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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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18F-FET-PET imaging results in the spotlight of the WHO 2016 classification system

18F-FET-PET Bildgebung im Spotlight der WHO 2016 Klassifikation

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  • presenting/speaker Karlijn Hakvoort - Rheinisch-Westfälische Technische Hochschule Aachen, Abteilung für Neurochirurgie, Aachen, Deutschland; Rheinisch-Westfälische Technische Hochschule Aachen, Neurosurgical Artificial Intelligence Laboratory Aachen (NAILA), Department of Neurosugery, Aachen, Deutschland
  • Jonas Ort - Rheinisch-Westfälische Technische Hochschule Aachen, Abteilung für Neurochirurgie, Aachen, Deutschland; Rheinisch-Westfälische Technische Hochschule Aachen, Neurosurgical Artificial Intelligence Laboratory Aachen (NAILA), Department of Neurosugery, Aachen, Deutschland
  • Julius Kernbach - Rheinisch-Westfälische Technische Hochschule Aachen, Abteilung für Neurochirurgie, Aachen, Deutschland; Rheinisch-Westfälische Technische Hochschule Aachen, Neurosurgical Artificial Intelligence Laboratory Aachen (NAILA), Department of Neurosugery, Aachen, Deutschland
  • Karl-Josef Langen - Forschungszentrum Jülich, Institut für Neurowissenschaften und Medizin (INM-4), Jülich, Deutschland; Rheinisch-Westfälische Technische Hochschule Aachen, Abteilung für Nuklearmedizin, Aachen, Deutschland; Jülich Aachen Research Alliance (JARA), Jülich, Deutschland
  • Philipp Lohmann - Forschungszentrum Jülich, Institut für Neurowissenschaften und Medizin (INM-4), Jülich, Deutschland; Jülich Aachen Research Alliance (JARA), Jülich, Deutschland
  • Georg Neuloh - Rheinisch-Westfälische Technische Hochschule Aachen, Abteilung für Neurochirurgie, Aachen, Deutschland
  • Hans Rainer Clusmann - Rheinisch-Westfälische Technische Hochschule Aachen, Abteilung für Neurochirurgie, Aachen, Deutschland
  • Daniel Delev - Rheinisch-Westfälische Technische Hochschule Aachen, Abteilung für Neurochirurgie, Aachen, Deutschland; Rheinisch-Westfälische Technische Hochschule Aachen, Neurosurgical Artificial Intelligence Laboratory Aachen (NAILA), Department of Neurosugery, Aachen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV088

doi: 10.3205/20dgnc091, urn:nbn:de:0183-20dgnc0911

Published: June 26, 2020

© 2020 Hakvoort et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: PET using 18F-Fluoroethyltyrosine (FET) represents an important imaging modality to assess tumor extent, treatment response and tumor progression of malignant glioma. In patients with suspected recurrent glioma, 18F-FET-PET additionally differentiates between malignant progression and pseudoprogression. The new WHO 2016 classification system highlights the pivotal role of molecular markers and their importance for oncological outcome. The aim of the study was to evaluate FET-PET imaging results with a particular focus on the revised WHO-classification.

Methods: We reviewed histopathological results as well as preoperative 18F-FET-PET imaging results in glioma patients (n=39) who underwent surgical resection between 2014 and 2018. 18F-FET-PET was performed in 26 patients before initial resection and in 13 additional cases before resection of suspected recurrent glioma.

Results: 18F-FET-PET showed a biologically active tumor volume (FET-PET positive result) prior to initial resection in 21 patients (81%). There was a significant correlation between FET-PET positivity and WHO grade (p=0.002, 95% CI 0.23 to 0.77); there were 15 high grade gliomas (WHO grade IV), who were all FET-PET positive, and 11 lower-grade gliomas (WHO grade II and III) of whom 5 cases had positive FET-PET results. IDH-wildtype status was significantly associated with FET-PET positivity (p<0.001, 95% CI -0.82 to -0.35). All IDH-wildtype tumors (n=16) were FET-PET positive, while the IDH-mutated tumors were equally distributed between FET-PET positive (n=5) and FET-PET negative (n=5). 1p/19 co-deletion was found in 7 patients, with 4 of them (57%) showing FET-PET positive results. MGMT was methylated in 13/21 (62%) patients, with 9 of them (69%) showing FET-PET positive results.

In the patient group with suspected recurrent glioma that underwent re-resection after FET-PET, 12 (92%) showed biologically active tumor. All 5 FET-PET negatives (4 in the first resection and 1 in the re-resection group) were IDH-mutated; all 4/4 were MGMT-methylated and 4/5 showed a 1p/19q-codeletion.

Conclusion: IDH-wildtype gliomas are biologically active tumors with highly malignant characteristics, which can be well detected by 18F-FET-PET. This may play an important role during the "preoperative tumor staging" and help to individualize patient’s oncological treatment.