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    Home > Active Ingredient News > Antitumor Therapy > 18F-FET PET identifies the value of glioma progression

    18F-FET PET identifies the value of glioma progression

    • Last Update: 2021-03-06
    • Source: Internet
    • Author: User
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    Glioma accounts for 26% of primary central nervous system tumors, 81% of which are malignant tumors.
    how to identify tumor progression (tumor, TP) and treatment-related changes (treatment-related changes, TRC) in glioma patients is challenging.
    it is difficult to identify glioma progression in imaging, which can lead to delays or unnecessary interruptions in treatment.
    currently recommends the use of O-2-18F fluoroelide-L-Tyrosine PET (18F-FET PET) to identify glioma TP and TRC.
    D. Maurer of the Institute of Neurocology at Goethe University Hospital in Frankfurt, Germany, et al. presented 18F-FETPET's experience in identifying TP and TRC for gliomas, published in the April 2020 issue of The Journal of Nuclear Medicine.
    method Retrospective analysis of 127 WHO II-IV glioma patients with 18F-FET PET imaging identification TP and TRC case data.
    validates the results of 18F-FET PET tests with 40 neuropathological tests and 87 clinical imaging follow-up tests, and determines the slope of 18F-FET maximum ingestion ratio (TBRmax) and the time-radioactivity curve (20-50 minutes after injection).
    accuracy of the 18F-FET PET parameter diagnostics is evaluated by receiver operating characteristics analysis χ 2 test.
    use the Kaplan-Meier method to evaluate the value of 18F-FET PET's prediction of glioma prognosis.
    patient and tumor characteristics can be found in Tables 1 and 2.
    36 re-surgical excisions, 4 biopsies, 10-215d from 18F-FET PET to surgery, with a medium of 21.5d.
    6 cases with 18F-FET PET prompts, time 12-215d, medium 90d, 34 cases of TP significantly longer than 18F-FET PET prompt, time 10-119d, medium 19d.
    to June 2019, 57 of the 127 patients died, from 18F-FET PET to 24-950d, with a medium of 208d, while the remaining 70 patients continued to follow, from 18F-FET PET to 128-1,050d, with a medium of 484d.
    Table 1. Characteristics of Patients and Tumors (Part I) Table 2. Analysis of the characteristics of patients and tumors (Part II) receiver operation characteristics shows that the optimal threshold for TBRmax identification of TP and TRC is 1.95 (sensitivity 70%; specificity 71%; accuracy 70%; area 0.76±00.05; P<001).
    TBRmean identifies TP with a critical value of 1.95 (sensitivity 56%; specificity 79%; accuracy 62%; area under curve is 0.75±0.05; P<0.001).
    the optimal threshold for identifying TP and TRC is less than 0.2 SUVs/h (sensitivity 54%; specificity 86%; accuracy 63%; area under curve 0.69±0.05; P<0.001).
    combined analysis shows that TBRmax greater than 1.95 or has a slope of less than 0.2 SUV/h is the best threshold for identifying TP and TRC (sensitivity 86%; specificity 67%; accuracy 81% ;P<0.001).
    18F-FET PET diagnosis of false positives and false negatives can be found in Figure 1.
    18F-FET PET diagnoses false positives and false negatives.
    A-D.1 cases of 45-year-old IDH mutants and MGMT initiaters methylated GBM patients.
    was given bevasan every other week after full oncology, radiotherapy and Elitacon chemotherapy in November 2010.
    January 2017, MRI follow-up shows disease progressity (RANO standard).
    , however, in February 2017, an 18F-FET PET test showed no tumor;
    MRI showed an increase in both fortified and unencumved lesions (tumor progression, RANO standard), but 18F-FET PET remained negative.
    November 2017, biopsies diagnosed tumor progress.
    October 2017 MRI-T2 axle (A.left) and T1 enhanced axon (A.right); November 18, 2017 F-FET PET (B); and November 2017 biopsy sample histology (Sumu-Ihong (C) and immunologic chemistry (IDH1_R132H, arrows indicating IDH1_R132H positive tumor cells) (D).
    E-H.1 patients with 39-year-old IDH1_R132H mutations and 1p/19q co-missing glioblastoma underwent a full excision in August 2010 and chemotherapy for molybamine to 2 Proton therapy in May and June 2015, and Lomostin chemotherapy from July to December 2015, with the removal of the recurrence tumor in July 2017.
    neuropathology showed changes after radiation, and no tumors were seen.
    May 2017 MRI-T2 axle (E.left) and T1 reinforced axon (E. right); June 18, 2017 F-F PETET indicates tumor progression (F); necrotizing and calcification (arrow, HE) (G) are visible in samples removed in July 2017, with no IDH1_R132H-positive tumor cells (H).
    I-K.1 patients with 38-year-old IDH mutation and MGMT initiater methylation GBM had a partial tumor excision in April 2016, radiotherapy after surgery, and chemotherapy for molybamine from April to June 2016.
    , the patient refused to proceed with the tumor-specific treatment.
    February 2017 MRI-T2 coronary (I.left) and T1 enhanced coronary (I.right); April 18, 2017 F-FET PET indicates tumor progression (J); and February 2018 follow-up MRI-T2 coronary (K. left) and T1 enhanced coronary (K.right).
    when the patient is finally diagnosed with TRC (Figure 2A) and the 18F-FET PET result is TRC (Figure 2B), the patient's total survival is longer.
    using single-factor and multi-factor analysis of total lifetime (Table 3), multi-factor analysis shows that 18F-FET PET ratings, WHO ratings, IDH status, and Karnofsky activity status scores are independent prognostic factors for gliomas.
    2. Total survival of 127 patients.
    life after A.18F-FET PET imaging depends on histological or follow-up evaluation of TP or TRC (P (log-rank) <0.001).
    lifetime after B.18F-FET PET imaging depends on the 18F-FET PET result (P (log-rank) <0.001).
    table 3. Single-factor and multi-factor analysis of total lifetime studies found that 18F-FET PET was more accurate in IDH wild gliomas than IDH mutant gliomas (P<0.001).
    The diagnosis results based on 18F-FET PET showed a misdiagnosis rate of 33% in IDH mutant gliomas (11 true negatives, 23 true positives, 8 false positives and 9 false negatives), and a 9% misdiagnosis rate in IDH wild gliomas (8 true negatives, 56 true positives, 3 false positives and 3 false negatives).
    The results show that 18F-FET PET improves the current level of progress in identifying gliomas, helps to develop a diagnosis and treatment plan, and serves as an independent prognostic factor.
    18F-FET PET results should take into account tumor IDH status, as 18F-FET PET is more accurate in diagnosing IDH wild type than IDH mutants.
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