Comparisons Between PET With 11C-Methyl-L-Methionine and Arterial Spin Labeling Perfusion Imaging in Recurrent Glioblastomas Treated With Bevacizumab

Purpose The aim of this study was to clarify whether arterial spin labeling (ASL) perfusion imaging can assess biological effects from bevacizumab (BEV) therapy as reliably as PET with 11C-methyl-L-methionine (11C-met-PET). Materials and Methods Twenty-four patients with recurrent glioblastoma were examined using both ASL and 11C-met-PET before and 4 and 8 weeks after starting BEV treatment. Tumor-to-normal brain (T/N) ratios, fluctuations in T/N ratio, and tumor volumes were compared between ASL and 11C-met-PET. Accuracy of predicting patient with long progression-free survival (PFS) was assessed for T/N ratios and fluctuations for ASL and 11C-met-PET in each phase and in each period using receiver operating characteristic curves. Between 2 groups of patients assigned by cutoff values from receiver operating characteristic curves, PFS was compared in each phase or in each period. Results T/N ratios, fluctuations in ratio, and tumor volumes correlated significantly between ASL and 11C-met-PET at all time points and all periods. Arterial spin labeling was eligible as a predictor for long PFS only in assessment of fluctuations in T/N ratio. However, the most accurate predictors for long PFS were T/N ratio from 11C-met-PET at 8 weeks and the fluctuation from baseline to 4 weeks in T/N ratio from 11C-met-PET. Conclusions Blood flows on ASL correlated with accumulations of 11C-met on PET in recurrent glioblastoma under BEV treatment. Although 11C-met-PET offered superior accuracy for predicting patients with long PFS from time points, ASL offered reliable prediction of long PFS, provided that fluctuations in T/N ratio between consecutive scans are assessed. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received for publication April 18, 2018; revision accepted October 23, 2018. Conflicts of interest and sources of funding: This study was supported in part by Grants-in-Aid for JSPS KAKENHI (grant no. 17K11590) and Strategic Medical Science Research (grant no. S1491001) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan. None declared to all authors. Correspondence to: Takaaki Beppu, MD, Department of Neurosurgery, Iwate Medical University, Uchimaru 19–1, Morioka, 020–8505, Japan. E-mail: tbeppu@iwate-med.ac.jp. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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