연세의대 / 김동우, 고해영, 윤미진*
Abstract
This study aimed to assess how to enhance the value of 18F-Fluorodeoxyglucose (FDG) PET/CTs for glioma grading and better delineation of the tumor boundary by glucose loading. In mouse models of brain tumor using U87MG cells, 18F-FDG-PET images were obtained after fasting and after glucose loading. There was a significant difference in the tumor-to-normal cortex-uptake ratio (TNR) between the fasting and glucose-loading scans. 14C-2-Deoxy-D-glucose (14C-DG) uptake was measured in vitro using U87MG, U373MG and primary neurons cultured with different concentrations of glucose. The tumor-to-neuron ratio of 14C-DG uptake increased with up to 10 mM of glucose. Finally, 10 low-grade and 17 high-grade glioma patients underwent fasting and glucose loading 18F-FDG PET/CT and the TNR was compared between scans. The effect of glucose loading was significant in high-grade but not in low-grade gliomas. The receiver operating characteristic curve analyses with a cut-off TNR of 0.81 showed a higher area under the curve after glucose loading than fasting for differentiating low-grade versus high-grade gliomas. In addition, the glucose loading PET/CT was more useful than the fasting PET/CT for the discrimination of oligodendrogliomas from IDH-wildtype glioblastomas. Glucose loading resulted in a greater reduction in 18F-FDG uptake in the normal cortex than in tumors, which increases the usefulness of 18F-FDG PET/CT for grading.
그림1) U87MG 마우스 뇌종양 모델에서 금식 상태와 포도당 주사 후, (a) 18F-FDG/PET 비교영상. (b) 종양과 정상 피질 에서의 SUV (standardized uptake value). (c) 종양 대 정상 피질의 섭취비율.
그림2) 악성 뇌종양 환자에서 금식 상태와 포도당 주사 후, 18F-FDG/PET 영상 (upper panel)과 FLAIR T1 enhanced MRI 영상 (bottom panel).
Affiliations
Dongwoo Kim 1 , Hae Young Ko 1 , Sangwon Lee 1 , Yong-Ho Lee 2 , Sujin Ryu 3 , Seon Yoo Kim 1 , Jee-In Chung 1 , Misu Lee 4 , Ju Hyung Moon 5 , Jong Hee Chang 5 , Mijin Yun 1
1 Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
2 Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
3 Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul 03722, Korea.
4 Division of Life Sciences, College of Life Science and Bioengineering, Incheon National University, Incheon 22012, Korea.
5 Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
편집위원
뇌종양에서 FDG PET의 평가에 glucose loading의 유용성을 평가해본 전임상 연구임. 해당 연구의 결과로 보아 glucose loading 이 뇌종양의 FDG PET 평가에 도움이 될 것으로 보임. 뇌종양 관련 신경외과 및 종양학 의사, 핵의학 의사에게 관심을 끌 논문으로 생각됨.
2020-08-26 13:30:38