Format

Send to

Choose Destination
J Neurosurg. 2019 Aug 16:1-10. doi: 10.3171/2019.5.JNS19780. [Epub ahead of print]

Usefulness of positron emission tomography for differentiating gliomas according to the 2016 World Health Organization classification of tumors of the central nervous system.

Author information

1
1Department of Neurosurgery and Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Gifu.
2
4Neurosurgery, Gifu University Graduate School of Medicine, Gifu; and.
3
2Departments of Clinical Brain Sciences and.
4
3Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.

Abstract

OBJECTIVE:

Positron emission tomography (PET) is important in the noninvasive diagnostic imaging of gliomas. There are many PET studies on glioma diagnosis based on the 2007 WHO classification; however, there are no studies on glioma diagnosis using the new classification (the 2016 WHO classification). Here, the authors investigated the relationship between uptake of 11C-methionine (MET), 11C-choline (CHO), and 18F-fluorodeoxyglucose (FDG) on PET imaging and isocitrate dehydrogenase (IDH) status (wild-type [IDH-wt] or mutant [IDH-mut]) in astrocytic and oligodendroglial tumors according to the 2016 WHO classification.

METHODS:

In total, 105 patients with newly diagnosed cerebral gliomas (6 diffuse astrocytomas [DAs] with IDH-wt, 6 DAs with IDH-mut, 7 anaplastic astrocytomas [AAs] with IDH-wt, 24 AAs with IDH-mut, 26 glioblastomas [GBMs] with IDH-wt, 5 GBMs with IDH-mut, 19 oligodendrogliomas [ODs], and 12 anaplastic oligodendrogliomas [AOs]) were included. All OD and AO patients had both IDH-mut and 1p/19q codeletion. The maximum standardized uptake value (SUV) of the tumor/mean SUV of normal cortex (T/N) ratios for MET, CHO, and FDG were calculated, and the mean T/N ratios of DA, AA, and GBM with IDH-wt and IDH-mut were compared. The diagnostic accuracy for distinguishing gliomas with IDH-wt from those with IDH-mut was assessed using receiver operating characteristic (ROC) curve analysis of the mean T/N ratios for the 3 PET tracers.

RESULTS:

There were significant differences in the mean T/N ratios for all 3 PET tracers between the IDH-wt and IDH-mut groups of all histological classifications (p < 0.001). Among the 27 gliomas with mean T/N ratios higher than the cutoff values for all 3 PET tracers, 23 (85.2%) were classified into the IDH-wt group using ROC analysis. In DA, there were no significant differences in the T/N ratios for MET, CHO, and FDG between the IDH-wt and IDH-mut groups. In AA, the mean T/N ratios of all 3 PET tracers in the IDH-wt group were significantly higher than those in the IDH-mut group (p < 0.01). In GBM, the mean T/N ratio in the IDH-wt group was significantly higher than that in the IDH-mut group for both MET (p = 0.034) and CHO (p = 0.01). However, there was no significant difference in the ratio for FDG.

CONCLUSIONS:

PET imaging using MET, CHO, and FDG was suggested to be informative for preoperatively differentiating gliomas according to the 2016 WHO classification, particularly for differentiating IDH-wt and IDH-mut tumors.

KEYWORDS:

11C-choline; 11C-methionine; 18F-fluorodeoxyglucose; AA = anaplastic astrocytoma; AO = anaplastic oligodendroglioma; AUC = area under the curve; CHO = 11C-choline; DA = diffuse astrocytoma; DOR = diagnostic odds ratio; FDG = 18F-fluorodeoxyglucose; GBM = glioblastoma; IDH = isocitrate dehydrogenase; IDH-mut = mutant IDH; IDH-wt = wild-type IDH; MET = 11C-methionine; OD = oligodendroglioma; PET = positron emission tomography; R-2HG = R-2-hydroxyglutarate; ROC = receiver operating characteristic; ROI = region of interest; SUV = standardized uptake value; T/N = tumor maximal SUV/normal brain cortex mean SUV; glioma; isocitrate dehydrogenase mutation; oncology; positron emission tomography

PMID:
31419796
DOI:
10.3171/2019.5.JNS19780

Supplemental Content

Full text links

Icon for Sheridan PubFactory
Loading ...
Support Center