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This month's Editor's favorite is Vicente and colleagues' “Early Recurrence Detection of Glioma Using 18F-Fluorocholine PET/CT GliReDe Pilot Study​". The authors' premise is that despite the standardized evaluation using the new response criteria for Response Assessment in Neuro-Oncology (RANO) and the multimodal MRI techniques, including MR spectroscopy, diffusion-weighted imaging (DWI), and perfusion-weighted imaging (PWI), limitations remain based on the images per se being not specific to PTRC or tumor progression (TP). They therefore analyzed the use of 18F-fluorocholine PET/CT in the early diagnosis of tumor recurrence, increasing the diagnosis confidence of MRI based on 24 studies in 21 patients. An independent and combined assessment of 18F-fluorocholine PET/CT and multimodal MRI was performed classifying the studies as positive or negative for tumor recurrence. Final diagnosis (recurrence or not) was obtained by histological confirmation or clinical and imaging follow-up. The relation of SUVmax and tumor-to-background ratio with progression, the diagnostic performance of imaging techniques, and their concordance (κ Cohen) were analyzed.

Recurrence was diagnosed in 20 cases. PET/CT was positive in 23 cases (3 false positive), whereas MRI was positive in 15 cases (1 false positive). MRI was false negative in 6 cases. There was no false negative on 18F-fluorocholine PET/CT.

Accuracy of PET/CT versus MRI was 87.5% and 70.8%, respectively. The combined evaluation of both techniques did not show any advantage with respect to PET/CT results alone. Concordance between both imaging techniques was low (κ = 0.135; P = 0.375). SUVmax and tumor-to-background ratio were related to recurrence (areas under the curve of 0.844 [P = 0.033] and 0.869 [P = 0.022], respectively).

The authors concluded that 18F-fluorocholine PET/CT was helpful for increasing diagnostic confidence in the cases of MRI doubtful for recurrence in order to avoid a delayed diagnosis.

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