Abstract
PurposeTo elucidate the biological association between tumor proliferation, tumor infiltration and neovascularization, we analyzed the association between volumetric information of 4′-[methyl-11C]thiothymidine (4DST) positron emission tomography (PET) and fluid-attenuated inversion recovery (FLAIR) and T1-weighted gadopentetate dimeglumine (Gd)-enhanced magnetic resonance imaging (MRI), in patients with newly diagnosed glioma.MethodsA total of 23 patients with newly diagnosed glioma who underwent both 4DST PET/CT and Gd-enhanced MRI before therapy were available for a retrospective analysis of prospectively collected data. The maximum standardized uptake value (SUVmax) for tumor (T) and the mean SUV for normal contralateral hemisphere (N) were calculated, and the tumor-to-normal (T/N) ratio was determined. Proliferative tumor volume (PTV) from 4DST PET and the volume of Gd enhancement (GdV) and hyperintense region on FLAIR (FLAIRV) from MRI were calculated.ResultsAll gliomas but 3 diffuse astrocytomas and one anaplastic astrocytoma had 4DST uptake and Gd enhancement on MRI. There was no significant difference between PTV and GdV although the exact edges of the tumor differed in each modality. The FLAIRV was significantly larger than PTV (P < 0.001). Significant correlations between PTV and GdV (ρ = 0.941, P < 0.001) and FLAIRV (ρ = 0.682, P < 0.001) were found.ConclusionThese preliminary results indicate that tumor proliferation assessed by 4DST PET is closely associated with tumor-induced neovascularization determined by Gd-enhanced MRI in patients with newly diagnosed glioma.
Highlights
Tumor proliferation is considered an important indicator of tumor growth and therapeutic effectiveness [1]
There was no significant difference between Proliferative tumor volume (PTV) and GdV the exact edges of the tumor differed in each modality (Figs. 1, 2)
The FLAIRV was significantly larger than PTV (P < 0.001)
Summary
Tumor proliferation is considered an important indicator of tumor growth and therapeutic effectiveness [1]. The most direct indicator of cellular proliferation is deoxyribonucleic acid (DNA) synthesis, which can be measured using radiolabeled thymidine or its analogs. A thymidine analog, 3′-deoxy-3′-[18F]-fluorothymidine (FLT), has been used to assess the tumor proliferative activity of various types of tumor including brain tumor [3,4,5,6]. FLT has been validated for evaluation of cellular proliferation and tumor grade [3]. Toyohara et al developed 4′-[methyl-11C] thiothymidine (4DST) for cellular proliferation imaging, which is resistant to degradation by thymidine phosphorylase and is Norikane et al EJNMMI Res (2021) 11:42 incorporated into DNA [7]. Toyohara et al developed 4′-[methyl-11C] thiothymidine (4DST) for cellular proliferation imaging, which is resistant to degradation by thymidine phosphorylase and is Norikane et al EJNMMI Res (2021) 11:42 incorporated into DNA [7]. 4DST PET has been shown to be helpful in noninvasive evaluation of the proliferation of several types of tumor including brain tumor [8, 9]
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