Abstract
PurposeTo evaluate radiomic features extracted from standard static images (20–40 min p.i.), early summation images (5–15 min p.i.), and dynamic [18F]FET PET images for the prediction of TERTp-mutation status in patients with IDH-wildtype high-grade glioma.MethodsA total of 159 patients (median age 60.2 years, range 19–82 years) with newly diagnosed IDH-wildtype diffuse astrocytic glioma (WHO grade III or IV) and dynamic [18F]FET PET prior to surgical intervention were enrolled and divided into a training (n = 112) and a testing cohort (n = 47) randomly. First-order, shape, and texture radiomic features were extracted from standard static (20–40 min summation images; TBR20–40), early static (5–15 min summation images; TBR5–15), and dynamic (time-to-peak; TTP) images, respectively. Recursive feature elimination was used for feature selection by 10-fold cross-validation in the training cohort after normalization, and logistic regression models were generated using the radiomic features extracted from each image to differentiate TERTp-mutation status. The areas under the ROC curve (AUC), accuracy, sensitivity, specificity, and positive and negative predictive value were calculated to illustrate diagnostic power in both the training and testing cohort.ResultsThe TTP model comprised nine selected features and achieved highest predictability of TERTp-mutation with an AUC of 0.82 (95% confidence interval 0.71–0.92) and sensitivity of 92.1% in the independent testing cohort. Weak predictive capability was obtained in the TBR5–15 model, with an AUC of 0.61 (95% CI 0.42–0.80) in the testing cohort, while no predictive power was observed in the TBR20–40 model.ConclusionsRadiomics based on TTP images extracted from dynamic [18F]FET PET can predict the TERTp-mutation status of IDH-wildtype diffuse astrocytic high-grade gliomas with high accuracy preoperatively.
Highlights
Mutations in the telomerase reverse transcriptase promoter (TERTp), leading to telomerase activation and lengthened telomeres, play an important role in the formation of brain cancer and individual prognosis [1,2,3]
As the early peak uptake in aggressive gliomas is missed in the standard 20–40 min p.i. summation images, it does not surprise that the maximal tumour-to-background ratio (TBRmax) evaluation obtained in early summation images (5–15 min p.i.) was reported to perform better than the standard static TBRmax values (20–40 min p.i.) for the differentiation between low-grade and high-grade gliomas [17], which led to the suggestion to include these early summation images for a better glioma characterization
107 radiomic features of candidates were generated from standard static images (20–40 min p.i.), early summation images (5–15 min p.i.), and dynamic [18F]FET positron emission tomography (PET) images respectively, including first-order statistics, shape-based features, and texture features
Summary
Mutations in the telomerase reverse transcriptase promoter (TERTp), leading to telomerase activation and lengthened telomeres, play an important role in the formation of brain cancer and individual prognosis [1,2,3]. As the early peak uptake in aggressive gliomas is missed in the standard 20–40 min p.i. summation images, it does not surprise that the maximal tumour-to-background ratio (TBRmax) evaluation obtained in early summation images (5–15 min p.i.) was reported to perform better than the standard static TBRmax values (20–40 min p.i.) for the differentiation between low-grade and high-grade gliomas [17], which led to the suggestion to include these early summation images for a better glioma characterization Another interesting parameter derived from dynamic [18F]FET PET is the minimal time-to-peak (TTPmin), which is extracted from the time-activity-curves and was reported to provide prognostic information [21]. In our recently published study investigating [18F]FET uptake characteristics in TERTp mutant and TERTp wildtype glioblastomas, neither the standard T BRmax as static parameter nor TTPmin as dynamic parameter were associated with the TERTp-mutation status [24]
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