Abstracts der 57. DGN-Jahrestagung 2019

PET: FDG und neue Tracer Vorsitz: A. Afshar-Oromieh, W. Weber 14:00 - 15:30 Saal Focke-Wulf

V29 Differentiation of treatment-related changes from high-grade glioma progression: A direct comparison between FET PET and ADC values obtained by DWI MRI J. Werner¹, G. Stoffels², T. Lichtenstein³, J. Borggrefe³, G. Ceccon¹, N. J. Shah², G. R. Fink¹, K. J. Langen², C. Kabbasch³, N. Galldiks¹ ¹University Hospital Cologne, Dept. of Neurology, Cologne; ²Research Center Jülich, Inst. of Neuroscience and Medicine (INM-4), Jülich; ³University Hospital Cologne, Dept. of Neuroradiology, Cologne
Ziel/Aim: Following brain cancer treatment, the capacity of anatomical MRI to differentiate neoplastic tissue from treatment-related changes such as pseudoprogression is limited. The aim of this study was to compare apparent diffusion coefficient (ADC) values obtained by diffusion-weighted MRI (DWI) with static parameters of O-(2-[¹⁸F]fluoroethyl)-L-tyrosine (FET) PET for the differentiation of treatment-related changes from tumor progression. Methodik/Methods: Forty-eight pretreated high-grade glioma patients (mean age, 50±15 years) with anatomical MRI findings suspicious for tumor progression (median time after completion of last treatment, 16 weeks) were additionally investigated using DWI MRI and FET PET. Maximum and mean tumor-to-brain ratios (TBR_max/mean) of FET uptake were determined (20-40 minutes post-injection). Regions-of-Interest analyses were performed concerning the enhancing lesion on ADC maps calculated from DWI MRI. Diagnoses were confirmed neuropathologically (21%; 10 patients) or clinico-radiologically (79%; 38 patients). Diagnostic performances of TBRs and ADC values for the correct differentiation were evaluated each alone using receiver-operating-characteristic analyses, or the Fisher Exact test for a combinational approach. Ergebnisse/Results: Ten of 48 patients had treatment-related changes (21%). The diagnostic performance of FET PET was clearly higher (threshold TBR_mean, 1.95; sensitivity, 100%; specificity, 79%; accuracy, 83%; AUC 0.89±0.05; P-3 mm²/s; sensitivity, 60%; specificity; 79%; accuracy, 75%; AUC 0.73±0.09; P=0.05). The combination of both imaging parameters did not increase the accuracy (64%; P=0.144). Schlussfolgerungen/Conclusions: Static FET PET seems to add valuable clinical information regarding the differentiation of early treatment-related changes from tumor progression and outperforms ADC values for this highly relevant clinical question.

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