11C-choline PET/CT tumor recurrence detection and survival prediction in post-treatment patients with high-grade gliomas

Abstract

The aim of the present study is to evaluate the role of (11)C-choline positron emission tomography/computed tomography (PET/CT) in detecting tumor recurrence and predicting survival in post-treatment patients with high-grade gliomas. A total of 16 previously treated histopathologically proven high-grade glioma patients were subjected to (11)C-choline PET/CT scan and survival analysis. We found that the sensitivity and specificity of (11)C-choline PET/CT were 100 and 70 %, whereas those of Gd-MRI were 83.3 and 60 %, respectively. By Cox regression analysis, (11)C-choline T/N ratio correlated obviously with overall survival (OS) (hazard ratio = 2.644, 95 % confidence interval [CI] = 1.027-6.807, p = 0.044) independent of Karnofsky performance score. Patients with lower T/N ratio (tumor uptake/normal brain tissue uptake) (≤1.42) had longer survival times than patients with higher T/N ratio (median OS = 15.4 vs. 5.3 months, p < 0.001; progression-free survival (PFS) =4.5 vs. 0.8 months, p = 0.004). Thus, this preliminary study suggests that (11)C-choline PET/CT is highly sensitive in detecting tumor recurrence in post-treatment patients with high-grade gliomas. Moreover, our preliminary results suggest that T/N ratio measured by (11)C-choline maybe serves as a predictor of patients' survival with suspected recurrent glioma.

Prognostic Value of MTV, SUVmax and the T/N Ratio of PET/CT in Patients with Glioma: A Systematic Review and Meta-Analysis

“…Considering definitions of these five indicators (T/CL, G/C, T/CL, TNR, SUVmax/BG) had analogous summarization with T/N ratio, we eliminated difference of terminology among studies and combined these parameters as T/N ratio. Thus, 35 studies evaluated T/N ratio with 23 studies 34-38, 40, 41, 45, 48, 50, 51, 53-62 for OS and 12 studies 34, 38, 41-45, 51, 55, 63, 64 for PFS were analyzed in our meta-analysis. Moreover, the eligible articles authored by Takuya Toyonaga 40 and Akira Toriihara 51 both investigated two different types of PET/CT so that we regarded each article as two studies.…”

18F-FCho PET and MRI for the prediction of response in glioblastoma patients according to the RANO criteria

“…In another 11 C-choline PET study, Li et al [30] reported that a tumor-to-brain ratio up to 1.4 might predict a longer overall survival in patients with suspected recurrent glioma after treatment. It is, however, noteworthy that in the literature (early), PET response in malignant glioma is defined as decreased tracer uptake over time, but that proposed thresholds vary strongly between studies [13,14,[27][28][29][30]. Importantly, different PET tracers visualize different biological processes, which probably (partly) explain the different threshold values.…”

PET/CT with 18 F–choline: Physiological whole bio-distribution in male and female subjects and diagnostic pitfalls on 1000 prostate cancer patients

“…All these experiences probably contributed to develop new clinical applications for radiolabeled choline PET/CT; some recently published papers investigate the possible role of this tracer in imaging brain tumors (BT) (17,18), parathyroid adenomas (19) and urothelial carcinoma (20). In fact, the uptake of radiolabeled choline can provide important information about the extension and growth of tumors (21) or inflammation (22).…”