Preoperative [11C]methionine PET to personalize treatment decisions in patients with lower-grade gliomas

Ninatti, Gaia; Sollini, Martina; Bono, Beatrice; Gozzi, Noemi; Fedorov, Daniil; Antunovic, Lidija; Gelardi, Fabrizia; Navarria, P.; Politi, Letterio S.; Pessina, Federico; Chiti, Arturo

doi:10.1093/neuonc/noac040

Cited by 23 publications

(10 citation statements)

References 52 publications

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“…The challenge to discriminate grade 2–3 astrocytomas from oligodendrogliomas remains, even though the fraction of PET positives among grade 2–3 oligodendrogliomas were larger. Oligodendrogliomas, especially grade 3, have a higher AA metabolism compared to IDH-mutated astrocytomas and are most commonly positive at AA PET compared to IDH mutated astrocytomas, as demonstrated both in this study and by Ninatti et al [ 54 ]. In this study, the group of included grade 2 oligodendrogliomas is larger than the group of grade 2 astrocytomas, and the group of grade 3 astrocytomas is larger than the group of grade 3 oligodendrogliomas.…”

Section: Discussionsupporting

confidence: 80%

Diagnostic accuracy of anti-3-[18F]-FACBC PET/MRI in gliomas

Karlberg,

Pedersen,

Vindstad

et al. 2023

Eur J Nucl Med Mol Imaging

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Purpose The primary aim was to evaluate whether anti-3-[18F]FACBC PET combined with conventional MRI correlated better with histomolecular diagnosis (reference standard) than MRI alone in glioma diagnostics. The ability of anti-3-[18F]FACBC to differentiate between molecular and histopathological entities in gliomas was also evaluated. Methods In this prospective study, patients with suspected primary or recurrent gliomas were recruited from two sites in Norway and examined with PET/MRI prior to surgery. Anti-3-[18F]FACBC uptake (TBRpeak) was compared to histomolecular features in 36 patients. PET results were then added to clinical MRI readings (performed by two neuroradiologists, blinded for histomolecular results and PET data) to assess the predicted tumor characteristics with and without PET. Results Histomolecular analyses revealed two CNS WHO grade 1, nine grade 2, eight grade 3, and 17 grade 4 gliomas. All tumors were visible on MRI FLAIR. The sensitivity of contrast-enhanced MRI and anti-3-[18F]FACBC PET was 61% (95%CI [45, 77]) and 72% (95%CI [58, 87]), respectively, in the detection of gliomas. Median TBRpeak was 7.1 (range: 1.4–19.2) for PET positive tumors. All CNS WHO grade 1 pilocytic astrocytomas/gangliogliomas, grade 3 oligodendrogliomas, and grade 4 glioblastomas/astrocytomas were PET positive, while 25% of grade 2–3 astrocytomas and 56% of grade 2–3 oligodendrogliomas were PET positive. Generally, TBRpeak increased with malignancy grade for diffuse gliomas. A significant difference in PET uptake between CNS WHO grade 2 and 4 gliomas (p < 0.001) and between grade 3 and 4 gliomas (p = 0.002) was observed. Diffuse IDH wildtype gliomas had significantly higher TBRpeak compared to IDH1/2 mutated gliomas (p < 0.001). Adding anti-3-[18F]FACBC PET to MRI improved the accuracy of predicted glioma grades, types, and IDH status, and yielded 13.9 and 16.7 percentage point improvement in the overall diagnoses for both readers, respectively. Conclusion Anti-3-[18F]FACBC PET demonstrated high uptake in the majority of gliomas, especially in IDH wildtype gliomas, and improved the accuracy of preoperatively predicted glioma diagnoses. Clinical trial registration ClinicalTrials.gov ID: NCT04111588, URL: https://clinicaltrials.gov/study/NCT04111588

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Section: Discussionsupporting

confidence: 80%

Diagnostic accuracy of anti-3-[18F]-FACBC PET/MRI in gliomas

Karlberg,

Pedersen,

Vindstad

et al. 2023

Eur J Nucl Med Mol Imaging

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“…For example, in addition to conventional CE MRI that might be negative, baseline 11 C-MET PET is particularly useful to characterize low-grade glioma. 35 Moreover, in pediatric high-grade glioma, it delineates the non-contrast-enhancing tumor regions, which are at increased risk for recurrence. 36 The present study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

“…CE reflects the blood-brain barrier disruption, but MET PET uptake reflects the l -type amino acid transporter 1 expression 34 ; hence, the MET uptake provides additional information to the CE MRI, with clinical implication. For example, in addition to conventional CE MRI that might be negative, baseline 11 C-MET PET is particularly useful to characterize low-grade glioma 35 . Moreover, in pediatric high-grade glioma, it delineates the non–contrast-enhancing tumor regions, which are at increased risk for recurrence 36 …”

