total of 51 patients (mean age 44.35 ± 27.15&#xa0;years, 26 males) with 37 gliomas and 14 non-gliomas were recruited for the study. More than half of PET-negative gliomas presented T2-FLAIR mismatch sign, whereas non-gliomas were more likely to present absence of T2-FLAIR mismatch sign (54.05% vs. 7.14%, <i>p</i> &lt; 0.001). Choline to creatine (Cho/Cr) ratios in gliomas were significantly higher than those in non-gliomas (2.21 vs. 1.30, <i>p</i> &lt; 0.001). Multiparametric MRI (AUC = 0.88) outperformed conventional MRI (AUC = 0.72) in differentiating gliomas from non-gliomas (NRI = 0.29, <i>p</i> = 0.02). And WHO grade was correlated with Cho/Cr and total lesion tracer standardized uptake (TLU) (r = 0.43 and 0.55; <i>p</i> = 0.007 and &lt; 0.001; respectively). Low-grade PET-negative gliomas exhibit low levels of both TLU and Cho/Cr, but the distribution of TLU and Cho/Cr is more variable in high-grade gliomas. Furthermore, there was a moderated correlation between TLU and Cho/Cr in low-grade PET-negative gliomas (r = 0.54, <i>p</i> = 0.017), whereas there was no correlation in the high-grade PET-negative gliomas (r = -0.017, <i>p</i> = 0.95).</p> Conclusion <p>Multiparametric MRI with <sup>1</sup>H-MRS demonstrates significant promise in enhancing the diagnosis and overall clinical management for [<sup>18</sup>F]FET PET-negative gliomas. Moreover, the correlation between TLU and Cho/Cr that was affected by tumor grading of 2021 WHO criteria provides a rationale for further research into the mechanisms of reduced [<sup>18</sup>F]FET uptake in gliomas.</p>

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Magnetic resonance spectroscopy for enhanced multiparametric MRI characterization of [18F]FET PET-negative gliomas

  • 期刊论文

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  • 发表日期：

    2025年4月7日

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  • Xiaoran Li,
  • Xinru Xiao,
  • Xin Han,
  • Ye Cheng,
  • Bixiao Cui,
  • Meng Zhang,
  • Huawei Liu,
  • Jie Lu

摘要

Background

Approximately 30–36% of gliomas presented with [18F]fluoroethyl-l-tyrosine ([18F]FET) PET-negative at primary diagnosis, which interferes with the differentiation of gliomas from other isolated brain lesions. Preoperative noninvasive identification of [18F]FET PET-negative gliomas to aggressive surgical treatment could reduce ineffective treatment and improve prognosis. This study aimed to assess the potential utility of multiparametric MRI with 1H-magnetic resonance spectroscopy (1H-MRS) in the diagnosis of gliomas within [18F]FET PET-negative isolated cerebral lesions.

Results

A total of 51 patients (mean age 44.35 ± 27.15 years, 26 males) with 37 gliomas and 14 non-gliomas were recruited for the study. More than half of PET-negative gliomas presented T2-FLAIR mismatch sign, whereas non-gliomas were more likely to present absence of T2-FLAIR mismatch sign (54.05% vs. 7.14%, p < 0.001). Choline to creatine (Cho/Cr) ratios in gliomas were significantly higher than those in non-gliomas (2.21 vs. 1.30, p < 0.001). Multiparametric MRI (AUC = 0.88) outperformed conventional MRI (AUC = 0.72) in differentiating gliomas from non-gliomas (NRI = 0.29, p = 0.02). And WHO grade was correlated with Cho/Cr and total lesion tracer standardized uptake (TLU) (r = 0.43 and 0.55; p = 0.007 and < 0.001; respectively). Low-grade PET-negative gliomas exhibit low levels of both TLU and Cho/Cr, but the distribution of TLU and Cho/Cr is more variable in high-grade gliomas. Furthermore, there was a moderated correlation between TLU and Cho/Cr in low-grade PET-negative gliomas (r = 0.54, p = 0.017), whereas there was no correlation in the high-grade PET-negative gliomas (r = -0.017, p = 0.95).

Conclusion

Multiparametric MRI with 1H-MRS demonstrates significant promise in enhancing the diagnosis and overall clinical management for [18F]FET PET-negative gliomas. Moreover, the correlation between TLU and Cho/Cr that was affected by tumor grading of 2021 WHO criteria provides a rationale for further research into the mechanisms of reduced [18F]FET uptake in gliomas.