Evaluation of isocitrate dehydrogenase mutation in 2021 world health organization classification grade 3 and 4 glioma adult-type diffuse gliomas with 18F-fluoromisonidazole PET
Yang Wang, Yasutaka Fushimi, Yoshiki Arakawa, Yoichi Shimizu, Kohei Sano, Akihiko Sakata, Satoshi Nakajima, Sachi Okuchi, Takuya Hinoda, Sonoko Oshima, Sayo Otani, Takayoshi Ishimori, Masahiro Tanji, Yohei Mineharu, Kazumichi Yoshida, Yuji Nakamoto
Abstract
Abstract Purpose This study aimed to investigate the uptake characteristics of 18 F-fluoromisonidazole (FMISO), in mutant-type isocitrate dehydrogenase ( IDH-mutant, grade 3 and 4) and wild-type IDH ( IDH-wildtype , grade 4) 2021 WHO classification adult-type diffuse gliomas. Materials and methods Patients with grade 3 and 4 adult-type diffuse gliomas (n = 35) were included in this prospective study. After registering 18 F-FMISO PET and MR images, standardized uptake value (SUV) and apparent diffusion coefficient (ADC) were evaluated in hyperintense areas on fluid-attenuated inversion recovery (FLAIR) imaging (HIA), and in contrast-enhanced tumors (CET) by manually placing 3D volumes of interest. Relative SUV max (rSUV max ) and SUV mean (rSUV mean ), 10th percentile of ADC (ADC 10pct ), mean ADC (ADC mean ) were measured in HIA and CET, respectively. Results rSUV mean in HIA and rSUV mean in CET were significantly higher in IDH-wildtype than in IDH-mutant (P = 0.0496 and 0.03, respectively). The combination of FMISO rSUV mean in HIA and ADC 10pct in CET, that of rSUV max and ADC 10pct in CET, that of rSUV mean in HIA and ADC mean in CET, were able to differentiate IDH-mutant from IDH-wildtype (AUC 0.80). When confined to astrocytic tumors except for oligodendroglioma, rSUV max , rSUV mean in HIA and rSUV mean in CET were higher for IDH-wildtype than for IDH-mutant , but not significantly (P = 0.23, 0.13 and 0.14, respectively). The combination of FMISO rSUV mean in HIA and ADC 10pct in CET was able to differentiate IDH-mutant (AUC 0.81). Conclusion PET using 18 F-FMISO and ADC might provide a valuable tool for differentiating between IDH mutation status of 2021 WHO classification grade 3 and 4 adult-type diffuse gliomas.