Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0043-1771282
Initial Experience of 18F-FET PET-MR Image Fusion for Evaluation of Recurrent Primary Brain Tumors
Funding None.![](https://www.thieme-connect.de/media/10.1055-s-00052852/202303/lookinside/thumbnails/10-1055-s-0043-1771282_2320005-1.jpg)
Abstract
Background An accurate monitoring technique is crucial in brain tumors to choose the best treatment approach after surgery and/or chemoradiation. Radiological assessment of brain tumors is widely based on the magnetic resonance imaging (MRI) modality in this regard; however, MRI criteria are unable to precisely differentiate tumoral tissue from treatment-related changes. This study was conducted to evaluate whether fused MRI and O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) positron emission tomography (PET) can improve the diagnostic accuracy of the practitioners to discriminate treatment-related changes from true recurrence of brain tumor.
Methods We retrospectively analyzed 18F-FET PET/computed tomography (CT) of 11 patients with histopathologically proven brain tumors that were suspicious for recurrence changes after 3 to 4 months of surgery. All the patients underwent MRI and 18F-FET PET/CT. As a third assessment, fused 18F-FET PET/MRI was also acquired. Finally, the diagnostic accuracy of the applied modalities was compared.
Results Eleven patients aged 27 to 73 years with a mean age of 47 ± 13 years were enrolled. According to the results, 9/11 cases (82%) showed positive MRI and 6 cases (55%) showed positive PET/CT and PET/MRI. Tumoral recurrence was observed in six patients (55%) in the follow-up period. Based on the follow-up results, accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 64, 85, 25, 67, and 50%, respectively, for MRI alone and 91, 85, 100, 100, and 80%, respectively, for both PET/CT and PET/MRI.
Conclusion This study found that 18F-FET PET-MR image fusion in the management of brain tumors might improve recurrence detection; however, further well-designed studies are needed to verify these preliminary data.
Keywords
magnetic resonance imaging - positron emission tomography - amino acid PET - brain tumor - 18F-FET PET/CTPublication History
Article published online:
06 September 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Galldiks N, Ullrich R, Schroeter M, Fink GR, Jacobs AH, Kracht LW. Volumetry of [(11)C]-methionine PET uptake and MRI contrast enhancement in patients with recurrent glioblastoma multiforme. Eur J Nucl Med Mol Imaging 2010; 37 (01) 84-92
- 2 Pauleit D, Floeth F, Hamacher K. et al. O-(2-[18F]fluoroethyl)-L-tyrosine PET combined with MRI improves the diagnostic assessment of cerebral gliomas. Brain 2005; 128 (Pt 3): 678-687
- 3 Ostrom QT, Gittleman H, Liao P. et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2010-2014. Neuro-oncol 2017; 19 (suppl_5): v1-v88
- 4 Albert NL, Weller M, Suchorska B. et al. Response Assessment in Neuro-Oncology working group and European Association for Neuro-Oncology recommendations for the clinical use of PET imaging in gliomas. Neuro-oncol 2016; 18 (09) 1199-1208
- 5 Rapp M, Heinzel A, Galldiks N. et al. Diagnostic performance of 18F-FET PET in newly diagnosed cerebral lesions suggestive of glioma. J Nucl Med 2013; 54 (02) 229-235
