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• W2593588511 abstract "31 Objectives Simultaneous PET/MRI offers opportunity to evaluate glioma recurrence both with O-(2-18F-fluoroethyl)-L tyrosine (FET) PET and MRI together in a single examination in a short period of time. Kinetic evaluation using 40-50 minutes dynamic besides routine static FET-PET has shown to help differentiate tumor recurrence from reactive lesions reliably in case of post treatment glioma. The aim of this study was to evaluate role of gadolinium (Gd) enhanced 18F-fluoroethyl-L-tyrosine (18F-FET) PET/MRI in distinguishing tumor recurrence from radiation necrosis using simultaneously acquired multiple morphological and functional parameters. Also in a subanalysis, we evaluated feasibility of kinetic analysis of dynamic FET PET acquired in 25 minutes and its role in differentiating brain tumor recurrence & radiation necrosis. Methods 32 patients (26 males, 6 females; mean age±SD: 50.64±14.17) with enhancing brain lesions (n=32) on MRI post-surgery and radiation therapy were evaluated with simultaneously acquired Gd enhanced 18F FET PET/MRI protocol with images acquired for 25 minutes. They were then followed up with re-surgery and histopathological diagnosis (n=12) and/or clinical /MRI or PET/MRI based imaging follow up (n=20). PET/MRI images were analyzed using manually drawn regions of interest (ROI) over areas of maximal contrast enhancement and/or FET uptake. TBRmax, TBRmean, and Cho:Cr ratios, normalized rCBVmean and ADCmean were determined. Accuracy of each parameter individually and in various possible combinations was evaluated using two tailed independent samples student’s t-test, MANOVA and multivariate receiver-operating-characteristic analysis. Positive histopathology and long term imaging/clinical follow up suggestive of disease progression served as gold standard. Additionally, 19 of 32 patients (5 women & 14 men; mean age±SD:53.94±13.79; range-27-79) underwent dynamic imaging. Accuracy of FET kinetic parameters such as curve pattern, Time to peak (TTP), net slope of the curve, peak slope & sum of difference (SOD) were also determined. Results Of 32 patients, 25 were classified as recurrence with 7 patients showing radiation necrosis. Individually, TBRmax, TBRmean, ADCmean and Cho: Cr ratios and normalized rCBVmean were significant in differentiating recurrence from radiation necrosis with an accuracy of 93.5%, 87.7%, 81.1%, 96.4% and 90% respectively. The accuracy of both normalized rCBVmean and ADCmean was improved in combination with TBRmax or Cho: Cr ratio. However, TBRmax (or TBRmean) with Cho: Cr ratio yielded the highest accuracy approaching upto 97%. Furthermore, maximum AUC was achieved with combination of TBRmean, CBV and Cho:Cr values. Of 19 patients having dynamic examinations, 15 were classified as having recurrence on HPE/clinical/imagingfollow up with 4 as radiation necrosis. TTP, Net Slope and Peak Slope of the lesion were found to be most significant parameters in distinguishing between recurrence & radiation necrosis with a p-value of Conclusions Our findings suggest that short time simultaneous dynamic and Multiparametric 18F FET PET/MRI examination is feasible and efficacious in differentiating true tumor recurrence from radiation necrosis. Incremental benefit was observed in combining several MRI and PET parameters with maximum accuracy observed using FET uptake in conjunction with Cho: Cr ratio and N rCBVmean." @default.
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• W2593588511 date "2016-05-01" @default.
• W2593588511 modified "2023-09-27" @default.
• W2593588511 title "Single Session 18F-FET Simultaneous PET/MRI including Uptake Kinetics in distinguishing Glioma Recurrence and Radiation Necrosis" @default.
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