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Simultaneously acquired PET and ASL imaging biomarkers are helpful in differentiating progression from pseudo-progression in treated gliomas

Nadya Pyatigorskaya^1,2,3, Arnaud Pellerin¹, Maya Kalife⁴, Marc Bertaux⁵, Marine Soret⁵, Didier Dormont¹, and Aurélie Kas⁵
¹Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Sorbonne universite, Paris, France, ²UMR S 1127, CNRS UMR 722, ICM, Sorbonne Universités, Paris, France, ³CENIR, ICM, Sorbonne Universités, Paris, France, ⁴CENIR, ICM, Paris, France, ⁵Nuclear Medecine, Pitié-Salpêtrière Hospital, APHP, Sorbonne universite, Paris, France

We aimed at investigating the methods based on coupling cerebral perfusion and amino-acid metabolism measurements to evaluate the PET/MRI in glioma follow-up. The tumour isocontour maps and T-maps showed the highest specificity and sensitivity for ASL and 18F-DOPA analysis.

PET-MR of a patient with left WHO IV glioblastoma treated by surgery and adjuvant radio-chemotherapy.

Upper row: A: enhancement on the frontal lesion on a contrast-enhanced axial T1-w image; B: hyper-perfusion with increased CBF on ASL images corresponds to the area of contrast enhancement; C: 18F-DOPA PET map with increased SUV

Lower row: SPM maps were concordant with significant clusters, which confirmed progression. The red ASL clusters appear to be more peripheral than the blue extensive PET clusters. D: T-score map; E: Z-score of asymmetry index; F: isocontour map.

PET-MR of patient with right glioblastoma, treated by surgery and adjuvant radiotherapy

Upper row: A: linear cavitary enhancement observed on the initially-treated frontal lesion site on a contrast-enhanced axial T1-w image; B: the absence of hyper-perfusion as assessed by CBF on ASL images; C: 18F-DOPA PET map showing no significantly increased SUV

Lower row: SPM maps were concordant, with the absence of significant clusters, which confirmed pseudo-progression. D: T-score map; E: Z-score of asymmetry index; F: isocontour map.