Prognostic implications of total hemispheric glucose metabolism ratio in cerebro-cerebellar diaschisis

Eivind Antonsen Segtnan, Peter Grupe, Jens Ole Jarden, Oke Gerke, Jana Ivanidze, Sofie Bæk Christlieb, Caius Mihail Constantinescu, John Erling Pedersen, Sina Houshmand, Søren Hess, Mojtaba Zarei, Albert Gjedde, Abass Alavi, Poul Flemming Høilund-Carlsen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Diaschisis denotes brain dysfunction remote from a focal brain lesion. We have quantified diaschisis and investigated its prognostic value in glioma. Methods: We compared 50 18F-FDG PET/CT studies collected prospectively from 14 patients with supratentorial glioma (5 men and 9 women; age range, 35-77 y) with 10 single scans from healthy controls (age range, 43-75 y). Dedicated 3-dimensional segmentation software was used to obtain total hemispheric glucose metabolic ratios (THGr) by dividing total hemispheric 18F-FDG uptake in each diaschitic hemisphere-that is, the ipsilateral cerebral hemisphere (THGr(Ce)) and the contralateral cerebellar hemisphere (THGr(Cb))-by its respective contralateral side. Receiver-operatingcharacteristic (ROC) analysis was performed to determine optimal cut-offs for combinations of THGr(Ce) and THGr(Cb). Two independent observers obtained data for reproducibility analysis, and THGr values were compared with qualitative assessment of diaschisis performed by a PET neuroimaging specialist. Results: Qualitative analysis confirmed cerebrocerebellar diaschisis in all glioblastoma PET studies performed within 1 y of death. Healthy subjects had significantly higher THGr(Ce) values (P = 0.0007) and THGr (Cb) values (P = 0.02) than glioblastoma patients. ROC analysis yielded diaschisis thresholds of 0.62 for THGr(Ce) and 0.84 for THGr (Cb). Qualitative assessment demonstrated cerebral diaschisis in 16 of 17 (94%) cases with THGr(Ce) below the determined threshold and cerebellar diaschisis in 25 of 26 (96%) cases with THGr(Cb) below the determined threshold. When both THGr(Ce) and THGr(Cb) were below the ROC threshold, the combined diaschisis measures had a positive predictive value for survival below 1 y of 100%. When one parameter was below the threshold, it had a positive predictive value of 75%, and when both parameters exceeded thresholds, the negative predictive value for survival above 1 y was 79%. Median interrater variability was 3.3% and 5.9% for THGr(Ce) and THGr(Cb), respectively. Conclusion: The THGr measures demonstrated diaschisis in the cerebrum and cerebellum of patients with glioma. Combined cerebrocerebellar diaschisis ratios with ROC thresholds for both forebrain and hindbrain had high negative and positive predictive values for survival for less than a year. The THGr method allows comparison of data obtained at different institutions and is now open for further validation in gliomas and other cerebral diseases.

OriginalsprogEngelsk
TidsskriftJournal of Nuclear Medicine
Vol/bind58
Udgave nummer5
Sider (fra-til)768-773
ISSN0161-5505
DOI
StatusUdgivet - maj 2017

