Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep;139(2):399-409.
doi: 10.1007/s11060-018-2877-6. Epub 2018 Apr 20.

18F-FDOPA PET and MRI characteristics correlate with degree of malignancy and predict survival in treatment-naïve gliomas: a cross-sectional study

Chirag B Patel  1   2 , Elisa Fazzari  1   2 , Ararat Chakhoyan  3   4 , Jingwen Yao  3   4 , Catalina Raymond  3   4 , Huytram Nguyen  1   2 , Jasmine Manoukian  1   2 , Nhung Nguyen  1   2 , Whitney Pope  3   4 , Timothy F Cloughesy  1   2 , Phioanh L Nghiemphu  1   2 , Johannes Czernin  5 , Albert Lai  1   2 , Benjamin M Ellingson  6   7   8   9
Affiliations

18F-FDOPA PET and MRI characteristics correlate with degree of malignancy and predict survival in treatment-naïve gliomas: a cross-sectional study

Chirag B Patel et al. J Neurooncol. 2018 Sep.

Abstract

Introduction: To report the potential value of pre-operative 18F-FDOPA PET and anatomic MRI in diagnosis and prognosis of glioma patients.

Methods: Forty-five patients with a pathological diagnosis of glioma with pre-operative 18F-FDOPA PET and anatomic MRI were retrospectively examined. The volume of contrast enhancement and T2 hyperintensity on MRI images along with the ratio of maximum 18F-FDOPA SUV in tumor to normal tissue (T/N SUVmax) were measured and used to predict tumor grade, molecular status, and overall survival (OS).

Results: A significant correlation was observed between WHO grade and: the volume of contrast enhancement (r = 0.67), volume of T2 hyperintensity (r = 0.42), and 18F-FDOPA uptake (r = 0.60) (P < 0.01 for each correlation). The volume of contrast enhancement and 18F-FDOPA T/N SUVmax were significantly higher in glioblastoma (WHO IV) compared with lower grade gliomas (WHO I-III), as well as for high-grade gliomas (WHO III-IV) compared with low-grade gliomas (WHO I-II). Receiver-operator characteristic (ROC) analyses confirmed the volume of contrast enhancement and 18F-FDOPA T/N SUVmax could each differentiate patient groups. No significant differences in 18F-FDOPA uptake were observed by IDH or MGMT status. Multivariable Cox regression suggested age (HR 1.16, P = 0.0001) and continuous measures of 18F-FDOPA PET T/N SUVmax (HR 4.43, P = 0.016) were significant prognostic factors for OS in WHO I-IV gliomas.

Conclusions: Current findings suggest a potential role for the use of pre-operative 18F-FDOPA PET in suspected glioma. Increased 18F-FDOPA uptake may not only predict higher glioma grade, but also worse OS.

