Voxelwise and Patientwise Correlation of 18F-FDOPA PET, Relative Cerebral Blood Volume, and Apparent Diffusion Coefficient in Treatment-Naïve Diffuse Gliomas with Different Molecular Subtypes

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Abstract
Purpose: To identify correlations of gliomas between 18F-fluorodihydroxyphenylalanine (FDOPA) uptake and physiological magnetic resonance imaging (MRI) including relative cerebral blood volume (rCBV) and apparent diffusion coefficient (ADC) with different molecular subtypes, and to evaluate their prognostic values. Methods: Sixty-eight treatment-naïve glioma patients who underwent FDOPA positron emission tomography (PET) and physiological MRI were retrospectively selected (isocitrate dehydrogenase wild-type [IDHwt], 36; mutant 1p/19q non-codeleted [IDHm-non-codel], 16; mutant codeleted [IDHm-codel], 16). Fluid-attenuated inversion recovery hyperintense areas were segmented and used as regions-of-interest. For voxel-wise and patient-wise analyses, Pearson’s correlation coefficients (rvoxel-wise and rpatient-wise) between the normalized standardized uptake value (nSUV), rCBV, and ADC were evaluated. Cox regression analysis was performed to investigate the associations between the overall survival (OS) and rvoxel-wise, max/median nSUV, median CBV, or median ADC. Results: For IDHwt and IDHm-non-codel gliomas, nSUV demonstrated significant positive correlations with rCBV (rvoxel-wise = 0.25 and 0.31, and rpatient-wise = 0.50 and 0.70, respectively), and negative correlations with ADC (rvoxel-wise = −0.19 and −0.19, and rpatient-wise = −0.58 and −0.61, respectively) in both voxel-wise and patient-wise analyses. IDHm-codel gliomas only demonstrated a significant positive correlation between nSUV and ADC in voxel-wise analysis (rvoxel-wise = 0.18). In Cox regression analysis, only rvoxel-wise between nSUV and rCBV (hazard ratio [HR] = 28.82) or ADC (HR = 0.085) had significant associations with OS for IDHwt gliomas. Conclusion: IDHm-codel gliomas showed distinctive patterns of correlations between amino acid PET and physiological MRI. Stronger correlations of nSUV and rCBV or ADC may result in worse prognosis for IDHwt gliomas.

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