Maximum Uptake and Hypermetabolic Volume of 18F-FDOPA PET Estimate Molecular Status and Overall Survival in Low-Grade Gliomas: A PET and MRI Study

Maximum Uptake and Hypermetabolic Volume of 18F-FDOPA PET Estimate Molecular Status and Overall Survival in Low-Grade Gliomas: A PET and MRI Study:

Purpose We evaluated 18F-FDOPA PET and MRI characteristics in association with the molecular status and overall survival (OS) in a large number of low-grade gliomas (LGGs). Methods Eighty-six patients who underwent 18F-FDOPA PET and MRI and were diagnosed with new or recurrent LGGs were retrospectively evaluated with respect to their isocitrate dehydrogenase (IDH) and 1p19q status (10 IDH wild type, 57 mutant, 19 unknown; 1p19q status in IDH mutant: 20 noncodeleted, 37 codeleted). After segmentation of the hyperintense area on fluid-attenuated inversion recovery image (FLAIRROI), the following were calculated: normalized SUVmax (nSUVmax) of 18F-FDOPA relative to the striatum, 18F-FDOPA hypermetabolic volume (tumor-to-striatum ratios >1), FLAIRROI volume, relative cerebral blood volume, and apparent diffusion coefficient within FLAIRROI. Receiver operating characteristic curve and Cox regression analyses were performed. Results PET and MRI metrics combined with age predicted the IDH mutation and 1p19q codeletion statuses with sensitivities of 73% and 76% and specificities of 100% and 94%, respectively. Significant correlations were found between OS and the IDH mutation status (hazard ratio [HR] = 4.939), nSUVmax (HR = 2.827), 18F-FDOPA hypermetabolic volume (HR = 1.048), and FLAIRROI volume (HR = 1.006). The nSUVmax (HR = 151.6) for newly diagnosed LGGs and the 18F-FDOPA hypermetabolic volume (HR = 1.038) for recurrent LGGs demonstrated significant association with OS. Conclusions Combining 18F-FDOPA PET and MRI with age proved useful for predicting the molecular status in patients with LGGs, whereas the nSUVmax and 18F-FDOPA hypermetabolic volume may be useful for prognostication. Received for publication June 12, 2020; revision accepted August 24, 2020. Conflicts of interest and sources of funding: Funding was received from SNMMI (H.T.), ACS Research Scholar Grant (RSG-15-003-01-CCE: B.M.E.), ABTA Research Collaborators Grant (ARC1700002: B.M.E.), NBTS Research Grant (B.M.E., T.F.C.), NIH/NCI UCLA Brain Tumor SPORE (1P50CA211015-01A1: B.M.E., A.L., T.F.C., P.L.N.), and NIH/NCI (1R21CA223757-01: B.M.E.). B.M.E. is an advisor for Hoffman La-Roche, Siemens, Nativis, Medicenna, MedQIA, Bristol Meyers Squibb, Imaging Endpoints, and Agios Pharmaceuticals. He is a paid consultant for Nativis, MedQIA, Siemens, Hoffman La-Roche, Imaging Endpoints, Medicenna, and Agios. He received grant funding from Siemens, Agios, and Janssen. T.F.C. is on the advisory board for Roche/Genentech, Amgen, Tocagen, NewGen, LPath, Proximagen, Celgene, Vascular Biogenics Ltd, Insys, Agios, Cortice Bioscience, Pfizer, Human Longevity, BMS, Merck, Notable Lab, and MedQIA. None declared for the other authors. Correspondence to: Benjamin M. Ellingson, PhD, David Geffen School of Medicine, University of California, Los Angeles, 924 Westwood Blvd, Suite 615, Los Angeles, CA 90024. E-mail: bellingson@mednet.ucla.edu. Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.nuclearmed.com). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.