Combining 3′-Deoxy-3′-[18F] fluorothymidine and MRI increases the sensitivity of glioma volume detection.

Philippe Fernandez, Paolo Zanotti-Fregonara, Sandrine Eimer, Edouard Gimbert, Pascal Monteil, Guillaume Penchet, Frédéric Lamare, Paul Perez, Delphine Vimont, Sylvain Ledure, Thomas Tourdias, Hugues Loiseau
Nuclear Medicine Communications. 2019-10-01; 40(10): 1066-1071
DOI: 10.1097/mnm.0000000000001056

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Fernandez P(1)(2)(3), Zanotti-Fregonara P(4), Eimer S(5)(2), Gimbert E(6), Monteil P(6), Penchet G(6), Lamare F(1), Perez P(7), Vimont D(8), Ledure S(1), Tourdias T(9), Loiseau H(6).

Author information:
(1)Service de Médecine Nucléaire.
(2)Université de Bordeaux.
(4)Houston Methodist Research Institute, Houston, Texas, USA.
(5)Service d’anatomopathologie.
(6)Service de neurochirurgie.
(7)Unité de soutien méthodologique à la recherche clinique et épidémiologique,
Pôle de Santé Publique, CHU Bordeaux, Bordeaux, France.
(8)Laboratoire de radiochimie.
(9)Service de neuroradiologie, Hôpital Pellegrin, CHRU Bordeaux.

OBJECTIVE: 3′-Deoxy-3′-[18F] fluorothymidine (18F-FLT) is a marker of cell
proliferation and displays a high tumor-to-background ratio in brain tumor
lesions. We determined whether combining 18F-FLT PET and MRI study improves the
detection of tumoral tissue compared to MRI alone and whether 18F-FLT uptake has
a prognostic value by studying its association with histopathological features.
METHODS: Thirteen patients with a supratentorial malignant glioma were recruited
and scheduled for surgery. The tumor volume was defined in all patients on both
18F-FLT PET and MRI images. The images were coregistered and uploaded onto a
neuronavigation system. During surgery, an average of 11 biopsies per patient
were taken in regions of the brain that were positive to one or both imaging
modalities, as well as from control peritumoral regions. The standardized uptake
values (SUVs) of each biopsy region were correlated to histopathological data
(i.e., proliferation index and number of mitoses) and the SUV values of high and
low-grade samples were compared.
RESULTS: Out of a total of 149 biopsies, 109 contained tumoral tissue at
histopathological analysis. The positive predictive value was 93.1% for MRI alone
and 78.3% for MRI and PET combined. In addition, 40% of the biopsy samples taken
from areas of the brain that were negative at both PET and MRI had evidence of
malignancy at pathology. The SUV values were not significantly correlated to
either the proliferation index or the number of mitoses, and could not
differentiate between high- and low-grade samples.
CONCLUSION: In patients with newly diagnosed glioma, a combination of MRI and
18F-FLT-PET detects additional tumoral tissue and this may lead to a more
complete surgical resection. Also, the addition of a negative PET to a negative
MRI increases the negative predictive value. However, 18F-FLT still
underestimated the margins of the lesion and did not correlate with
histopathological features.

DOI: 10.1097/MNM.0000000000001056
PMID: 31469809 [Indexed for MEDLINE]

Auteurs Bordeaux Neurocampus