Abstract
PurposeVentricle contact is associated with a worse prognosis and more aggressive tumor characteristics in glioblastoma (GBM). This is hypothesized to be a result of neural stem cells located around the lateral ventricles, in the subventricular zone. 11C Methionine positron emission tomography (metPET) is an indicator for increased proliferation, as it shows uptake of methionine, an amino acid needed for protein synthesis. This study is the first to study metPET characteristics of GBM in relation to ventricle contact.MethodsA total of 12 patients with IDH wild-type GBM were included. Using MRI, the following regions were determined: primary tumor (defined as contrast enhancing lesion on T1) and peritumoral edema (defined as edema visible on FLAIR excluding the enhancement). PET parameters in these areas were extracted using PET fused with MRI imaging. Parameters extracted from the PET included maximum and mean tumor-to-normal ratio (TNRmax and TNRmean) and metabolic tumor volume (MTV).ResultsTNRmean of the primary tumor showed significantly higher values for the ventricle-contacting group compared to that for the non-contacting group (4.44 vs 2.67, p = 0.030). Other metPET parameters suggested higher values for the ventricle-contacting group, but these differences did not reach statistical significance.ConclusionGBM with ventricle contact demonstrated a higher methionine uptake and might thus have increased proliferation compared with GBM without ventricle contact. This might explain survival differences and should be considered in treatment decisions.
Highlights
Glioblastoma (GBM) is a high-grade primary brain malignancy with a dire prognosis
Patients were only eligible for inclusion if they conformed to the following inclusion criteria: (1) isocitrate dehydrogenase wild-type (IDHwt) GBM was confirmed by pathological report, (2) preoperative/prebiopsy Methionine positron emission tomography (metPET) imaging was available, and (3) preoperative MRI with at least T1 post-contrast and T2 fluid-attenuated inversion recovery (FLAIR) sequences was available
After scoring these patients for ventricle contact, there was only one disagreement resulting in a good inter-rater agreement with a kappa of 0.80 (20)
Summary
Glioblastoma (GBM) is a high-grade primary brain malignancy with a dire prognosis. Median survival ranges from 12 to 18 months [1, 2]. This short life expectancy is related to the almost certain recurrence of GBM, which is due to the infiltrative nature of the tumor [3,4,5]. A meta-analysis showed that ventricle contact is associated with lower survival independent of other prognostic influences [6]. Ventricle contact has not been shown to be related to a different cell lineage in this regard, it has been associated with
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