title: Prognostic Molecular and Imaging Biomarkers in Primary Glioblastoma.
abstract: OBJECTIVE
  Several molecular glioma markers (including isocitrate dehydrogenase 1 [IDH1] mutation, amplification of the epidermal growth factor receptor [EGFR], and methylation of the O6-methylguanine-DNA methyltransferase [MGMT] promoter) have been associated with glioblastoma survival. In this study, we examined the association between tumoral amino acid uptake, molecular markers, and overall survival in patients with IDH1 wild-type (primary) glioblastoma.
  
  
  METHODS
  Twenty-one patients with newly diagnosed IDH1 wild-type glioblastomas underwent presurgical MRI and PET scanning with alpha[C-11]-L-methyl-tryptophan (AMT). MRI characteristics (T2- and T1-contrast volume), tumoral tryptophan uptake, PET-based metabolic tumor volume, and kinetic variables were correlated with prognostic molecular markers (EGFR and MGMT) and overall survival.
  
  
  RESULTS
  EGFR amplification was associated with lower T1-contrast volume (P = 0.04) as well as lower T1-contrast/T2 volume (P = 0.04) and T1-contrast/PET volume ratios (P = 0.02). Tumors with MGMT promoter methylation showed lower metabolic volume (P = 0.045) and lower tumor/cortex AMT unidirectional uptake ratios than those with unmethylated MGMT promoter (P = 0.009). While neither EGFR amplification nor MGMT promoter methylation was significantly associated with survival, high AMT tumor/cortex uptake ratios on PET were strongly prognostic for longer survival (hazards ratio, 30; P = 0.002). Estimated mean overall survival was 26 months in patients with high versus 8 months in those with low tumoral AMT uptake ratios.
  
  
  CONCLUSIONS
  The results demonstrate specific MRI and amino acid PET imaging characteristics associated with EGFR amplification and MGMT promoter methylation in patients with primary glioblastoma. High tryptophan uptake on PET may identify a subgroup with prolonged survival.
authors.affiliation: From the Department of *Pediatrics, Wayne State University, Detroit; †PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit; Departments of ‡Neurosurgery, and §Neurology, Wayne State University, Detroit; ∥Karmanos Cancer Institute, Detroit; and ¶Deparment of Oncology, Wayne State University, Detroit, Michigan.
authors.forename: Edit
authors.initials: E
authors.lastname: Bosnyák
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Michelhaugh
authors.forename: Neil V
authors.initials: NV
authors.lastname: Klinger
authors.forename: David O
authors.initials: DO
authors.lastname: Kamson
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Barger
authors.forename: Sandeep
authors.initials: S
authors.lastname: Mittal
authors.forename: Csaba
authors.initials: C
authors.lastname: Juhász
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002250:Carbon Radioisotopes / Q000378:metabolism; D016543:Central Nervous System Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism; D019175:DNA Methylation; D066246:ErbB Receptors / Q000378:metabolism; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000378:metabolism; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009154:Mutation; D049268:Positron-Emission Tomography; D011379:Prognosis; D011401:Promoter Regions, Genetic / Q000502:physiology*; D014364:Tryptophan / Q000031:analogs & derivatives / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D002250:Carbon Radioisotopes; C020774:alpha-methyltryptophan; D014364:Tryptophan; D066246:ErbB Receptors