Multimodal Imaging of Nonenhancing Glioblastoma Regions
Background: Clinical glioblastoma treatment mostly focuses on the contrast-enhancing tumor mass. Amino acid positron emission tomography (PET) can detect additional, nonenhancing glioblastoma-infiltrated brain regions that are difficult to distinguish on conventional magnetic resonance imaging (MRI)...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2019-11-01
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| Series: | Molecular Imaging |
| Online Access: | https://doi.org/10.1177/1536012119885222 |
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| author | Flóra John MD Natasha L. Robinette MD Alit J. Amit-Yousif MD Edit Bosnyák MD Geoffrey R. Barger MD Keval D. Shah MD Sandeep Mittal MD Csaba Juhász MD, PhD |
| author_facet | Flóra John MD Natasha L. Robinette MD Alit J. Amit-Yousif MD Edit Bosnyák MD Geoffrey R. Barger MD Keval D. Shah MD Sandeep Mittal MD Csaba Juhász MD, PhD |
| author_sort | Flóra John MD |
| collection | DOAJ |
| description | Background: Clinical glioblastoma treatment mostly focuses on the contrast-enhancing tumor mass. Amino acid positron emission tomography (PET) can detect additional, nonenhancing glioblastoma-infiltrated brain regions that are difficult to distinguish on conventional magnetic resonance imaging (MRI). We combined MRI with perfusion imaging and amino acid PET to evaluate such nonenhancing glioblastoma regions. Methods: Structural MRI, relative cerebral blood volume (rCBV) maps from perfusion MRI, and α-[ 11 C]-methyl- l -tryptophan (AMT)-PET images were analyzed in 20 patients with glioblastoma. The AMT uptake and rCBV (expressed as tumor to normal [T/N] ratios) were compared in nonenhancing tumor portions showing increased signal on T2/fluid-attenuated inversion recovery (T2/FLAIR) images. Results: Thirteen (65%) tumors showed robust heterogeneity in nonenhancing T2/FLAIR hyperintense areas on AMT-PET, whereas the nonenhancing regions in the remaining 7 cases had homogeneous AMT uptake (low in 6, high in 1). AMT and rCBV T/N ratios showed only a moderate correlation in the nonenhancing regions ( r = 0.41, P = .017), but regions with very low rCBV (<0.79 T/N ratio) had invariably low AMT uptake. Conclusions: The findings demonstrate the metabolic and perfusion heterogeneity of nonenhancing T2/FLAIR hyperintense glioblastoma regions. Amino acid PET imaging of such regions can detect glioma-infiltrated brain for treatment targeting; however, very low rCBV values outside the contrast-enhancing tumor mass make increased AMT uptake in nonenhancing glioblastoma regions unlikely. |
| format | Article |
| id | doaj-art-0210e45e9bab42379c3568a03c19c7cb |
| institution | Kabale University |
| issn | 1536-0121 |
| language | English |
| publishDate | 2019-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Molecular Imaging |
| spelling | doaj-art-0210e45e9bab42379c3568a03c19c7cb2025-01-03T01:22:40ZengSAGE PublishingMolecular Imaging1536-01212019-11-011810.1177/1536012119885222Multimodal Imaging of Nonenhancing Glioblastoma RegionsFlóra John MD0Natasha L. Robinette MD1Alit J. Amit-Yousif MD2Edit Bosnyák MD3Geoffrey R. Barger MD4Keval D. Shah MD5Sandeep Mittal MD6Csaba Juhász MD, PhD7 Department of Pediatrics, Wayne State University and PET Center and Translational Imaging Laboratory, Children’s Hospital of Michigan, Detroit, MI, USA Karmanos Cancer Institute, Detroit, MI, USA Karmanos Cancer Institute, Detroit, MI, USA Department of Pediatrics, Wayne State University and PET Center and Translational Imaging Laboratory, Children’s Hospital of Michigan, Detroit, MI, USA Karmanos Cancer Institute, Detroit, MI, USA Department of Neurology, Wayne State University, Detroit, MI, USA Virginia Tech School of Neuroscience, Blacksburg, VA, USA Karmanos Cancer Institute, Detroit, MI, USABackground: Clinical glioblastoma treatment mostly focuses on the contrast-enhancing tumor mass. Amino acid positron emission tomography (PET) can detect additional, nonenhancing glioblastoma-infiltrated brain regions that are difficult to distinguish on conventional magnetic resonance imaging (MRI). We combined MRI with perfusion imaging and amino acid PET to evaluate such nonenhancing glioblastoma regions. Methods: Structural MRI, relative cerebral blood volume (rCBV) maps from perfusion MRI, and α-[ 11 C]-methyl- l -tryptophan (AMT)-PET images were analyzed in 20 patients with glioblastoma. The AMT uptake and rCBV (expressed as tumor to normal [T/N] ratios) were compared in nonenhancing tumor portions showing increased signal on T2/fluid-attenuated inversion recovery (T2/FLAIR) images. Results: Thirteen (65%) tumors showed robust heterogeneity in nonenhancing T2/FLAIR hyperintense areas on AMT-PET, whereas the nonenhancing regions in the remaining 7 cases had homogeneous AMT uptake (low in 6, high in 1). AMT and rCBV T/N ratios showed only a moderate correlation in the nonenhancing regions ( r = 0.41, P = .017), but regions with very low rCBV (<0.79 T/N ratio) had invariably low AMT uptake. Conclusions: The findings demonstrate the metabolic and perfusion heterogeneity of nonenhancing T2/FLAIR hyperintense glioblastoma regions. Amino acid PET imaging of such regions can detect glioma-infiltrated brain for treatment targeting; however, very low rCBV values outside the contrast-enhancing tumor mass make increased AMT uptake in nonenhancing glioblastoma regions unlikely.https://doi.org/10.1177/1536012119885222 |
| spellingShingle | Flóra John MD Natasha L. Robinette MD Alit J. Amit-Yousif MD Edit Bosnyák MD Geoffrey R. Barger MD Keval D. Shah MD Sandeep Mittal MD Csaba Juhász MD, PhD Multimodal Imaging of Nonenhancing Glioblastoma Regions Molecular Imaging |
| title | Multimodal Imaging of Nonenhancing Glioblastoma Regions |
| title_full | Multimodal Imaging of Nonenhancing Glioblastoma Regions |
| title_fullStr | Multimodal Imaging of Nonenhancing Glioblastoma Regions |
| title_full_unstemmed | Multimodal Imaging of Nonenhancing Glioblastoma Regions |
| title_short | Multimodal Imaging of Nonenhancing Glioblastoma Regions |
| title_sort | multimodal imaging of nonenhancing glioblastoma regions |
| url | https://doi.org/10.1177/1536012119885222 |
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