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