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Combined amino acid PET-MRI for identifying recurrence in post-treatment gliomas: together we grow

  • Jabeen, Shumyla1
  • Arbind, Arpana2
  • Kumar, Dinesh2
  • Singh, Pardeep Kumar2
  • Saini, Jitender2
  • Sadashiva, Nishanth2
  • Krishna, Uday3
  • Arimappamagan, Arivazhagan2
  • Santosh, Vani2
  • Nagaraj, Chandana2
  • 1 Sher-i-Kashmir Institute of Medical Sciences,
  • 2 National Institute of Mental Health and Neurosciences,
  • 3 Kidwai Memorial Institute of Oncology,
Published Article
European Journal of Hybrid Imaging
Springer International Publishing
Publication Date
Aug 18, 2021
DOI: 10.1186/s41824-021-00109-y
PMID: 34405282
PMCID: PMC8371055
PubMed Central
  • Original Article


Abstract Purpose The aim of this study is to compare the diagnostic accuracy of amino acid PET, MR perfusion and diffusion as stand-alone modalities and in combination in identifying recurrence in post-treatment gliomas and to qualitatively assess spatial concordance between the three modalities using simultaneous PET-MR acquisition. Methods A retrospective review of 48 cases of post-treatment gliomas who underwent simultaneous PET-MRI using C11 methionine as radiotracer was performed. MR perfusion and diffusion sequences were acquired during the PET study. The following parameters were obtained: TBRmax, TBRmean, SUVmax, and SUVmean from the PET images; rCBV from perfusion; and ADCmean and ADCratio from the diffusion images. The final diagnosis was based on clinical/imaging follow-up and histopathology when available. ROC curve analysis in combination with logistic regression analysis was used to compare the diagnostic performance. Spatial concordance between modalities was graded as 0, 1, and 2 representing discordance, < 50% and > 50% concordance respectively. Results There were 35 cases of recurrence and 13 cases of post-treatment changes without recurrence. The highest area under curve (AUC) was obtained for TBRmax followed by rCBV and ADCratio. The AUC increased significantly with a combination of rCBV and TBRmax. Amino acid PET showed the highest diagnostic accuracy and maximum agreement with the final diagnosis. There was discordance between ADC and PET in 22.9%, between rCBV and PET in 16.7% and between PET and contrast enhancement in 14.6% cases. Conclusion Amino acid PET had the highest diagnostic accuracy in identifying recurrence in post-treatment gliomas. Combination of PET with MRI further increased the AUC thus improving the diagnostic performance.

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