Comparison of diagnostic accuracy of ¹⁸F-FDG PET, ¹²³I-IMT- and ^99mTc-MIBI SPECT

Summary

Aim was to evaluates the diagnostic accuracy of the SPECTtracers 3-¹²³I-α-methyl-L-tyrosine (IMT) and ^99mTc(I)- hexakis(2-methoxyisobutylisonitrile) (MIBI) as well as the PET-tracer 2-¹⁸F-2-deoxyglucose (FDG) for detecting tumour progression in irradiated low grade astrocytomas (LGA). Patients, methods: We examined 91 patients (56 males; 35 females; 44.7 ± 11.5 years), initially suffering from histologically proven LGAs (mean WHO grade II) and treated by stereotactic radiotherapy (59.0 ± 4.6 Gy). On average 21.9 ± 11.2 months after radiotherapy, patients presented new Gd-DTPA enhancing lesions on MRI, which did not allow a differentiation between progressive tumour (PT) and non-PT (nPT) at this point of time. PET scans (n=82) were acquired 45 min after injection of 208 ± 32 MBq FDG. SPECT scans started 10 min after injection of 269 ± 73 MBq IMT (n=68) and 15 min after injection of 706 ± 63 MBq MIBI (n=34). Lesions were classified as PT and nPT based on prospective follow-up (clinically, MRI) for 17.2 ± 9.9 months after PET/SPECT. Lesion-to-normal ratios (L/N) were calculated using contra lateraly mirrored reference regions for the SPECT examinations and reference regions in the contra lateral grey (GM) and white matter (WM) for FDG PET. Ratios were evaluated by Receiver Operating Characteristic (ROC) analysis. Results: In the patient groups nPT and PT, L/N ratios for FDG (GS) were 0.6 ± 0.3 vs. 1.2 ± 0.5 (p = 0.003), for FDG (WS) 1.2 ± 0.4 vs. 2.6 ± 0.4 (p <0.001), for IMT 1.1 ± 0.1 vs. 1.8 ± 0.4 (p <0.001) and for MIBI 1.6 ± 0.7 vs. 2.6 ± 2.2 (p = 0.554). Areas under the non-parametric ROC-curves were: 0.738 ± 0.059 for FDG (GS), 0.790 ± 0.057 for FDG (WS), 0.937 ± 0.037 for IMT and 0.564 ± 0.105 for MIBI. Conclusion: MIBI-SPECT examinations resulted in a low accuracy and especially in a poor sensitivity even at modest specificity values. A satisfying diagnostic accuracy was reached with FDG PET. Using WM as reference region for FDG PET, a slightly higher AUC as compared to GM was calculated. IMT yielded the best ROC characteristics and the highest diagnostic accuracy for differentiating between PT and nPT in irradiated LGA.

Zusammenfassung

Ziel: Ermittlung der diagnostischen Genauigkeit des PETTracers 2-¹⁸F-2-Deoxyglukose (FDG) sowie der SPECT-Tracer ¹²³I-α-Methyl-L-Tyrosin (IMT) und ^99mTc-Hexakis-Methoxy- isobutyl-isonitril (MIBI) zur Detektion einer Tumorprogression bei bestrahlten niedriggradigen Astrozytomen (LGA). Patienten, Methoden: Das Kollektiv bestand aus 91 Patienten (56 Männer; 35 Frauen; 44,7 ± 11,5 Jahre) mit histologisch gesicherten LGA (mittlerer WHO-Grad II), die stereotaktisch bestrahlt wurden (59,0 ± 4,6 Gy). Durchschnittlich 21,9 ± 11,2 Monate nach Strahlentherapie zeigten die Patienten Gd-DTPA anreichernde Läsionen in der MRT, progressive (PT) und nicht progressive Tumoren (nPT) waren nicht zu unterscheiden. Die PET (n = 82) wurde 45 min nach Injektion von 208 ± 32 MBq FDG durchgeführt. Die SPECT begann 10 min nach Injektion von 269 ± 73 MBq IMT (n = 68) bzw. 15 min nach Injektion von 706 ± 63 MBq MIBI (n = 34). Die Läsionen wurden basierend auf einer prospektiven Nachbeobachtung (klinisch, MRT) von 17,2 ± 9,9 Monaten als PT bzw. nPT klassifiziert und mittels Receiver Operating Characteristic (ROC)- Analyse ausgewertet. Referenzregion bei SPECT-Untersuchungen war das in die kontralaterale Hemisphäre gespiegelte Läsionsgebiet und für die FDG PET die kontralaterale graue und weiße Substanz (GS bzw. WS). Ergebnisse: In den Patientengruppen nPT und PT waren L/N für FDG (GS) 0,6 ± 0,3 vs. 1,2 ± 0,5 (p = 0,003), für FDG (WS) 1,2 ± 0,4 vs. 2,6 ± 0,4 (p <0,001), für IMT 1,1 ± 0,1 vs. 1,8 ± 0,4 (p <0,001) und für MIBI 1,6 ± 0,7 vs. 2,6 ± 2,2 (p = 0,554). Flächen unter der nicht parametrischen ROC-Kurve: für FDG (GS) 0,738 ± 0,059, für FDG (WS) 0,790 ± 0,057, für IMT 0,937 ± 0,037 und für MIBI 0,564 ± 0,105. Schlussfolgerung: Für die MIBISPECT unterschied sich die AUC nicht signifikant von der einer Zufallsdiagnose. FDG PET zeigte eine befriedigende diagnostische Genauigkeit. Mit WS als Referenz wurde gegenüber GS eine geringfügig höhere AUC berechnet, IMT SPECT erwies eine sehr gute diagnostische Genauigkeit, um zwischen PT und nPT bei bestrahlten LGA zu differenzieren.

Keywords

¹⁸F-FDG PET - ¹²³I-IMT SPECT - ^99mTc-MIBI SPECT - low grade astrocytoma - radiotherapy - ROC analysis

Schlüsselwörter

¹⁸F-FDG PET - ¹²³I-IMT SPECT - ^99mTc-MIBI SPECT - niedriggradiges Astrozytom - Strahlentherapie - ROC-Analyse

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