Elsevier

NeuroImage: Clinical

Volume 8, 2015, Pages 448-454
NeuroImage: Clinical

[18F]-fluoro-l-thymidine PET and advanced MRI for preoperative grading of gliomas

https://doi.org/10.1016/j.nicl.2015.05.012Get rights and content
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open access

Highlights

  • Comparison of advanced MRI and FLT PET in glioma grading

  • FLT shows the best correlation with glioma grade.

  • Both MRI and PET should be used for doubtful patients.

Abstract

Purpose

Conventional MRI based on contrast enhancement is often not sufficient in differentiating grade II from grade III and grade III from grade IV diffuse gliomas. We assessed advanced MRI, MR spectroscopy and [18F]-fluoro-l-thymidine ([18F]-FLT) PET as tools to overcome these limitations.

Methods

In this prospective study, thirty-nine patients with diffuse gliomas of grades II, III or IV underwent conventional MRI, perfusion, diffusion, proton MR spectroscopy (1H-MRS) and [18F]-FLT-PET imaging before surgery. Relative cerebral blood volume (rCBV), apparent diffusion coefficient (ADC), Cho/Cr, NAA/Cr, Cho/NAA and FLT-SUV were compared between grades.

Results

Cho/Cr showed significant differences between grade II and grade III gliomas (p = 0.03). To discriminate grade II from grade IV and grade III from grade IV gliomas, the most relevant parameter was the maximum value of [18F]-FLT uptake FLTmax (respectively, p < 0.001 and p < 0.0001). The parameter showing the best correlation with the grade was the mean value of [18F]-FLT uptake FLTmean (R2 = 0.36, p < 0.0001) and FLTmax (R2 = 0.5, p < 0.0001).

Conclusion

Whereas advanced MRI parameters give indications for the grading of gliomas, the addition of [18F]-FLT-PET could be of interest for the accurate preoperative classification of diffuse gliomas, particularly for identification of doubtful grade III and IV gliomas.

Keywords

Glioma
Glioblastoma
Grading
MRI
MR spectroscopy
[18F]-FLT-PET

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