Prognostic value positron emission tomography with [18F]fluoro-2-deoxy-D-glucose in the low-grade glioma.
OBJECTIVE
The natural history of the supratentorial low-grade glioma (LGG) of the adult is variable, and its malignant transformation is hardly predictable. Because positron emission tomography with [18F]fluoro-2-deoxy-D-glucose (FDG) has prognostic value in high-grade gliomas, this study was designed to search for a possible relationship between glucose metabolism and risk of malignant evolution in LGGs.


METHODS
Positron emission tomography with FDG was performed in 28 patients with LGGs (22 at the time of diagnosis and 6 after the diagnosis). A metabolic grading system based on the visual inspection of the positron emission tomographic images was used.


RESULTS
In 19 patients, no area of FDG uptake higher than in the white matter was detected (metabolic Grade 1). All of those patients were alive at the end of the follow-up period. Only one of the patients presented a histological modification 7 months after the diagnosis. Nine patients presented areas of increased FDG uptake (metabolic Grade 2 or 3). Those areas were found in the tumor area in eight patients and in an area of radionecrosis in one. Of the nine patients with FDG "hot spots," six died, two had recurrence but were alive at the end of the follow-up period, and the patient with radionecrosis had no signs of recurrence.


CONCLUSIONS
The presence of areas of increased FDG uptake in a histologically proven LGG predicts, in most cases, a deleterious evolution. This metabolic feature, detectable with a noninvasive procedure, may provide a clue to cellular changes, announcing malignant transformation in a tumor that retains the histological features of an LGG. Protocols with aggressive therapeutic strategies in this situation should be considered for evaluation.
De Witte
O
O
Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Belgium.
Levivier
M
M
Violon
P
P
Salmon
I
I
Damhaut
P
P
Wikler
D
D
Hildebrand
J
J
Brotchi
J
J
Goldman
S
S
D000293:Adolescent; D000328:Adult; D001254:Astrocytoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D001706:Biopsy; D001786:Blood Glucose / Q000378:metabolism*; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D003847:Deoxyglucose / Q000031:analogs & derivatives / Q000378:metabolism; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D019788:Fluorodeoxyglucose F18; D018303:Ganglioglioma / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D005910:Glioma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D009837:Oligodendroglioma / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D015996:Survival Rate; D014055:Tomography, Emission-Computed
D001786:Blood Glucose; D019788:Fluorodeoxyglucose F18; D003847:Deoxyglucose