gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Comparative evaluation of CT perfusion versus FET-PET in differentiating recurrent malignant glioma from pseudoprogression

Meeting Abstract

  • S.A. Ahmadi - Heinrich-Heine-Universität Düsseldorf, Neurochirurgische Klinik
  • W. Lindemann - Heinrich-Heine-Universität Düsseldorf, Neurochirurgische Klinik
  • K.J. Langen - Forschungszentrum Jülich, Institut für Neurowissenschaften und Medizin
  • B. Turowski - Heinrich-Heine-Universität Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie
  • H.J. Steiger - Heinrich-Heine-Universität Düsseldorf, Neurochirurgische Klinik
  • M. Sabel - Heinrich-Heine-Universität Düsseldorf, Neurochirurgische Klinik

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocSA.07.04

DOI: 10.3205/12dgnc344, URN: urn:nbn:de:0183-12dgnc3448

Published: June 4, 2012

© 2012 Ahmadi et al.
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Outline

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Objective: Gadolinium enhanced MR imaging has been shown to be of limited value in differentiating brain tumor recurrence from pseudoprogression due to therapeutic effects of irradiation and chemotherapy. Metabolic imaging (FET-PET) is an accepted but not ubiquitously available modality for differentiation. It has been reported that reduced cerebral blood flow (CBF) measurements in CT perfusion imaging may also be used to delineate pseudoprogression from growing tumor. Our objective was to determine the predictive value of CBF and FET-PET in differentiating recurrent malignant glioma from pseudo progression in patients previously treated with chemo- and/or radiotherapy after surgical resection.

Methods: 21 patients (13 male, 8 female) presenting with new or increased contrast enhancement on follow-up MR imaging after surgical resection and adjuvant chemo- and/or radiotherapy were enrolled. Results were evaluated independently by two investigators. Predictive values of either modality were established using histopathology results in patients undergoing subsequent surgery or by employing RANO criteria.

Results: On CT perfusion imaging, 18 patients were diagnosed with tumor recurrence and 3 patients were found to show pseudoprogression. FET-PET demonstrated tumor recurrence in 19 patients, with therapy induced changes occurring in 2 patients. CT perfusion and FET-PET diagnoses differed in 3 out of 21 patients (14%). CT perfusion correctly predicted end points for 2 of these 3 patients, while FET-PET imaging correctly predicted the end point in one patient. Both FET-PET and CT perfusion incorrectly predicted tumor recurrence in 3 patients who subsequently were diagnosed with pseudoprogression by RANO and / or histopathology findings. In total, CT perfusion showed an accuracy in end point prediction of 81% (17 out of 21), versus 76% (16 out of 21) accuracy for FET-PET.

Conclusions: We postulate a non-inferiority of CT perfusion imaging to FET-PET as a predictive tool in differentiating pseudoprogression from tumor recurrence in malignant gliomas.