Identification of time-to-peak on dynamic 18F-FET-PET as a prognostic marker specifically in IDH1/2 mutant diffuse astrocytoma

Abstract

Background

Stratification of glioma according to isocitrate dehydrogenase 1/2 (IDH1/2) mutation and 1p/19q codeletion status has gained major importance in the new World Health Organization (WHO) classification. Parameters derived from uptake dynamics of ¹⁸F-fluoro-ethyl-tyrosine PET (¹⁸F-FET-PET) such as minimal time-to-peak (TTP_min) allow discrimination between different prognostic glioma subgroups, too. The present study is aimed at exploring whether TTP_min analysis provides prognostic information beyond the WHO classification.

Methods

Three hundred patients with newly diagnosed WHO 2007 grades II–IV gliomas with ¹⁸F-FET-PET imaging at diagnosis were grouped into 4 subgroups (IDH1/2 mut–1p/19q codel; IDH1/2 mut–1p/19q non-codel; IDH1/2 wildtype WHO grade II and III tumors; and glioblastoma). Clinical and imaging factors such as age, Karnofsky performance score, treatment, TTP_min, and maximal tumor-to-brain ratio (TBR_max) were analyzed with regard to progression-free and overall survival (PFS and OS) via univariate and multivariate regression analysis.

Results

PFS and OS were longest in the IDH1/2 mut–1p/19q codel subgroup, followed by IDH1/2 mut–1p/19q non-codel, IDH1/2 wildtype, and GBM (P < 0.001). Further, outcome stratified by TTP_min with a cutoff of 17.5 minutes revealed significantly longer PFS and OS in patients with TTP_min >17.5 minutes (P < 0.001 for PFS and OS). Lower TBR_max values or the absence of ¹⁸F-FET uptake was also associated with favorable outcome in the entire group. In the subgroup analyses, longer median TTP_min was associated with improved outcome specifically in the IDH1/2 mut–1p/19q non-codel group.

Conclusion

¹⁸F-FET-PET–derived dynamic analysis defines prognostically distinct subgroups of IDH1/2 mutant–1p/19q non-codel gliomas which cannot be distinguished as yet by molecular marker analysis.