Voxel-wise analysis of fluoroethyltyrosine PET and MRI in the assessment of recurrent glioblastoma during antiangiogenic therapy

Elizabeth George, Marie F. Kijewski, Shipra Dubey, Anthony P. Belanger, David A. Reardon, Patrick Y. Wen, Santosh Kesari, Laura Horky, Mi Ae Park, Raymond Y. Huang

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

OBJECTIVE. In MRI of patients with recurrent glioblastoma, bevacizumab-induced normalization of tumor vascularity can be difficult to differentiate from antitumor effects. The aim of this study was to assess the utility of 18F-fluoroethyl-L-tyrosine (FET) PET in the evaluation of recurrent glioblastoma treated with bevacizumab. SUBJECTS AND METHODS. MRI and FET PET were performed before and after administration of two doses of bevacizumab to 11 patients with recurrent glioblastoma. The ratio between normalized FET uptake at follow-up and baseline of the entire (volume of T2 FLAIR abnormality) and enhancing tumor were assessed for prediction of progression-free survival (PFS) and overall survival (OS). Voxel-wise Spearman correlation between normalized FET uptake and contrast-enhanced T1 signal intensity was assessed and tested as a predictor of PFS and OS. RESULTS. Mean Spearman correlation between FET uptake and contrast-enhanced T1 signal intensity before therapy was 0.65 and after therapy was 0.61 (p = 0.256). The median PFS after initiation of bevacizumab therapy was 111 days, and the OS was 223 days. A posttreatment to pretreatment PET uptake ratio (mean and 90th percentile) greater than 0.7 for both entire and enhancing tumor was associated with lower PFS and OS (p < 0.001–0.049). The increase in correlation between PET uptake and contrast-enhanced T1 intensity after treatment was associated with lower PFS (p < 0.001) and OS (p = 0.049). CONCLUSION. There is only a moderate correlation between FET PET uptake and contrast-enhanced T1 signal intensity. High posttreatment-to-pretreatment FET PET uptake ratio and increase in correlation between PET uptake and contrast-enhanced T1 signal intensity after bevacizumab treatment are associated with poor PFS and OS.

Original languageEnglish (US)
Pages (from-to)1342-1347
Number of pages6
JournalAmerican Journal of Roentgenology
Volume211
Issue number6
DOIs
StatePublished - Dec 2018
Externally publishedYes

Keywords

  • Bevacizumab
  • FET
  • Fluoroethyl tyrosine
  • Glioblastoma
  • MRI
  • PET

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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