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Comparison of [18F]Fluoroethyltyrosine PET and Sodium MRI in Cerebral Gliomas: a Pilot Study

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Abstract

Purpose

Positron emission tomography (PET) using O-(2-[18F]fluoroethyl)-L-tyrosine ([18F]FET) improves the diagnostics of cerebral gliomas compared with conventional magnetic resonance imaging (MRI). Sodium MRI is an evolving method to assess tumor metabolism. In this pilot study, we explored the relationship of [18F]FET-PET and sodium MRI in patients with cerebral gliomas in relation to the mutational status of the enzyme isocitrate dehydrogenase (IDH).

Procedures

Ten patients with untreated cerebral gliomas and one patient with a recurrent glioblastoma (GBM) were investigated by dynamic [18F]FET-PET and sodium MRI using an enhanced simultaneous single-quantum- and triple-quantum-filtered imaging of 23Na (SISTINA) sequence to estimate total (NaT), weighted non-restricted (NaNR, mainly extracellular), and restricted (NaR, mainly intracellular) sodium in tumors and normal brain tissue. [18F]FET uptake and sodium parameters in tumors with a different IDH mutational status were compared. After biopsy or resection, histology and the IDH mutational status were determined neuropathologically.

Results

NaT (p = 0.05), tumor-to-brain ratios (TBR) of NaT (p = 0.02), NaNR (p = 0.003), and the ratio of NaT/NaR (p < 0.001) were significantly higher in IDH-mutated than in IDH-wild-type gliomas (n = 5 patients each) while NaR was significantly lower in IDH-mutated gliomas (p = 0.01). [18F]FET parameters (TBR, time-to-peak) were not predictive of IDH status in this small cohort of patients. There was no obvious relationship between sodium distribution and [18F]FET uptake. The patient with a recurrent GBM exhibited an additional radiation injury with strong abnormalities in sodium MRI.

Conclusions

Sodium MRI appears to be more strongly related to the IDH mutational status than are [18F]FET-PET parameters. A further evaluation of the combination of the two methods in a larger group of high- and low-grade gliomas seems promising.

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Acknowledgements

The authors thank Petra Engels, Elke Bechholz, Anita Köth, Suzanne Schaden, Elisabeth Theelen, Silke Frensch, Kornelia Frey, Stefan Schwan, and Lutz Tellmann for assistance in the patient studies; Johannes Ermert, Silke Grafmüller, Erika Wabbals and Sascha Rehbein for radiosynthesis of [18F]FET.

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Author notes

  1. Aliaksandra Shymanskaya and Wieland A. Worthoff contributed equally to this work.

Authors and Affiliations

  1. Institute of Neuroscience and Medicine (3, 4, 5, 11), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany

    Aliaksandra Shymanskaya, Wieland A. Worthoff, Gabriele Stoffels, Johannes Lindemeyer, Bernd Neumaier, Philipp Lohmann, Norbert Galldiks, Karl-Josef Langen & N. Jon Shah

  2. Department of Neurology, University of Cologne, Cologne, Germany

    Norbert Galldiks

  3. Center of Integrated Oncology (CIO), Universities of Bonn and Cologne, Cologne, Germany

    Norbert Galldiks

  4. Department of Nuclear Medicine, RWTH Aachen University, Aachen, Germany

    Karl-Josef Langen

  5. Jülich-Aachen Research Alliance (JARA) – Section JARA-Brain, Aachen, Germany

    Karl-Josef Langen & N. Jon Shah

  6. Department of Neurology, RWTH Aachen University, Aachen, Germany

    N. Jon Shah

Authors
  1. Aliaksandra Shymanskaya
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  2. Wieland A. Worthoff
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  3. Gabriele Stoffels
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Corresponding author

Correspondence to Wieland A. Worthoff.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Shymanskaya, A., Worthoff, W.A., Stoffels, G. et al. Comparison of [18F]Fluoroethyltyrosine PET and Sodium MRI in Cerebral Gliomas: a Pilot Study. Mol Imaging Biol 22, 198–207 (2020). https://doi.org/10.1007/s11307-019-01349-y

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