Multiparametric Evaluation in Differentiating Glioma Recurrence from Treatment-Induced Necrosis Using Simultaneous18F-FDG-PET/MRI: A Single-Institution Retrospective Study.
OBJECTIVE
Differentiating glioma recurrence from treatment-induced necrosis can be a challenge on conventional imaging. This study aimed to assess the diagnostic performance of each functional MR imaging and PET parameter derived by using simultaneous FDG-PET/MR imaging individually and in combination in the evaluation of suspected glioma recurrence.


METHODS
Thirty-five treated glioma patients with 41 enhancing lesions (World Health Organization grade II = 9, III = 13, IV = 19) on MR imaging after an operation followed by radiation therapy and/or chemotherapy formed part of this study. Using PET/MR imaging, we calculated the normalized mean relative CBV, mean ADC, Cho/Cr, and maximum and mean target-to-background ratios. Statistical analysis was performed to determine the diagnostic performance of each parameter by receiver operating characteristic analysis individually and in combination with multivariate receiver operating characteristic analysis for the detection of glioma recurrence. Histopathology or clinicoradiologic follow-up was considered the criterion standard.


RESULTS
Of 35 patients, 25 (30 lesions) were classified as having a recurrence and 10 (11 lesions) patients as having treatment-induced necrosis. Parameters like rCBVmean(mean relative CBV), ADCmean, Cho/Cr, and maximum and mean target-to-background ratios were statistically significant in the detection of recurrent lesions with an accuracy of 77.5%, 78.0%, 90.9%, 87.8%, and 87.8%, respectively. On multivariate receiver operating characteristic analysis, the combination of all 3 MR imaging parameters resulted in an area under the curve of 0.913 ± 0.053. Furthermore, an area under the curve of 0.935 ± 0.046 was obtained when MR imaging parameters (ADCmeanand Cho/Cr) were combined with the PET parameter (mean target-to-background ratio), demonstrating an increase in diagnostic accuracy.


CONCLUSIONS
Simultaneous PET/MR imaging with FDG offers correlative and synergistic multiparametric assessment of glioma recurrence with increased accuracy and clinical utility.
From the PET SUITE (A. Jena, S.T., A. Jha, P.N.) drjena2002@yahoo.com.
A
http://orcid.org/0000-0003-2154-7884
A
Jena
From the PET SUITE (A. Jena, S.T., A. Jha, P.N.).
S
http://orcid.org/0000-0003-0544-9133
S
Taneja
From the PET SUITE (A. Jena, S.T., A. Jha, P.N.).
A
http://orcid.org/0000-0002-1489-2471
A
Jha
Neurosurgery (N.K.D., S.K.S.), Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India.
N K
http://orcid.org/0000-0001-7260-1807
NK
Damesha
From the PET SUITE (A. Jena, S.T., A. Jha, P.N.).
P
http://orcid.org/0000-0002-8591-6311
P
Negi
Departments of Molecular Imaging and Nuclear Medicine, Radiation Oncology (G.K.J., S.M.V.).
G K
http://orcid.org/0000-0003-3000-1154
GK
Jadhav
Departments of Molecular Imaging and Nuclear Medicine, Radiation Oncology (G.K.J., S.M.V.).
S M
http://orcid.org/0000-0002-2659-1393
SM
Verma
Neurosurgery (N.K.D., S.K.S.), Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India.
S K
http://orcid.org/0000-0003-3531-0976
SK
Sogani
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D005910:Glioma / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009336:Necrosis / Q000000981:diagnostic imaging*; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology; D059906:Neuroimaging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods; D012372:ROC Curve; D012189:Retrospective Studies
D019788:Fluorodeoxyglucose F18