MRI and amino acid PET detection of whole-brain tumor burden

Peng Chen; Matthew L Scarpelli; Debbie R Healey; Shwetal Mehta; C Chad Quarles

doi:10.3389/fonc.2023.1248249

MRI and amino acid PET detection of whole-brain tumor burden

Front Oncol. 2023 Sep 21:13:1248249. doi: 10.3389/fonc.2023.1248249. eCollection 2023.

Authors

Peng Chen¹, Matthew L Scarpelli¹, Debbie R Healey², Shwetal Mehta³, C Chad Quarles²

Affiliations

¹ School of Health Sciences, Purdue University, West Lafayette, IN, United States.
² Department of Cancer Systems Imaging, The University of Texas (UT) MD Anderson Cancer Center, Houston, TX, United States.
³ Ivy Brain Tumor Center, Barrow Neurological Institute, Phoenix, AZ, United States.

Abstract

Background: [¹⁸F]fluciclovine amino acid PET has shown promise for detecting brain tumor regions undetected on conventional anatomic MRI scans. However, it remains unclear which of these modalities provides a better assessment of the whole brain tumor burden. This study quantifies the performance of [¹⁸F]fluciclovine PET and MRI for detecting the whole brain tumor burden.

Methods: Thirteen rats were orthotopically implanted with fluorescently transduced human glioblastoma cells. Rats underwent MRI (T1- and T2-weighted) and [¹⁸F]fluciclovine PET. Next brains were excised, optically cleared, and scanned ex vivo with fluorescence imaging. All images were co-registered using a novel landmark-based registration to enable a spatial comparison. The tumor burden identified on the fluorescent images was considered the ground truth for comparison with the in vivo imaging.

Results: Across all cases, the PET sensitivity for detecting tumor burden (median 0.67) was not significantly different than MRI (combined T1+T2-weighted) sensitivity (median 0.61; p=0.85). However, the combined PET+MRI sensitivity (median 0.86) was significantly higher than MRI alone (41% higher; p=0.004) or PET alone (28% higher; p=0.0002). The specificity of combined PET+MRI (median=0.91) was significantly lower compared with MRI alone (6% lower; p=0.004) or PET alone (2% lower; p=0.002).

Conclusion: In these glioblastoma xenografts, [¹⁸F]fluciclovine PET did not provide a significant increase in tumor burden detection relative to conventional anatomic MRI. However, a combined PET and MRI assessment did significantly improve detection sensitivity relative to either modality alone, suggesting potential value in a combined assessment for some tumors.

Keywords: MRI; amino acid PET; brain tumor; glioblastoma; imaging; tissue clearing.

Grants and funding

We acknowledge the generosity of our sponsors for funding this work, including the Barrow Neurological Foundation, the Arizona Biomedical Research Centre (grant ADHS18-198850), Students Supporting Brain Tumor Research, and Blue Earth Diagnostics Ltd. These sponsors had no role in the research design, execution, analysis, interpretation, or reporting of these results.