Prediction of Overall Survival Based on Isocitrate Dehydrogenase 1 Mutation and 18F-FDG Uptake on PET/CT in Patients With Cerebral Gliomas

Purpose This retrospective study aimed to correlate F-18-FDG uptake on PET/CT with isocitrate dehydrogenase enzyme isoform 1 (IDH1) mutation in patients with cerebral gliomas. Hierarchical interactions between factors affecting overall survival (OS) were also examined. Methods In 59 patients with glioma, the ratio of the SUVmax of a glioma to the SUVmean of the contralateral cortex (G/C ratio) on F-18-FDG PET/CT and the presence of IDH1 mutation were correlated. The prognostic value of clinicopathologic factors and G/C ratio for OS were assessed using a Cox proportional hazards model and classification and regression tree models. Results The mean G/C ratio of IDH1-mutant tumors was significantly lower than that of IDH1 wild-type tumors (0.73 vs 1.14, P = 0.004). In multivariate analysis, IDH1-mutant and G/C ratio were significant for OS. The classification and regression tree modeling identified 3 risk groups for OS (group 1: IDH1 mutant [hazard ratio, 0.2]; group 2: G/C ratio 0.8 with IDH1 wild type [hazard ratio, 0.83]; group 3: G/C ratio >0.8 with IDH1 wild type [hazard ratio, 1.9]) (overall P < 0.001). The mean OS was 37.0 months in group 1, 28.6 months in group 2, and 20.7 months in group 3, respectively, showing significant differences among the groups (group 1 vs group 2: P = 0.023, group 2 vs group 3: P = 0.049, group 1 vs group3: P < 0.001). Conclusions F-18-FDG uptake of IDH1-mutant gliomas was significantly lower than that of IDH1 wild-type gliomas. IDH1 mutation was the most important factor in identifying patients with the best prognosis, whereas increased F-18-FDG uptake provided additional prognostic information for predicting poor OS among patients with IDH1 wild-type gliomas.