Added value of 18F-FDOPA PET to the management of high-grade glioma patients after their initial treatment: a prospective multicentre study

Abstract Background. Diagnostic value of 18F-fluoro-L-dihydrophenylalanine (18F-FDOPA) PET in patients with suspected recurrent gliomas is recognised. We conducted a multicentre prospective study to assess its added value in the practical management of patients suspected of recurrence of high grade gliomas (HGG). Methods. Patients with a proven HGG (WHO grade III and IV) were referred to the multidisciplinary neuro-oncology board (MNOB) during their follow-up after initial standard of care treatment and when MRI findings were not fully conclusive. Each case was discussed in 2 steps. For step 1, a diagnosis and a management proposal was made only based on the clinical and the MRI data. For step 2, the same process was repeated taking the 18F-FDOPA PET results into consideration. A level of confidence of the decisions was assigned to each step. Changes in diagnosis and management induced by 18F-FDOPA PET information were measured. When unchanged, the difference in the confidence of the decisions were assessed. The diagnostic performances of each step was measured. Results. 107 patients underwent a total of 138 MNOB assessments. The proposed diagnosis changed between step 1 and step 2 in 37 cases (26.8%) and the proposed management changed in 31 cases (22.5%). When the management did not change, the confidence in the MNOB final decision was increased in 87 cases (81.3 %). Step 1 had a sensitivity, specificity and accuracy of 83%, 58% and 66% and step 2, 86%, 64% and 71% respectively. Conclusion. 18F-FDOPA PET adds significant information for the follow-up of HGG patients in clinical practice.