Diagnosis of Pseudoprogression Following Lomustine–Temozolomide Chemoradiation in Newly Diagnosed Glioblastoma Patients Using FET-PET

Werner, Jan-Michael; Weller, Johannes; Ceccon, Garry; Schaub, Christina; Tscherpel, Caroline; Lohmann, Philipp; Bauer, Elena; Schäfer, Niklas; Stoffels, Gabriele; Baues, Christian; Celik, Eren; Marnitz, Simone; Kabbasch, Christoph; Gielen, Gerrit H.; Fink, Gereon R.; Langen, Karl‐Josef; Herrlinger, Ulrich; Galldiks, Norbert

doi:10.1158/1078-0432.ccr-21-0471

Cited by 25 publications

(15 citation statements)

References 58 publications

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“…Kebir et al noted that the mean and maximum tumor-to-brain (TBR) 18 F-FET uptake ratios were increased in patients with enhancing lesions which presented 3 months after completion of CRT, suggesting its value in the evaluation of PsP (148). In a recent study by Werner et al, the mean TBR calculated from 18 F-FET-PET showed the highest accuracy among static and dynamic 18 F-FET uptake parameters (149). In the post-BVZ setting, George et al showed that 18 F-FET uptake decreases after BVZ therapy and only moderately correlates with contrastenhanced T1 signal intensity; they also found that a high ratio of the 18 F-FET uptake before and after treatment as well as an increased correlation between 18 F-FET uptake and contrastenhancing signal were associated with poor PFS and OS (150).…”

Section: Amino Acid Pet Radiotracersmentioning

confidence: 99%

Conventional and Advanced Imaging Techniques in Post-treatment Glioma Imaging

Iv²

2022

Front. Radio

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Despite decades of advancement in the diagnosis and therapy of gliomas, the most malignant primary brain tumors, the overall survival rate is still dismal, and their post-treatment imaging appearance remains very challenging to interpret. Since the limitations of conventional magnetic resonance imaging (MRI) in the distinction between recurrence and treatment effect have been recognized, a variety of advanced MR and functional imaging techniques including diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), perfusion-weighted imaging (PWI), MR spectroscopy (MRS), as well as a variety of radiotracers for single photon emission computed tomography (SPECT) and positron emission tomography (PET) have been investigated for this indication along with voxel-based and more quantitative analytical methods in recent years. Machine learning and radiomics approaches in recent years have shown promise in distinguishing between recurrence and treatment effect as well as improving prognostication in a malignancy with a very short life expectancy. This review provides a comprehensive overview of the conventional and advanced imaging techniques with the potential to differentiate recurrence from treatment effect and includes updates in the state-of-the-art in advanced imaging with a brief overview of emerging experimental techniques. A series of representative cases are provided to illustrate the synthesis of conventional and advanced imaging with the clinical context which informs the radiologic evaluation of gliomas in the post-treatment setting.

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Section: Amino Acid Pet Radiotracersmentioning

confidence: 99%

Conventional and Advanced Imaging Techniques in Post-treatment Glioma Imaging

Iv²

2022

Front. Radio

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“…FET-PET performed a mean of 10 (SD, 7) days after the equivocal MR imaging findings showed a high accuracy of 87% to identify pseudoprogression, with an improved specificity of 100%. 42 A combined analysis of arterial spin-labeled CBF and FDOPA uptake allowed high diagnostic performance in differentiating progression and pseudoprogression in treated gliomas. 43 Given the high sensitivity for identifying tumor progression, FET-PET MR imaging could change clinical management in nearly one-half of patients.…”

Section: Disease and Treatment Monitoring: Differentiation Betweenmentioning

confidence: 99%

Amino Acid Tracer PET MRI in Glioma Management: What a Neuroradiologist Needs to Know

