DOI: 10.1007/s00259-018-3948-9Pages: 1-9

The roles of 11C-acetate PET/CT in predicting tumor differentiation and survival in patients with cerebral glioma

1. Yonsei University College of Medicine, Department of Nuclear Medicine, Severance Hospital

2. Yonsei University College of Medicine, Department of Pathology, Severance Hospital

3. Brigham and Women’s Hospital and Harvard Medical School, Department of Radiology

4. Yonsei University College of Medicine, Department of Neurosurgery, Severance Hospital

Correspondence to:
Mijin Yun
Tel: +82-2-2228-2350
Email: yunmijin@yuhs.ac

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Abstract

Purpose

This prospective study aimed to evaluate the clinical values of 11C–acetate positron emission tomography/computed tomography (PET/CT) in predicting histologic grades and survival in patients with cerebral glioma.

Methods

Seventy-three patients with surgically confirmed cerebral gliomas (19 grade II, 21 grade III, and 33 grade IV) who underwent 11C–acetate PET/CT before surgery were included. Tumor-to-choroid plexus ratio (TCR), which was defined as the maximum standardized uptake value (SUV) of tumors to the mean SUV of choroid plexus, was compared between three World Health Organization (WHO) grade groups. Moreover, metabolic tumor volumes (MTV) were calculated. Progression-free survival (PFS) and overall survival (OS) curves were plotted using the Kaplan–Meier method, and differences in survival between groups were assessed using the log-rank test.

Results

Median TCR was 1.20 (interquartile range [IQR], 1.14 to 1.4) in grade II, 1.65 (IQR, 1.26 to 1.79) in grade III, and 2.53 (IQR, 1.93 to 3.30) in grade IV gliomas. Significant differences in TCR were seen among the three WHO grade groups (P < 0.001). In Cox regression analysis including TCR, MTV, molecular markers, and other clinical factors, TCR was prognostic for PFS (P = 0.016) and TCR and MTV were prognostic for OS (P = 0.024 [TCR], P = 0.030 [MTV]). PFS and OS were significantly shorter in patients with a TCR ≥ 1.6 than in those with a TCR < 1.6. OS were significantly shorter in patients with a MTV ≥ 1 than in those with a TCR < 1.

Conclusions

TCR on 11C–acetate PET/CT significantly differed between low- and high-grade cerebral gliomas, and it showed the capability to further differentiate grade III from grade IV tumors. TCR and MTV were independent prognostic factors and predicted survival better than did the WHO grade.

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  • Accepted: Jan 11, 2018
  • Online: Mar 6, 2018

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