Oncotarget

Research Papers:

Unsupervised consensus cluster analysis of [18F]-fluoroethyl-L-tyrosine positron emission tomography identified textural features for the diagnosis of pseudoprogression in high-grade glioma

Sied Kebir, Zain Khurshid, Florian C. Gaertner, Markus Essler, Elke Hattingen, Rolf Fimmers, Björn Scheffler, Ulrich Herrlinger, Ralph A. Bundschuh and Martin Glas _

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Oncotarget. 2017; 8:8294-8304. https://doi.org/10.18632/oncotarget.14166

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Abstract

Sied Kebir1,2,*, Zain Khurshid3,*, Florian C. Gaertner3, Markus Essler3, Elke Hattingen4, Rolf Fimmers5, Björn Scheffler2,6, Ulrich Herrlinger1, Ralph A. Bundschuh3,#, Martin Glas1,2,7,#

1Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Germany

2Stem Cell Pathologies Group, Institute of Reconstructive Neurobiology, University of Bonn Medical Center, Germany

3Department of Nuclear Medicine, University of Bonn Medical Center, Germany

4Neuroradiology, Department of Radiology, University of Bonn Medical Center, Germany

5Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn Medical Center, Germany

6DKFZ –Division of Translational Oncology/Neurooncology, German Cancer Consortium (DKTK) & University Hospital Essen, Germany

7Clinical Cooperation Unit Neurooncology, MediClin Robert Janker Klinik, Bonn, Germany

*Shared first authorship

#Shared last authorship

Correspondence to:

Martin Glas, email: [email protected]

Keywords: heterogeneity, FET-PET, pseudoprogression, glioblastoma, textural

Received: September 30, 2016     Accepted: November 23, 2016     Published: December 24, 2016

ABSTRACT

Rationale: Timely detection of pseudoprogression (PSP) is crucial for the management of patients with high-grade glioma (HGG) but remains difficult. Textural features of O-(2-[18F]fluoroethyl)-L-tyrosine positron emission tomography (FET-PET) mirror tumor uptake heterogeneity; some of them may be associated with tumor progression.

Methods: Fourteen patients with HGG and suspected of PSP underwent FET-PET imaging. A set of 19 conventional and textural FET-PET features were evaluated and subjected to unsupervised consensus clustering. The final diagnosis of true progression vs. PSP was based on follow-up MRI using RANO criteria.

Results: Three robust clusters have been identified based on 10 predominantly textural FET-PET features. None of the patients with PSP fell into cluster 2, which was associated with high values for textural FET-PET markers of uptake heterogeneity. Three out of 4 patients with PSP were assigned to cluster 3 that was largely associated with low values of textural FET-PET features. By comparison, tumor-to-normal brain ratio (TNRmax) at the optimal cutoff 2.1 was less predictive of PSP (negative predictive value 57% for detecting true progression, p=0.07 vs. 75% with cluster 3, p=0.04).

Principal Conclusions: Clustering based on textural O-(2-[18F]fluoroethyl)-L-tyrosine PET features may provide valuable information in assessing the elusive phenomenon of pseudoprogression.


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