Faculty, Staff and Student Publications

Publication Date

11-1-2025

Journal

Journal of Neuro-Oncology

DOI

10.1007/s11060-025-05146-2

PMID

40591209

PMCID

PMC12420720

PubMedCentral® Posted Date

7-1-2025

PubMedCentral® Full Text Version

Post-print

Abstract

PURPOSE: Recent evidence supports incorporating 18 F-Fluciclovine PET for glioblastoma treatment planning and monitoring, as it better captures tumor infiltration compared to conventional MRI. However, the relationship between PET- and MRI-defined tumor volumes remains unclear, particularly in the post-treatment setting. This study prospectively compares tumor volumes on MRI and PET at multiple timepoints throughout the treatment course and evaluates volumetric changes with therapy.

METHODS: We prospectively enrolled 8 adults with IDH-wildtype glioblastoma treated with surgery and chemoradiation between September 2019 and 2021. Participants underwent paired 18 F-Fluciclovine PET/CT and conventional MRI at four timepoints: preoperatively, pre-radiation, and at one- and six-months post-radiation. Biological tumor volume (BTV) from PET, FLAIR, and post-contrast T1volumes (T1CV) were segmented. Volumetric changes were compared using the Friedman test.

RESULTS: Participants (5 males, median age 63 years [IQR 54,66]) showed significantly larger BTVs compared to T1CV at diagnosis (median BTV = 27.2mL vs. T1CV = 13.3mL, adjusted P =.03), pre-radiation (BTV = 25.2mL vs. T1CV = 6.9mL, adjusted P =.03), and at one-month post-radiation (BTV = 27.3mL vs. T1CV = 12.1mL, P =.04). BTVs closely approximated yet were slightly smaller than their corresponding FLAIR volumes at all timepoints. After surgery, the median decrease in BTV (-4.4%) was significantly smaller than T1CV (-66.5%, P =.046), with a similar nonsignificant trend observed post-radiation (P =.50).

CONCLUSION: Glioblastoma BTVs consistently exceed post-contrast T1 volumes and closely approximate FLAIR abnormalities throughout treatment. BTVs decline more gradually post-treatment, indicating persistent hypermetabolic tumor burden. Thus, 18 F-Fluciclovine PET can serve as an adjunct to conventional MRI in glioblastoma treatment planning and monitoring.

Keywords

Humans, Male, Glioblastoma, Middle Aged, Brain Neoplasms, Female, Aged, Cyclobutanes, Prospective Studies, Tumor Burden, Carboxylic Acids, Magnetic Resonance Imaging, Positron Emission Tomography Computed Tomography, Positron-Emission Tomography, Radiopharmaceuticals, Neurosurgical Procedures

Published Open-Access

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