Unsupervised consensus cluster analysis of [18F]-fluoroethyl-L-tyrosine positron emission tomography identified textural features for the diagnosis of pseudoprogression in high-grade glioma.

Sied Kebir,Martin Glas,Björn Scheffler,Markus Essler,Ulrich Herrlinger,Elke Hattingen,Florian C Gaertner,Zain Khurshid,Ralph A Bundschuh,Rolf Fimmers

doi:10.18632/oncotarget.14166

Abstract

RationaleTimely detection of pseudoprogression (PSP) is crucial for the management of patients with high-grade glioma (HGG) but remains difficult. Textural features of O-(2-[18F]fluoroethyl)-L-tyrosine positron emission tomography (FET-PET) mirror tumor uptake heterogeneity; some of them may be associated with tumor progression.MethodsFourteen patients with HGG and suspected of PSP underwent FET-PET imaging. A set of 19 conventional and textural FET-PET features were evaluated and subjected to unsupervised consensus clustering. The final diagnosis of true progression vs. PSP was based on follow-up MRI using RANO criteria.ResultsThree robust clusters have been identified based on 10 predominantly textural FET-PET features. None of the patients with PSP fell into cluster 2, which was associated with high values for textural FET-PET markers of uptake heterogeneity. Three out of 4 patients with PSP were assigned to cluster 3 that was largely associated with low values of textural FET-PET features. By comparison, tumor-to-normal brain ratio (TNRmax) at the optimal cutoff 2.1 was less predictive of PSP (negative predictive value 57% for detecting true progression, p=0.07 vs. 75% with cluster 3, p=0.04).Principal ConclusionsClustering based on textural O-(2-[18F]fluoroethyl)-L-tyrosine PET features may provide valuable information in assessing the elusive phenomenon of pseudoprogression.

Highlights

Despite state-of-the-art surgery, radiation therapy and chemotherapy, the prognosis of patients with highgrade glioma (HGG) is grim
None of the patients with PSP fell into cluster 2, which was associated with high values for textural FET-Position emission tomography (PET) markers of uptake heterogeneity
Principal Conclusions: Clustering based on textural O-(2-[18F]fluoroethyl)-Ltyrosine PET features may provide valuable information in assessing the elusive phenomenon of pseudoprogression

Summary

Introduction

Despite state-of-the-art surgery, radiation therapy and chemotherapy, the prognosis of patients with highgrade glioma (HGG) is grim. The diagnosis of pseudoprogression is retrospective, requiring follow-up MRIs. Patient management would benefit from earliest diagnosis of pseudoprogression, ideally, when expanding contrast-enhancing lesions are detected for the first time. Patient management would benefit from earliest diagnosis of pseudoprogression, ideally, when expanding contrast-enhancing lesions are detected for the first time This is important for patients with greatly increasing contrast-enhancing lesions and deteriorating clinical status. These patients might not be able to wait for 4-8 weeks for a follow-up MRI to decide whether secondary surgery or any other therapeutic adjustments are necessary

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Conclusion