Abstract
Brain tumors have been widely evaluated using the 3,4-dihydroxy-6-18fluoro-L-phenylalanine (18F-FDOPA) PET imaging. The aim of the study is to evaluate the role of 18F-FDOPA PET in low-grade glioma (LGG). We enrolled 60 patients (37 males and 23 females) affected with LGG; 23% were newly diagnosed, 45% were studied during treatment; and 32% were observed out of treatment during a periodic follow-up. All patients underwent 18F-FDOPA PET and MRI examination; both FLAIR and contrast-enhanced T1-weighted sequences were considered for the response assessment in according to RANO criteria. The PET images were interpreted as positive when the lesion presented definite tracer accumulation considering background and controlateral site. The slices with a maximal 18F-FDOPA uptake in the ROI were chosen for quantitative measurement of metabolic activity of the tracer [standardized uptake value (SUV)]. The concordance between MRI and 18F-FDOPA PET was evaluated measuring the unweighted kappa statistic and its relative 95% Confidence interval (95%CI). The Kappa statistic for the whole sample was equal to 0.301 (95%CIs from 0.21 to 0.40) showing a fair concordance between the two tests in terms of diagnostic ability. We found a good correlations between residual volume and SUV max (r = 0.435, p = 0.002 by Spearman Rank Correlation Coefficient), indicating that the greater the residual volume, higher the SUV max is. Also multivariate analysis documented that a SUV max greater than 1.75 represents the only independent predictor of disease progression (HR = 4.59, 95% CIs from 0.99 to 21.31, p = .054). This implies that a patient with a SUV max higher than 1.75 yielded an almost 5-fold increased risk of disease progression, regardless of its clinical and MRI characteristics. Present results confirm that 18F-FDOPA PET imaging may assume a relevant role mainly in the prognostic assessment of patients affected with primary and recurrent LGG.
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