- 6 Karunanithi S, Sharma P, Kumar A. et al. Comparative diagnostic accuracy of contrast-enhanced MRI and (18)F-FDOPA PET-CT in recurrent glioma. Eur Radiol 2013; 23 (09) 2628-2635
- 7 Glaudemans AW, Enting RH, Heesters MA. et al. Value of 11C-methionine PET in imaging brain tumours and metastases. Eur J Nucl Med Mol Imaging 2013; 40 (04) 615-635
- 8 Pirotte BJ, Levivier M, Goldman S. et al. Positron emission tomography-guided volumetric resection of supratentorial high-grade gliomas: a survival analysis in 66 consecutive patients. Neurosurgery 2009; 64 (03) 471-481 , discussion 481
- 9 Maurer GD, Brucker DP, Stoffels G. et al. 18F-FET PET imaging in differentiating glioma progression from treatment-related changes: a single-center experience. J Nucl Med 2020; 61 (04) 505-511
- 10 Jager PL, Vaalburg W, Pruim J, de Vries EG, Langen KJ, Piers DA. Radiolabeled amino acids: basic aspects and clinical applications in oncology. J Nucl Med 2001; 42 (03) 432-445
- 11 Plotkin M, Blechschmidt C, Auf G. et al. Comparison of F-18 FET-PET with F-18 FDG-PET for biopsy planning of non-contrast-enhancing gliomas. Eur Radiol 2010; 20 (10) 2496-2502
- 12 Wen PY, Macdonald DR, Reardon DA. et al. Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 2010; 28 (11) 1963-1972
- 13 Rachinger W, Goetz C, Pöpperl G. et al. Positron emission tomography with O-(2-[18F]fluoroethyl)-l-tyrosine versus magnetic resonance imaging in the diagnosis of recurrent gliomas. Neurosurgery 2005; 57 (03) 505-511 , discussion 505–511
- 14 Deuschl C, Kirchner J, Poeppel TD. et al. 11C-MET PET/MRI for detection of recurrent glioma. Eur J Nucl Med Mol Imaging 2018; 45 (04) 593-601
- 15 Ellingson BM, Bendszus M, Boxerman J. et al; Jumpstarting Brain Tumor Drug Development Coalition Imaging Standardization Steering Committee. Consensus recommendations for a standardized Brain Tumor Imaging Protocol in clinical trials. Neuro-oncol 2015; 17 (09) 1188-1198
- 16 Verger A, Langen K-J. . PET Imaging in Glioblastoma: Use in Clinical Practice. Brisbane, Queensland: Exon Publications; 2017:155–174
- 17 Stockhammer F, Plotkin M, Amthauer H, van Landeghem FK, Woiciechowsky C. Correlation of F-18-fluoro-ethyl-tyrosin uptake with vascular and cell density in non-contrast-enhancing gliomas. J Neurooncol 2008; 88 (02) 205-210
- 18 Shooli H, Dadgar H, Wáng YJ. et al. An update on PET-based molecular imaging in neuro-oncology: challenges and implementation for a precision medicine approach in cancer care. Quant Imaging Med Surg 2019; 9 (09) 1597-1610
- 19 Almansory KO, Fraioli F. Combined PET/MRI in brain glioma imaging. Br J Hosp Med (Lond) 2019; 80 (07) 380-386
- 20 Bertolini F, Bagni B, Valentini A. et al , eds. 18 F-FET PET in Early Detection of Relapse/Progression in High-Grade Gliomas. Neuro-oncology. Durham, NC: Duke Univ Press; 2008
- 21 Brandes AA, Tosoni A, Spagnolli F. et al. Disease progression or pseudoprogression after concomitant radiochemotherapy treatment: pitfalls in neurooncology. Neuro-oncol 2008; 10 (03) 361-367
- 22 Herholz K, Kracht LW, Heiss WD. Monitoring the effect of chemotherapy in a mixed glioma by C-11-methionine PET. J Neuroimaging 2003; 13 (03) 269-271
- 23 Hamacher K, Coenen HH. Efficient routine production of the 18F-labelled amino acid O-2-18F fluoroethyl-L-tyrosine. Appl Radiat Isot 2002; 57 (06) 853-856
