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. 2021 Aug 31;62(4):310-317.
doi: 10.3325/cmj.2021.62.310.

18F-FET and 18F-choline PET-CT in patients with MRI-suspected low-grade gliomas: a pilot study

Ana Mišir Krpan, Marina Hodolič  1 , Anja Tea Golubić, Maja Baučić, Jakob Nemir, Goran Mrak, Marijan Žuvić, Dražen Huić
Affiliations

18F-FET and 18F-choline PET-CT in patients with MRI-suspected low-grade gliomas: a pilot study

Ana Mišir Krpan et al. Croat Med J. .

Abstract

Aim: To investigate the diagnostic accuracy of O-(2-[18F]-fluoroethyl)-L-tyrosine (18F-FET) and fluoromethyl-(18F)-dimethyl-2-hydroxyethyl-ammonium chloride (18F-FCH) computed tomography (CT) in patients with primary low-grade gliomas (LGG).

Methods: The study enrolled patients with magnetic resonance imaging (MRI)-suspected LGG. Patients underwent both 18F-FET and 18F-FCH positron emission tomography (PET)-CT. Brain PET-CT was performed according to standard protocol - 20 minutes after intravenous injection of 185 MBq of 18F-FET and 185 MBq of 18F-FCH PET. Surgery and pathohistological diagnosis were performed in the next two weeks.

Results: We observed significantly better concordance between tumor histology and 18F-FET PET (weighted Kappa 0.74) compared with both 18F-FCH (weighted Kappa 0.15) and MRI (weighted Kappa 0.00). Tumor histology was significantly associated with 18F-FET (odds ratio 12.87; 95% confidence interval [CI], 0.49-333.70; P=0.013, logistic regression analysis). Receiver operating characteristic curve analysis comparing 18F-FCH (area under the curve [AUC] 0.625, 95% CI 0.298-0.884) and 18F-FET (AUC 0.833, 95% CI 0.499-0.982) showed better diagnostic properties of 18F-FET (AUC difference 0.208, 95% CI -0.145 to 0.562, P=0.248).

Conclusion: Performing PET-CT in patients with newly diagnosed LGG should be preceded by a selection of an appropriate radiopharmaceutical. 18F-FET seems to be more accurate than 18F-FCH in the LGG diagnosis.

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Figures

Figure 1
Figure 1
Positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) fluid attenuated inversion recovery (FLAIR) images of a 38-year-old male patient with an isocitrate dehydrogenase 1-mutated 1p/19q-non-codeleted World Health Organization grade II diffuse astrocytoma. O-(2-[18F]-fluoroethyl)-L-tyrosine PET was positive (standardized uptake value [SUV] max 2.8) (A) and fluoromethyl-(18F)-dimethyl-2-hydroxyethyl-ammonium chloride PET was minimal (SUV max 0.47) (B). MRI FLAIR tumor in the right frontal lobe (C).
Figure 2
Figure 2
Positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) fluid attenuated inversion recovery (FLAIR) images of a 69-year-old male patient with an isocitrate dehydrogenase 1-wildtype glioblastoma. Both   O-(2-[18F]-fluoroethyl)-L-tyrosine PET (A) and fluoromethyl-(18F)-dimethyl-2-hydroxyethyl-ammonium chloride PET-CT (B) were positive (standardized uptake value max 3.9 and 3.1, respectively). MRI FLAIR tumor in the left parietooccipital region (C).
Figure 3
Figure 3
Receiver operating characteristic curves for the prediction of sensitivity and specificity of fluoromethyl-(18F)-dimethyl-2-hydroxyethyl-ammonium chloride maximum standardized uptake value and  O-(2-[18F]-fluoroethyl)-L-tyrosine maximum standardized uptake value.
See this image and copyright information in PMC

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