Fingeraftryk

Glioma
Fluorodeoxyglucose F18
Glioblastoma
Neuroimaging

Bibliografisk note

First published October 27, 2016. Sl-tjh 22.3.17

Citer dette

Segtnan, Eivind Antonsen ; Grupe, Peter ; Jarden, Jens Ole ; Gerke, Oke ; Ivanidze, Jana ; Christlieb, Sofie Bæk ; Constantinescu, Caius Mihail ; Pedersen, John Erling ; Houshmand, Sina ; Hess, Søren ; Zarei, Mojtaba ; Gjedde, Albert ; Alavi, Abass ; Høilund-Carlsen, Poul Flemming. / Prognostic implications of total hemispheric glucose metabolism ratio in cerebro-cerebellar diaschisis. I: Journal of Nuclear Medicine. 2017 ; Bind 58, Nr. 5. s. 768-773.
@article{105ef7e7351e4d38be536c0a12ade65e,
title = "Prognostic implications of total hemispheric glucose metabolism ratio in cerebro-cerebellar diaschisis",
abstract = "Diaschisis denotes brain dysfunction remote from a focal brain lesion. We have quantified diaschisis and investigated its prognostic value in glioma. Methods: We compared 50 18F-FDG PET/CT studies collected prospectively from 14 patients with supratentorial glioma (5 men and 9 women; age range, 35-77 y) with 10 single scans from healthy controls (age range, 43-75 y). Dedicated 3-dimensional segmentation software was used to obtain total hemispheric glucose metabolic ratios (THGr) by dividing total hemispheric 18F-FDG uptake in each diaschitic hemisphere-that is, the ipsilateral cerebral hemisphere (THGr(Ce)) and the contralateral cerebellar hemisphere (THGr(Cb))-by its respective contralateral side. Receiver-operatingcharacteristic (ROC) analysis was performed to determine optimal cut-offs for combinations of THGr(Ce) and THGr(Cb). Two independent observers obtained data for reproducibility analysis, and THGr values were compared with qualitative assessment of diaschisis performed by a PET neuroimaging specialist. Results: Qualitative analysis confirmed cerebrocerebellar diaschisis in all glioblastoma PET studies performed within 1 y of death. Healthy subjects had significantly higher THGr(Ce) values (P = 0.0007) and THGr (Cb) values (P = 0.02) than glioblastoma patients. ROC analysis yielded diaschisis thresholds of 0.62 for THGr(Ce) and 0.84 for THGr (Cb). Qualitative assessment demonstrated cerebral diaschisis in 16 of 17 (94{\%}) cases with THGr(Ce) below the determined threshold and cerebellar diaschisis in 25 of 26 (96{\%}) cases with THGr(Cb) below the determined threshold. When both THGr(Ce) and THGr(Cb) were below the ROC threshold, the combined diaschisis measures had a positive predictive value for survival below 1 y of 100{\%}. When one parameter was below the threshold, it had a positive predictive value of 75{\%}, and when both parameters exceeded thresholds, the negative predictive value for survival above 1 y was 79{\%}. Median interrater variability was 3.3{\%} and 5.9{\%} for THGr(Ce) and THGr(Cb), respectively. Conclusion: The THGr measures demonstrated diaschisis in the cerebrum and cerebellum of patients with glioma. Combined cerebrocerebellar diaschisis ratios with ROC thresholds for both forebrain and hindbrain had high negative and positive predictive values for survival for less than a year. The THGr method allows comparison of data obtained at different institutions and is now open for further validation in gliomas and other cerebral diseases.",
keywords = "Brain, Cerebellum, Diaschisis, FDG-PET/CT, Glioma, Quantification, Glioma/diagnostic imaging, Brain Neoplasms/diagnostic imaging, Prognosis, Fluorodeoxyglucose F18/pharmacokinetics, Humans, Middle Aged, Male, Positron-Emission Tomography, Biomarkers/metabolism, Tissue Distribution, Radiopharmaceuticals/pharmacokinetics, Adult, Female, Aged, Glucose/metabolism, Observer Variation",
author = "Segtnan, {Eivind Antonsen} and Peter Grupe and Jarden, {Jens Ole} and Oke Gerke and Jana Ivanidze and Christlieb, {Sofie B{\ae}k} and Constantinescu, {Caius Mihail} and Pedersen, {John Erling} and Sina Houshmand and S{\o}ren Hess and Mojtaba Zarei and Albert Gjedde and Abass Alavi and H{\o}ilund-Carlsen, {Poul Flemming}",
note = "First published October 27, 2016. Sl-tjh 22.3.17",
year = "2017",
month = "5",
doi = "10.2967/jnumed.116.180398",
language = "English",
volume = "58",
pages = "768--773",
journal = "Journal of Nuclear Medicine",
issn = "0161-5505",
publisher = "Society of Nuclear Medicine",
number = "5",

}

Prognostic implications of total hemispheric glucose metabolism ratio in cerebro-cerebellar diaschisis. / Segtnan, Eivind Antonsen; Grupe, Peter; Jarden, Jens Ole; Gerke, Oke; Ivanidze, Jana; Christlieb, Sofie Bæk; Constantinescu, Caius Mihail; Pedersen, John Erling; Houshmand, Sina; Hess, Søren; Zarei, Mojtaba; Gjedde, Albert; Alavi, Abass; Høilund-Carlsen, Poul Flemming.

I: Journal of Nuclear Medicine, Bind 58, Nr. 5, 05.2017, s. 768-773.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Prognostic implications of total hemispheric glucose metabolism ratio in cerebro-cerebellar diaschisis

