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. 2021 Jan;46(1):16-20.
doi: 10.1097/RLU.0000000000003404.

Assessment of Central Nervous System Lymphoma Based on CXCR4 Expression In Vivo Using 68Ga-Pentixafor PET/MRI

Angelika M Starzer  1 , Anna S Berghoff  1 , Tatjana Traub-Weidinger  2 , Alexander R Haug  2 , Georg Widhalm  3 , Marcus Hacker  2 , Ivo Rausch  4 , Matthias Preusser  1 , Marius E Mayerhoefer
Affiliations

Assessment of Central Nervous System Lymphoma Based on CXCR4 Expression In Vivo Using 68Ga-Pentixafor PET/MRI

Angelika M Starzer et al. Clin Nucl Med. 2021 Jan.

Abstract

Purpose of the report: F-FDG PET is limited for assessment of central nervous system lymphoma (CNSL) due to physiologic tracer accumulation in the brain. We prospectively evaluated the novel PET tracer Ga-pentixafor, which targets the C-X-C chemokine receptor 4 (CXCR4), for lesion visualization and response assessment of CNSL.

Materials and methods: Seven CNSL patients underwent Ga-pentixafor PET/MRI with contrast enhancement (CE-MRI) and diffusion-weighted sequences. The accuracy of Ga-pentixafor PET for CNSL lesion detection relative to the CE-MRI reference standard was determined. Standardized uptake values (SUVmean and SUVmax), PET-based (PTV) and MRI-based (VOLMRI) tumor volumes, and apparent diffusion coefficients (ADCs) were assessed, and correlation coefficients were calculated. Three SUVmax thresholds (41%, 50%, and 70%) were evaluated for PTV definitions (PTV41%, PTV50%, and PTV70%) and tested against VOLMRI using paired sample t tests.

Results: Twelve Ga-pentixafor PET/MRI examinations (including 5 follow-up scans) of 7 patients were evaluated. Ga-pentixafor PET demonstrated 18 lesions, all of which were confirmed by CE-MRI; there were no false-positive lesions on PET (accuracy, 100%). PTV41% showed the highest concordance with lesion morphology, with no significant difference compared with VOLMRI (mean difference, -0.24 cm; P = 0.45). The correlation between ADCmean and SUVmean41% (r = 0.68) was moderate. Changes in PTV41% on follow-up PET/MRI showed the same trend as VOLMRI changes, including progression of 1 lesion each in patient 1 (+456.0% PTV41% and +350.8% VOLMRI) and patient 3 (+110.4% PTV41% and +85.1% VOLMRI).

Conclusions: Ga-pentixafor PET may be feasible for assessment and follow-up of CNSL. Future studies need to focus on testing its clinical value to distinguish between glioma and CNSL, and between radiation-induced inflammation and viable residual tumor.

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Conflict of interest statement

Conflicts of interest:

All other authors report no conflicts of interest concerning this specific publication.

Figures

Figure 1.
Figure 1.
A 54-year-old female patient (no. 5) with secondary CNSL adjacent to the left interventricular foramen (arrows). The lesion shows marked focal tracer uptake on [68Ga]Pentixafor-PET and contrast enhancement on T1-weighted CE-MRI, as well as moderately hyperintense signal on the DWI and FLAIR images. On the ADC map, diffusivity is similar to that of the surrounding brain tissue.
Figure 2.
Figure 2.
A 49-year-old male patient (no. 1) with recurrent PCNSL of the right thalamus that shows high [68Ga]Pentixafor uptake correlated to- the pathological contrast enhancement on the T1-weighted CE-MRI. [68Ga]Pentixafor-PET-based metabolic tumor volumes (PTV41% shown) showed good concordance with morphologic tumor volumes (VOLMRI) both at baseline and after treatment demonstrating progression under chemotherapy with high-dose methotrexate and treatment response after WBRT.
See this image and copyright information in PMC

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