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Distinguishing Progression from Pseudoprogression in Glioblastoma Using 18F-Fluciclovine PET.

Author information

Affiliations

  • 1. Department of Radiology, Hospital of University of Pennsylvania, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania;
      Authors
    • Nabavizadeh A 1
    (1 author)
  • 2. Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.
      Authors
    • Bagley SJ 2
    • Carpenter EL 2
    • Till J 2
    • Amankulor NM 2, 6
    • O'Rourke DM 2, 6
    • Desai A 2
    • Brem S 2, 6
    (7 authors)
  • 3. Department of Radiology, Hospital of University of Pennsylvania, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.
      Authors
    • Doot RK 3
    • Ware JB 3
    • Young AJ 3
    • Ghodasara S 3
    • Anderson H 3
    • Schubert E 3
    • Pantel AR 3
    (7 authors)
  • 4. Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
      Authors
    • Zhao C 4
    (1 author)
  • 5. Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California.
      Authors
    • Henderson F Jr 5
    (1 author)
    • Show all (7)

ORCIDs linked to this article

Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine, 22 Dec 2022, 64(6):852-858
https://doi.org/10.2967/jnumed.122.264812 PMID: 36549916 

Abstract 

Accurate differentiation between tumor progression (TP) and pseudoprogression remains a critical unmet need in neurooncology. 18F-fluciclovine is a widely available synthetic amino acid PET radiotracer. In this study, we aimed to assess the value of 18F-fluciclovine PET for differentiating pseudoprogression from TP in a prospective cohort of patients with suspected radiographic recurrence of glioblastoma. Methods: We enrolled 30 glioblastoma patients with radiographic progression after first-line chemoradiotherapy for whom surgical resection was planned. The patients underwent preoperative 18F-fluciclovine PET and MRI. The relative percentages of viable tumor and therapy-related changes observed in histopathology were quantified and categorized as TP (≥50% viable tumor), mixed TP (<50% and >10% viable tumor), or pseudoprogression (≤10% viable tumor). Results: Eighteen patients had TP, 4 had mixed TP, and 8 had pseudoprogression. Patients with TP/mixed TP had a significantly higher 40- to 50-min SUVmax (6.64 + 1.88 vs. 4.11 ± 1.52, P = 0.009) than patients with pseudoprogression. A 40- to 50-min SUVmax cutoff of 4.66 provided 90% sensitivity and 83% specificity for differentiation of TP/mixed TP from pseudoprogression (area under the curve [AUC], 0.86). A maximum relative cerebral blood volume cutoff of 3.672 provided 90% sensitivity and 71% specificity for differentiation of TP/mixed TP from pseudoprogression (AUC, 0.779). Combining a 40- to 50-min SUVmax cutoff of 4.66 and a maximum relative cerebral blood volume of 3.67 on MRI provided 100% sensitivity and 80% specificity for differentiating TP/mixed TP from pseudoprogression (AUC, 0.95). Conclusion: 18F-fluciclovine PET uptake can accurately differentiate pseudoprogression from TP in glioblastoma, with even greater accuracy when combined with multiparametric MRI. Given the wide availability of 18F-fluciclovine, larger, multicenter studies are warranted to determine whether amino acid PET with 18F-fluciclovine should be used in the routine posttreatment assessment of glioblastoma.

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Read article at publisher's site: https://doi.org/10.2967/jnumed.122.264812

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