Section: Discussionmentioning

confidence: 99%

Preoperative 11C-Methionine PET-MRI in Pediatric Infratentorial Tumors

Beuriat,

Flaus,

Portefaix

et al. 2024

Clin Nucl Med

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Purpose MRI is the main imaging modality for pediatric brain tumors, but amino acid PET can provide additional information. Simultaneous PET-MRI acquisition allows to fully assess the tumor and lower the radiation exposure. Although symptomatic posterior fossa tumors are typically resected, the patient management is evolving and will benefit from an improved preoperative tumor characterization. We aimed to explore, in children with newly diagnosed posterior fossa tumor, the complementarity of the information provided by amino acid PET and MRI parameters and the correlation to histopathological results. Patients and Methods Children with a newly diagnosed posterior fossa tumor prospectively underwent a preoperative 11C-methionine (MET) PET-MRI. Images were assessed visually and semiquantitatively. Using correlation, minimum apparent diffusion coefficient (ADCmin) and contrast enhancement were compared with MET SUVmax. The diameter of the enhancing lesions was compared with metabolic tumoral volume. Lesions were classified according to the 2021 World Health Organization (WHO) classification. Results Ten children were included 4 pilocytic astrocytomas, 2 medulloblastomas, 1 ganglioglioma, 1 central nervous system embryonal tumor, and 1 schwannoma. All lesions showed visually increased MET uptake. A negative moderate correlation was found between ADCmin and SUVmax values (r = −0.39). Mean SUVmax was 3.8 (range, 3.3–4.2) in WHO grade 4 versus 2.5 (range, 1.7–3.0) in WHO grade 1 lesions. A positive moderate correlation was found between metabolic tumoral volume and diameter values (r = 0.34). There was no correlation between SUVmax and contrast enhancement intensity (r = −0.15). Conclusions Preoperative 11C-MET PET and MRI could provide complementary information to characterize pediatric infratentorial tumors.

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“…Furthermore, accurate delineation of tumor extent to ensure a maximal resection is also of particular interest in patients with IDH-mutant gliomas, as even minimal tumor remnants after surgery may negatively impact overall survival [ 55 ]. A recent study by Ninatti et al compared the additional value of preoperative MET PET for delineating tumor extent in patients with IDH-mutant gliomas (i.e., oligodendrogliomas and astrocytomas of the WHO CNS grade 2 or 3) with anatomical MRI alone [ 56 ]. In that study, MET PET improved the target volume for surgical resection in 28 of 153 patients (25%).…”

Section: Most Important Clinical Applicationsmentioning

confidence: 99%

“…In that study, MET PET improved the target volume for surgical resection in 28 of 153 patients (25%). Moreover, in patients with IDH-mutant astrocytomas, higher maximum tumor-to-brain ratios on preoperative MET PET were independent predictors of shorter progression-free survival [ 56 ].…”

Section: Most Important Clinical Applicationsmentioning

confidence: 99%

Clinical applications and prospects of PET imaging in patients with IDH-mutant gliomas

et al. 2022

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PET imaging using radiolabeled amino acids in addition to MRI has become a valuable diagnostic tool in the clinical management of patients with brain tumors. This review provides a comprehensive overview of PET studies in glioma patients with a mutation in the isocitrate dehydrogenase gene (IDH). A considerable fraction of these tumors typically show no contrast enhancement on MRI, especially when classified as grade 2 according to the World Health Organization classification of Central Nervous System tumors. Major diagnostic challenges in this situation are differential diagnosis, target definition for diagnostic biopsies, delineation of glioma extent for treatment planning, differentiation of treatment-related changes from tumor progression, and the evaluation of response to alkylating agents. The main focus of this review is the role of amino acid PET in this setting. Furthermore, in light of clinical trials using IDH inhibitors targeting the mutated IDH enzyme for treating patients with IDH-mutant gliomas, we also aim to give an outlook on PET probes specifically targeting the IDH mutation, which appear potentially helpful for response assessment.

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Preoperative [11C]methionine PET to personalize treatment decisions in patients with lower-grade gliomas

Cited by 23 publications

References 52 publications

Diagnostic accuracy of anti-3-[18F]-FACBC PET/MRI in gliomas

Diagnostic accuracy of anti-3-[18F]-FACBC PET/MRI in gliomas

Preoperative 11C-Methionine PET-MRI in Pediatric Infratentorial Tumors

Clinical applications and prospects of PET imaging in patients with IDH-mutant gliomas

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