Research Papers:

Comparison among conventional and advanced MRI, 18F-FDG PET/CT, phenotype and genotype in glioblastoma

Maria Consuelo Valentini, Marta Mellai, Laura Annovazzi, Antonio Melcarne, Tetyana Denysenko, Paola Cassoni, Cristina Casalone, Cristiana Maurella, Silvia Grifoni, Piercarlo Fania, Angelina Cistaro and Davide Schiffer _

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Oncotarget. 2017; 8:91636-91653. https://doi.org/10.18632/oncotarget.21482

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Maria Consuelo Valentini1, Marta Mellai2, Laura Annovazzi2, Antonio Melcarne3, Tetyana Denysenko2, Paola Cassoni4, Cristina Casalone5, Cristiana Maurella5, Silvia Grifoni5, Piercarlo Fania6, Angelina Cistaro6,7 and Davide Schiffer2

1Department of Neuroradiology, A.O.U. Città della Salute e della Scienza, 10126 Turin, Italy

2Research Center/Policlinico di Monza Foundation, 13100 Vercelli, Italy

3Department of Neurosurgery, A.O.U. Città della Salute e della Scienza, 10126 Turin, Italy

4Department of Medical Sciences, University of Turin, 10126 Turin, Italy

5Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d’Aosta, 10154 Turin, Italy

6Positron Emission Tomography Center IRMET S.p.A, Euromedic Inc., 10136 Turin, Italy

7Institute of Cognitive Sciences and Technologies, National Research Council, 00185 Rome, Italy

Correspondence to:

Davide Schiffer, email: [email protected]

Keywords: glioblastoma, MRI, 18F-FDG PET/CT, phenotype, genotype

Received: November 15, 2016     Accepted: July 30, 2017     Published: October 04, 2017


Glioblastoma (GB) is a highly heterogeneous tumor. In order to identify in vivo the most malignant tumor areas, the extent of tumor infiltration and the sites giving origin to GB stem cells (GSCs), we combined positron emission tomography/computed tomography (PET/CT) and conventional and advanced magnetic resonance imaging (MRI) with histology, immunohistochemistry and molecular genetics. Prior to dura opening and tumor resection, forty-eight biopsy specimens [23 of contrast-enhancing (CE) and 25 of non-contrast enhancing (NE) regions] from 12 GB patients were obtained by a frameless image-guided stereotactic biopsy technique.

The highest values of 2-[18F]-fluoro-2-deoxy-D-glucose maximum standardized uptake value (18F-FDG SUVmax), relative cerebral blood volume (rCBV), Choline/Creatine (Cho/Cr), Choline/N-acetylaspartate (Cho/NAA) and Lipids/Lactate (LL) ratio have been observed in the CE region. They corresponded to the most malignant tumor phenotype, to the greatest molecular spectrum and stem cell potential. On the contrary, apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in the CE region were very variable.

18F-FDG SUVmax, Cho/Cr and Cho/NAA ratio resulted the most suitable parameters to detect tumor infiltration. In edematous areas, reactive astrocytes and microglia/macrophages were influencing variables.

Combined MRI and 18F-FDG PET/CT allowed to recognize the specific biological significance of the different identified areas of GB.

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