title: The use of (18)F-FDG PET to differentiate progressive disease from treatment induced necrosis in high grade glioma.
abstract: In the follow-up of patients treated for high grade glioma, differentiation between progressive disease (PD) and treatment-induced necrosis (TIN) is challenging. The purpose of this study is to evaluate the diagnostic accuracy of FDG PET for the differentiation between TIN and PD after high grade glioma treatment. We retrospectively identified patients between January 2011 and July 2013 that met the following criteria: age >18; glioma grade 3 or 4; treatment with radiotherapy or chemoradiotherapy; new or progressive enhancement on post treatment MRI; FDG PET within 4 weeks of MRI. Absolute and relative (to contralateral white matter) values of SUVmax and SUVpeak were determined in new enhancing lesions on MRI. The outcome of PD or TIN was determined by neurosurgical biopsy/resection, follow-up MRI, or clinical deterioration. The association between FDG PET and outcome was analyzed with univariate logistic regression and ROC analysis for: all lesions, lesions >10, >15, and >20 mm. We included 30 patients (5 grade 3 and 25 grade 4), with 39 enhancing lesions on MRI. Twenty-nine lesions represented PD and 10 TIN. Absolute and relative values of SUVmax and SUVpeak showed no significant differences between PD and TIN. ROC analysis showed highest AUCs for relative SUVpeak in all lesion sizes. Relative SUVpeak for lesions >20 mm showed reasonable discriminative properties [AUC 0.69 (0.41-0.96)]. FDG PET has reasonable discriminative properties for differentiation of PD from TIN in high grade gliomas larger than 20 mm. Overall diagnostic performance is insufficient to guide clinical decision-making.
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands. j.w.dankbaar@umcutrecht.nl.
authors.forename: J W
authors.identifier: http://orcid.org/0000-0003-4646-9587
authors.initials: JW
authors.lastname: Dankbaar
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: T J
authors.initials: TJ
authors.lastname: Snijders
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: P A
authors.initials: PA
authors.lastname: Robe
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Seute
authors.affiliation: Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Eppinga
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Hendrikse
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: De Keizer
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D015331:Cohort Studies; D018450:Disease Progression; D004358:Drug Therapy; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D005910:Glioma / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000175:diagnosis / Q000209:etiology; D017063:Outcome Assessment, Health Care; D049268:Positron-Emission Tomography; D012372:ROC Curve; D011878:Radiotherapy / Q000009:adverse effects
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: FDG PET; High grade glioma; MRI; Progressive disease; Treatment induced necrosis