Dynamic ¹⁸F-FET PET is a powerful imaging biomarker in gadolinium-negative gliomas

Abstract

Background

We aimed to elucidate the place of dynamic O-(2-[ ¹⁸F]-fluoroethyl)-L-tyrosine ( ¹⁸F-FET) PET in prognostic models of gadolinium (Gd)-negative gliomas.

Methods

In 98 patients with Gd-negative gliomas undergoing ¹⁸F-FET PET guided biopsy, time activity curves (TACs) of each tumor were qualitatively categorized as either increasing or decreasing. Additionally, post-hoc quantitative analyses were done using minimal time-to-peak (TTP _min) measurements. Prognostic factors were obtained from multivariate hazards models. The fit of the biospecimen- and imaging-derived models was compared.

Results

A homogeneous increasing, mixed, and homogeneous decreasing TAC pattern was seen in 51, 19, and 28 tumors, respectively. Mixed TAC tumors exhibited both increasing and decreasing TACs. Corresponding adjusted 5-year survival was 85%, 47%, and 19%, respectively ( P < 0.001). Qualitative and quantitative TAC measurements were highly intercorrelated ( P < 0.0001). TTP _min was longest (shortest) in the homogeneous increasing (decreasing) TAC group and in between in the mixed TAC group. TTP _min was longer in isocitrate dehydrogenase ( IDH)-mutant tumors ( P < 0.001). Outcome was similarly precisely predicted by biospecimen- and imaging-derived models. In the biospecimen model, World Health Organization (WHO) grade ( P < 0.0001) and IDH status ( P < 0.001) were predictors for survival. Outcome of homogeneous increasing (homogeneous decreasing) TAC tumors was nearly identical, with both TTP _min > 25 min (TTP _min ≤ 12.5 min) tumors and IDH-mutant grade II ( IDH-wildtype) gliomas. Outcome of mixed TAC tumors matched that of both intermediate TTP _min (>12.5 min and ≤25 min) and IDH-mutant, grade III gliomas. Each of the 3 prognostic clusters differed significantly from the other ones of the respective models ( P < 0.001).

Conclusion

TAC measurements constitute a powerful biomarker independent from tumor grade and IDH status.