Keywords: 18F-FDOPA PET; Biomarker; Glioma; MRI.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1. Post-contrast T1-weighted images, T2-weighted turbo spin echo or fluid attenuated inversion recovery (FLAIR) images, and 18F-FDOPA PET SUV maps for representative patients
A) 19-year-old female with a World Health Organization (WHO) grade I ganglioglioma. B) 24-year-old female with a WHO grade II diffuse astrocytoma. C) 32-year-old male with WHO grade III anaplastic oligodendroglioma. D) 74-year-old male with WHO IV glioblastoma.
Fig. 2
Fig. 2. Anatomic MRI and 18F-FDOPA PET measurements in glioma patients
A) Volume of contrast enhancement, B) volume of T2 hyperintensity, and C) 18F-FDOPA PET T/N SUVmax ratio comparisons between World Health Organization (WHO) IV glioblastoma (GBM) and lower grade gliomas (WHO I–III). D) Receiver-operator characteristic (ROC) curves illustrating sensitivity and specificity of anatomic MRI and 18F-FDOPA PET measurements to differentiate WHO IV GBM from lower trade gliomas (WHO I–III). E) Volume of contrast enhancement, F) volume of T2 hyperintensity, and G) 18F-FDOPA PET T/N SUVmax ratio comparisons between high-grade gliomas (HGG; WHO III–IV) and low-grade gliomas (LGG; WHO I–II). H) ROC curves illustrating sensitivity and specificity of anatomic MRI and 18F-FDOPA PET measurements in discriminating HGG from LGG.
Fig. 3
Fig. 3. Anatomic MRI and 18F-FDOPA PET measurements across IDH mutation status and MGMT promoter methylation status
A) Volume of contrast enhancement, B) volume of T2 hyperintensity, and C) 18F-FDOPA PET T/N SUVmax ratio comparisons between isocitrate dehydrogenase (IDH) mutant (IDHMUT) and wild type (IDHWT) gliomas (n=39 evaluable). D) Volume of contrast enhancement, E) volume of T2 hyperintensity, and F) 18F-FDOPA PET T/N SUVmax ratio comparisons between O6-methylguanine-DNA methyltransferase (MGMT) promoter methylated and unmethylated gliomas (n=33 evaluable).
Fig. 4
Fig. 4. Kaplan-Meier survival curves for composite MRI and 18F-FDOPA PET index of high-risk glioma patients
High-risk patients (N=14) were defined as those with volume of contrast enhancement (CE) greater than 1 cc (“measurable tumor”) and 18F-FDOPA PET T/N SUVmax ratio greater than 1.7 (group median). Results demonstrate a significantly shorter OS in high high-risk patients (Log-rank, HR = 3.05, P=0.012).
See this image and copyright information in PMC

References

    1. Ostrom QT, Gittleman H, Fulop J, Liu M, Blanda R, Kromer C, Wolinsky Y, Kruchko C, Barnholtz-Sloan JS. CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2008–2012. Neuro Oncol. 2015;17(Suppl 4):iv1–iv62. - PMC - PubMed
    1. Stupp R, Taillibert S, Kanner AA, Kesari S, Steinberg DM, Toms SA, Taylor LP, Lieberman F, Silvani A, Fink KL, Barnett GH, Zhu JJ, Henson JW, Engelhard HH, Chen TC, Tran DD, Sroubek J, Tran ND, Hottinger AF, Landolfi J, Desai R, Caroli M, Kew Y, Honnorat J, Idbaih A, Kirson ED, Weinberg U, Palti Y, Hegi ME, Ram Z. Maintenance Therapy With Tumor-Treating Fields Plus Temozolomide vs Temozolomide Alone for Glioblastoma: A Randomized Clinical Trial. JAMA. 2015;314:2535–2543. - PubMed
    1. Chinot OL, Nishikawa R, Mason W, Henriksson R, Saran F, Cloughesy T, Garcia J, Revil C, Abrey L, Wick W. Upfront bevacizumab may extend survival for glioblastoma patients who do not receive second-line therapy: an exploratory analysis of AVAglio. Neuro Oncol. 2016;18:1313–1318. - PMC - PubMed
    1. Stupp R, Taillibert S, Kanner A, Read W, Steinberg DM, Lhermitte B, Toms S, Idbaih A, Ahluwalia MS, Fink K, Di Meco F, Lieberman F, Zhu JJ, Stragliotto G, Tran DD, Brem S, Hottinger AF, Kirson ED, Lavy-Shahaf G, Weinberg U, Kim CY, Paek SH, Nicholas G, Burna J, Hirte H, Weller M, Palti Y, Hegi ME, Ram Z. Effect of Tumor-Treating Fields Plus Maintenance Temozolomide vs Maintenance Temozolomide Alone on Survival in Patients With Glioblastoma: A Randomized Clinical Trial. JAMA. 2017;318:2306–2316. - PMC - PubMed
    1. Ellingson BM, Wen PY, Cloughesy TF. Evidence and Context of Use for Contrast Enhancement as a Surrogate of Disease Burden and Treatment Response in Malignant Glioma. Neuro Oncol. 2017 - PMC - PubMed

MeSH terms