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OtherClinical Investigations (Human)
Distinguishing Progression from Pseudoprogression in Glioblastoma Using 18F-Fluciclovine PET
Ali Nabavizadeh, Stephen J Bagley, Robert K. Doot, Jeffrey B Ware, Anthony J. Young, Satyam Ghodasara, Chao Zhao, Hannah Anderson, Erin Schubert, Erica L. Carpenter, Jacob Till, Fraser Henderson, Austin R. Pantel, H. Isaac Chen, John Y. K. Lee, Nduka M. Amankulor, Donald M. O'Rourke, Arati Desai, MacLean P. Nasrallah and Steven Brem
Journal of Nuclear Medicine December 2022, jnumed.122.264812; DOI: https://doi.org/10.2967/jnumed.122.264812
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Abstract
Rationale: Accurate differentiation between tumor progression (TP) and pseudoprogression remains a critical unmet need in neuro-oncology. 18F-fluciclovine is a widely available synthetic amino acid PET radiotracer. In this study, we aimed to assess the value of 18F-fluciclovine PET for differentiating pseudoprogression from TP in a prospective cohort of patients with suspected radiographic recurrence of glioblastoma. Methods: We enrolled 30 glioblastoma patients with radiographic progression after first-line chemoradiotherapy who were planned for surgical resection. Patients underwent pre-operative 18F-fluciclovine PET and MRI. Relative percentages of viable tumor and therapy-related changes observed in histopathology were quantified and categorized as TP (=50% viable tumor), mixed TP (<50% and >10% viable tumor), or pseudoprogression (=10% viable tumor). Results: Eighteen patients had TP, 4 mixed TP, and 8 pseudoprogression. Patients with TP/mixed TP had significantly higher 40-50 minutes SUVmax (6.64+ 1.88 vs 4.11± 1.52, P = 0.009) compared to patients with pseudoprogression. A 40-50 minutes SUVmax cut-off of 4.66 provided 90% sensitivity and 83% specificity for differentiation of TP/mixed TP from pseudoprogression (Area under the curve (AUC)=0.86). Relative cerebral blood volume (rCBVmax) cut-off 3.672 provided 90% sensitivity and 71% specificity for differentiation of TP/mixed TP from Pseudoprogression (AUC=0.779). Combining a 40-50 minutes SUVmax cut-off of 4.66 and a rCBVmax cut-off of 3.67 on MRI provided 100% sensitivity and 80% specificity for differentiating TP/mixed TP from Pseudoprogression (AUC=0.95). Conclusion: 18F-fluciclovine PET uptake can accurately differentiate pseudoprogression from TP in glioblastoma, with even greater accuracy when combined with multi-parametric MRI. Given the wide availability of 18F-fluciclovine, larger, multicenter studies are warranted to determine whether amino acid PET with 18F-fluciclovine should be used in the routine assessment of post-treatment glioblastoma.

MRIOncology: BrainPET18F-fluciclovineGlioblastomaPseudoprogressionTumor progression
Copyright © 2022 by the Society of Nuclear Medicine and Molecular Imaging, Inc.
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In this issue
Journal of Nuclear Medicine: 63 (12)
Journal of Nuclear Medicine
Vol. 63, Issue 12
December 1, 2022
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MRIOncology: BrainPET18F-fluciclovineGlioblastomaPseudoprogressionTumor progression
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