AU - Segtnan, Eivind Antonsen

AU - Grupe, Peter

AU - Jarden, Jens Ole

AU - Gerke, Oke

AU - Ivanidze, Jana

AU - Christlieb, Sofie Bæk

AU - Constantinescu, Caius Mihail

AU - Pedersen, John Erling

AU - Houshmand, Sina

AU - Hess, Søren

AU - Zarei, Mojtaba

AU - Gjedde, Albert

AU - Alavi, Abass

AU - Høilund-Carlsen, Poul Flemming

N1 - First published October 27, 2016. Sl-tjh 22.3.17

PY - 2017/5

Y1 - 2017/5

N2 - Diaschisis denotes brain dysfunction remote from a focal brain lesion. We have quantified diaschisis and investigated its prognostic value in glioma. Methods: We compared 50 18F-FDG PET/CT studies collected prospectively from 14 patients with supratentorial glioma (5 men and 9 women; age range, 35-77 y) with 10 single scans from healthy controls (age range, 43-75 y). Dedicated 3-dimensional segmentation software was used to obtain total hemispheric glucose metabolic ratios (THGr) by dividing total hemispheric 18F-FDG uptake in each diaschitic hemisphere-that is, the ipsilateral cerebral hemisphere (THGr(Ce)) and the contralateral cerebellar hemisphere (THGr(Cb))-by its respective contralateral side. Receiver-operatingcharacteristic (ROC) analysis was performed to determine optimal cut-offs for combinations of THGr(Ce) and THGr(Cb). Two independent observers obtained data for reproducibility analysis, and THGr values were compared with qualitative assessment of diaschisis performed by a PET neuroimaging specialist. Results: Qualitative analysis confirmed cerebrocerebellar diaschisis in all glioblastoma PET studies performed within 1 y of death. Healthy subjects had significantly higher THGr(Ce) values (P = 0.0007) and THGr (Cb) values (P = 0.02) than glioblastoma patients. ROC analysis yielded diaschisis thresholds of 0.62 for THGr(Ce) and 0.84 for THGr (Cb). Qualitative assessment demonstrated cerebral diaschisis in 16 of 17 (94%) cases with THGr(Ce) below the determined threshold and cerebellar diaschisis in 25 of 26 (96%) cases with THGr(Cb) below the determined threshold. When both THGr(Ce) and THGr(Cb) were below the ROC threshold, the combined diaschisis measures had a positive predictive value for survival below 1 y of 100%. When one parameter was below the threshold, it had a positive predictive value of 75%, and when both parameters exceeded thresholds, the negative predictive value for survival above 1 y was 79%. Median interrater variability was 3.3% and 5.9% for THGr(Ce) and THGr(Cb), respectively. Conclusion: The THGr measures demonstrated diaschisis in the cerebrum and cerebellum of patients with glioma. Combined cerebrocerebellar diaschisis ratios with ROC thresholds for both forebrain and hindbrain had high negative and positive predictive values for survival for less than a year. The THGr method allows comparison of data obtained at different institutions and is now open for further validation in gliomas and other cerebral diseases.

AB - Diaschisis denotes brain dysfunction remote from a focal brain lesion. We have quantified diaschisis and investigated its prognostic value in glioma. Methods: We compared 50 18F-FDG PET/CT studies collected prospectively from 14 patients with supratentorial glioma (5 men and 9 women; age range, 35-77 y) with 10 single scans from healthy controls (age range, 43-75 y). Dedicated 3-dimensional segmentation software was used to obtain total hemispheric glucose metabolic ratios (THGr) by dividing total hemispheric 18F-FDG uptake in each diaschitic hemisphere-that is, the ipsilateral cerebral hemisphere (THGr(Ce)) and the contralateral cerebellar hemisphere (THGr(Cb))-by its respective contralateral side. Receiver-operatingcharacteristic (ROC) analysis was performed to determine optimal cut-offs for combinations of THGr(Ce) and THGr(Cb). Two independent observers obtained data for reproducibility analysis, and THGr values were compared with qualitative assessment of diaschisis performed by a PET neuroimaging specialist. Results: Qualitative analysis confirmed cerebrocerebellar diaschisis in all glioblastoma PET studies performed within 1 y of death. Healthy subjects had significantly higher THGr(Ce) values (P = 0.0007) and THGr (Cb) values (P = 0.02) than glioblastoma patients. ROC analysis yielded diaschisis thresholds of 0.62 for THGr(Ce) and 0.84 for THGr (Cb). Qualitative assessment demonstrated cerebral diaschisis in 16 of 17 (94%) cases with THGr(Ce) below the determined threshold and cerebellar diaschisis in 25 of 26 (96%) cases with THGr(Cb) below the determined threshold. When both THGr(Ce) and THGr(Cb) were below the ROC threshold, the combined diaschisis measures had a positive predictive value for survival below 1 y of 100%. When one parameter was below the threshold, it had a positive predictive value of 75%, and when both parameters exceeded thresholds, the negative predictive value for survival above 1 y was 79%. Median interrater variability was 3.3% and 5.9% for THGr(Ce) and THGr(Cb), respectively. Conclusion: The THGr measures demonstrated diaschisis in the cerebrum and cerebellum of patients with glioma. Combined cerebrocerebellar diaschisis ratios with ROC thresholds for both forebrain and hindbrain had high negative and positive predictive values for survival for less than a year. The THGr method allows comparison of data obtained at different institutions and is now open for further validation in gliomas and other cerebral diseases.

KW - Brain

KW - Cerebellum

KW - Diaschisis

KW - FDG-PET/CT

KW - Glioma

KW - Quantification

KW - Glioma/diagnostic imaging

KW - Brain Neoplasms/diagnostic imaging

KW - Prognosis

KW - Fluorodeoxyglucose F18/pharmacokinetics

KW - Humans

KW - Middle Aged

KW - Male

KW - Positron-Emission Tomography

KW - Biomarkers/metabolism

KW - Tissue Distribution

KW - Radiopharmaceuticals/pharmacokinetics

KW - Adult

KW - Female

KW - Aged

KW - Glucose/metabolism

KW - Observer Variation

U2 - 10.2967/jnumed.116.180398

DO - 10.2967/jnumed.116.180398

M3 - Journal article

C2 - 27789719

VL - 58

SP - 768

EP - 773

JO - Journal of Nuclear Medicine

JF - Journal of Nuclear Medicine

SN - 0161-5505

IS - 5

ER -