Soni¹,

Ora²,

Jena³

et al. 2023

AJNR Am J Neuroradiol

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PET with amino acid tracers provides additional insight beyond MR imaging into the biology of gliomas that can be used for initial diagnosis, delineation of tumor margins, planning of surgical and radiation therapy, assessment of residual tumor, and evaluation of posttreatment response. Hybrid PET MR imaging allows the simultaneous acquisition of various PET and MR imaging parameters in a single investigation with reduced scanning time and improved anatomic localization. This review aimed to provide neuroradiologists with a concise overview of the various amino acid tracers and a practical understanding of the clinical applications of amino acid PET MR imaging in glioma management. Future perspectives in newer advances, novel radiotracers, radiomics, and cost-effectiveness are also outlined.ABBREVIATIONS: AAT ¼ amino acid tracer; AA ¼ amino acid; ASCT ¼ alanine-serine-cysteine transporter; BTV ¼ biologic tumor volume; GBM ¼ glioblas-G liomas represent approximately 80% of malignant brain tumors, with an annual incidence rate of 5.6 cases per 100,000 individuals worldwide. Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor, representing approximately 50% of all gliomas and 16% of all brain tumors. 1 Depending on the size and extent of these tumors, the standard of care for newly diagnosed GBMs usually includes maximal surgical resection followed by radiation and chemotherapy. Despite substantial development in managing high-grade gliomas (HGGs), the median survival is ,15 months, with 1-and 5-year survival rates of 40% and 5.5%, respectively. 2 Imaging is crucial for diagnosing, guiding biopsy, surgical planning, and distinguishing treatment-related changes (TRC) from recurrence in glioma management. MR imaging is the primary imaging technique; however, it lacks specificity to distinguish between viable neoplastic tissue and tumor-free areas.Advanced MR imaging techniques such as PWI, DWI, DTI, MRS, and molecular imaging (PET) facilitate visualization and quantification of different metabolic processes and improve overall diagnostic performance in brain tumors. Hybrid PET MR imaging with novel radiotracers provides a noninvasive, simultaneous assessment of brain tumor morphologic, functional, metabolic, and molecular parameters. 3,4 This review aimed to provide neuroradiologists with a concise overview of the various amino acid tracers (AATs) and a practical understanding of the clinical applications of amino acid (AA) PET MR imaging in glioma management. We will review the current literature regarding AA-PET MR imaging in glioma treatment and discuss its role in the initial diagnosis, delineation of tumor margin, planning of radiation therapy, assessment of residual tumor, and evaluation of treatment response. We will sum up with future perspectives on newer advances, novel radiotracers, radiomics, and cost-effectiveness. RadiopharmaceuticalsThe Joint European Association of Nuclear Medicine (EANM)/ European Association of Neuro-Oncology (EANO)/Response Assessment in Neuro-Oncology (RA...

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“…This observation was consistent with those seen in several other studies utilizing dynamic AA PET. 24 , 26 , 28 In a later study, Werner et al diagnosed pseudoprogression with 87% accuracy using static [ 18 F]FET-PET in GBM patients treated with TMZ-lomustine RCT. The addition of dynamic parameter, TTP, further improved the diagnostic specificity and positive predictive value to 100%.…”

Section: Review Of Studiesmentioning

confidence: 99%

“… 34–36 In differentiating pseudoprogression from true progression, most studies utilized a TBR max threshold ranging from 1.9-2.3 with success. 18 , 25 , 28 , 31 In these studies, TBR values after treatment were used for diagnosis without comparison to pretreatment TBR. Similar to clinical outcome prediction, TBR max appears to be more accurate than TBR mean in diagnosing pseudoprogression.…”

Section: Review Of Studiesmentioning

confidence: 99%

“…In a later study by Werner et al, TTP again demonstrated additional value in the diagnosis of pseudoprogression when combined with TBR, increasing the specificity and positive predictive value to 100%. 28 Overall, dynamic analysis using [ 18 F]FET appears to increase the efficacy of AA PET in predicting treatment outcome and diagnosing pseudoprogression.…”

Section: Review Of Studiesmentioning

confidence: 99%

See 1 more Smart Citation

A systematic review of amino acid PET in assessing treatment response to temozolomide in glioma

Prather

O’Neal

Westrup

et al. 2022

Neuro-Oncology Advances

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The response assessment in neuro-oncology (RANO) criteria have been the gold standard for monoitoring treatment response in glioblastoma (GBM) and differentiating tumor progression from pseudoprogression. While the RANO criteria have played a key role in detecting early tumor progression, their ability to identify pseudoprogression is limited by post-treatment damage to the blood-brain barrier (BBB), which often leads to contrast-enhancement on MRI and correlates poorly to tumor status. Amino acid positron emission tomography (AA PET) is a rapidly growing imaging modality in neuro-oncology. While contrast-enhanced MRI relies on leaky vascularity or a compromised BBB for delivery of contrast agents, amino acid tracers can cross the BBB, making AA PET particularly well-suited for monitoring treatment response and diagnosing pseudoprogression. The authors performed a systematic review of PubMed, MEDLINE, and Embase through December 2021 with the search terms “temozolomide” OR “Temodar,” “glioma” OR “glioblastoma,” “PET,” and “amino acid.” There were 19 studies meeting inclusion criteria. Thirteen studies utilized [ 18F]FET, five utilized [ 11C]MET, and one utilized both. All studies used static AA PET parameters to evaluate TMZ treatment in glioma patients, with nine using dynamic tracer parameters in addition. Throughout these studies, AA PET demonstrated utility in TMZ treatment monitoring and predicting patient survival.

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Diagnosis of Pseudoprogression Following Lomustine–Temozolomide Chemoradiation in Newly Diagnosed Glioblastoma Patients Using FET-PET

Cited by 25 publications

References 58 publications

Conventional and Advanced Imaging Techniques in Post-treatment Glioma Imaging

Conventional and Advanced Imaging Techniques in Post-treatment Glioma Imaging

Amino Acid Tracer PET MRI in Glioma Management: What a Neuroradiologist Needs to Know

A systematic review of amino acid PET in assessing treatment response to temozolomide in glioma

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