- 24 Dunet V, Pomoni A, Hottinger A, Nicod-Lalonde M, Prior JO. Performance of 18F-FET versus 18F-FDG-PET for the diagnosis and grading of brain tumors: systematic review and meta-analysis. Neuro-oncol 2016; 18 (03) 426-434
- 25 Grosu A-L, Astner ST, Riedel E. et al. An interindividual comparison of O-(2-[18F]fluoroethyl)-L-tyrosine (FET)- and L-[methyl-11C]methionine (MET)-PET in patients with brain gliomas and metastases. Int J Radiat Oncol Biol Phys 2011; 81 (04) 1049-1058
- 26 Pöpperl G, Götz C, Rachinger W, Gildehaus F-J, Tonn J-C, Tatsch K. Value of O-(2-[18F]fluoroethyl)- L-tyrosine PET for the diagnosis of recurrent glioma. Eur J Nucl Med Mol Imaging 2004; 31 (11) 1464-1470
- 27 Weber DC, Zilli T, Buchegger F. et al. [(18)F]Fluoroethyltyrosine- positron emission tomography-guided radiotherapy for high-grade glioma. Radiat Oncol 2008; 3 (01) 44
- 28 Calcagni ML, Galli G, Giordano A. et al. Dynamic O-(2-[18F]fluoroethyl)-L-tyrosine (F-18 FET) PET for glioma grading: assessment of individual probability of malignancy. Clin Nucl Med 2011; 36 (10) 841-847
- 29 Garibotto V, Heinzer S, Vulliemoz S. et al. Clinical applications of hybrid PET/MRI in neuroimaging. Clin Nucl Med 2013; 38 (01) e13-e18
- 30 Yu J, Zheng J, Xu W. et al. Accuracy of 18F-FDOPA positron emission tomography and 18F-FET positron emission tomography for differentiating radiation necrosis from brain tumor recurrence. World Neurosurg 2018; 114: e1211-e1224
- 31 Furuse M, Nonoguchi N, Yamada K. et al. Radiological diagnosis of brain radiation necrosis after cranial irradiation for brain tumor: a systematic review. Radiat Oncol 2019; 14 (01) 28
- 32 Kim SJ, Ryul Shim S. Diagnostic value of radiolabeled amino acid PET for detection of pseudoprogression of brain tumor after treatment: a meta-analysis. Nucl Med Commun 2019; 40 (09) 965-972
- 33 Dunet V, Maeder P, Nicod-Lalonde M. et al. Combination of MRI and dynamic FET PET for initial glioma grading. Nucl Med (Stuttg) 2014; 53 (04) 155-161
- 34 Thon N, Kunz M, Lemke L. et al. Dynamic 18F-FET PET in suspected WHO grade II gliomas defines distinct biological subgroups with different clinical courses. Int J Cancer 2015; 136 (09) 2132-2145
- 35 Pöpperl G, Kreth FW, Mehrkens JH. et al. FET PET for the evaluation of untreated gliomas: correlation of FET uptake and uptake kinetics with tumour grading. Eur J Nucl Med Mol Imaging 2007; 34 (12) 1933-1942
- 36 Jansen NL, Graute V, Armbruster L. et al. MRI-suspected low-grade glioma: is there a need to perform dynamic FET PET?. Eur J Nucl Med Mol Imaging 2012; 39 (06) 1021-1029
- 37 Katsanos AH, Alexiou GA, Fotopoulos AD, Jabbour P, Kyritsis AP, Sioka C. Performance of 18F-FDG, 11C-Methionine, and 18F-FET PET for glioma grading: a meta-analysis. Clin Nucl Med 2019; 44 (11) 864-869
- 38 Lopez WOC, Cordeiro JG, Albicker U. et al. Correlation of (18)F-fluoroethyl tyrosine positron-emission tomography uptake values and histomorphological findings by stereotactic serial biopsy in newly diagnosed brain tumors using a refined software tool. OncoTargets Ther 2015; 8: 3803-3815
- 39 Cicuendez M, Lorenzo-Bosquet C, Cuberas-Borrós G. et al. Role of [(11)C] methionine positron emission tomography in the diagnosis and prediction of survival in brain tumours. Clin Neurol Neurosurg 2015; 139: 328-333