18F-Fluorodeoxyglucose PET/Computed Tomography for Primary Brain Tumors

Segtnan, Eivind Antonsen; Hess, Søren; Grupe, Peter; Høilund‐Carlsen, Poul Flemming

doi:10.1016/j.cpet.2014.09.005

Cited by 23 publications

(9 citation statements)

References 57 publications

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“…However, other brain diseases may require different algorithms, and the specific cutoff points require validation by comparison with a suitable reference. Glioblastomas normally are recognized by their hypermetabolism (26). However, we observed that some or all of the ipsilateral hemisphere of glioblastoma patients had lower glucose metabolism than the contralateral hemisphere.…”

Section: Strengths and Weaknessesmentioning

confidence: 50%

Prognostic Implications of Total Hemispheric Glucose Metabolism Ratio in Cerebrocerebellar Diaschisis

et al. 2016

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Diaschisis denotes brain dysfunction remote from a focal brain lesion. We have quantified diaschisis and investigated its prognostic value in glioma. We compared 50F-FDG PET/CT studies collected prospectively from 14 patients with supratentorial glioma (5 men and 9 women; age range, 35-77 y) with 10 single scans from healthy controls (age range, 43-75 y). Dedicated 3-dimensional segmentation software was used to obtain total hemispheric glucose metabolic ratios (THGr) by dividing total hemispheric F-FDG uptake in each diaschitic hemisphere-that is, the ipsilateral cerebral hemisphere (THGr(Ce)) and the contralateral cerebellar hemisphere (THGr(Cb))-by its respective contralateral side. Receiver-operating-characteristic (ROC) analysis was performed to determine optimal cut-offs for combinations of THGr(Ce) and THGr(Cb). Two independent observers obtained data for reproducibility analysis, and THGr values were compared with qualitative assessment of diaschisis performed by a PET neuroimaging specialist. Qualitative analysis confirmed cerebrocerebellar diaschisis in all glioblastoma PET studies performed within 1 y of death. Healthy subjects had significantly higher THGr(Ce) values ( = 0.0007) and THGr(Cb) values ( = 0.02) than glioblastoma patients. ROC analysis yielded diaschisis thresholds of 0.62 for THGr(Ce) and 0.84 for THGr (Cb). Qualitative assessment demonstrated cerebral diaschisis in 16 of 17 (94%) cases with THGr(Ce) below the determined threshold and cerebellar diaschisis in 25 of 26 (96%) cases with THGr(Cb) below the determined threshold. When both THGr(Ce) and THGr(Cb) were below the ROC threshold, the combined diaschisis measures had a positive predictive value for survival below 1 y of 100%. When one parameter was below the threshold, it had a positive predictive value of 75%, and when both parameters exceeded thresholds, the negative predictive value for survival above 1 y was 79%. Median interrater variability was 3.3% and 5.9% for THGr(Ce) and THGr(Cb), respectively. The THGr measures demonstrated diaschisis in the cerebrum and cerebellum of patients with glioma. Combined cerebrocerebellar diaschisis ratios with ROC thresholds for both forebrain and hindbrain had high negative and positive predictive values for survival for less than a year. The THGr method allows comparison of data obtained at different institutions and is now open for further validation in gliomas and other cerebral diseases.

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Section: Strengths and Weaknessesmentioning

confidence: 50%

Prognostic Implications of Total Hemispheric Glucose Metabolism Ratio in Cerebrocerebellar Diaschisis

et al. 2016

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“…More specifically, in the differentiation of tumor recurrence and RN, 18 F-FDG has also a low specificity, ranging from 40 to 94%, mainly during the first few weeks post therapy, with a study that showed a sensitivity of 81-86%. Therefore, it is recommended to perform 18 F-FDG PET no less than 3 months after the end of RT, also because it can cause inflammatory changes that can last up to 6 months after therapy but slowly decreases over time, for example in lung parenchyma, which will take up FDG and make it difficult to differentiate from recurrent tumor [46].…”

Section: F-fdgmentioning

confidence: 99%

“…For the detection of tumor recurrence, compared to 201 Tl, 18 F-FDG is more specific but less sensitive since the former, prior to its uptake through the Na + -K + ATPase pump, has a non-specific accumulation due to BBB breakdown, whereas the latter lacks sensitivity because of the physiological uptake of normal brain [45]. More specifically, in the differentiation of tumor recurrence and RN, 18 F-FDG has also a low specificity, ranging from 40 to 94%, mainly during the first few weeks post therapy, with a study that showed a sensitivity of 81-86%.Therefore,it is recommended to perform 18 F--FDG PET no less than 3 months after the end of RT, also because it can cause inflammatory changes that can last up to 6 months after therapy but slowly decreases over time, for example in lung parenchyma, which will take up FDG and make it difficult to differentiate from recurrent tumor [46].…”

Section: F-fdgmentioning

confidence: 99%

The Molecular Effects of Ionizing Radiations on Brain Cells: Radiation Necrosis vs. Tumor Recurrence

et al. 2019

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The central nervous system (CNS) is generally resistant to the effects of radiation, but higher doses, such as those related to radiation therapy, can cause both acute and long-term brain damage. The most important results is a decline in cognitive function that follows, in most cases, cerebral radionecrosis. The essence of radio-induced brain damage is multifactorial, being linked to total administered dose, dose per fraction, tumor volume, duration of irradiation and dependent on complex interactions between multiple brain cell types. Cognitive impairment has been described following brain radiotherapy, but the mechanisms leading to this adverse event remain mostly unknown. In the event of a brain tumor, on follow-up radiological imaging often cannot clearly distinguish between recurrence and necrosis, while, especially in patients that underwent radiation therapy (RT) post-surgery, positron emission tomography (PET) functional imaging, is able to differentiate tumors from reactive phenomena. More recently, efforts have been done to combine both morphological and functional data in a single exam and acquisition thanks to the co-registration of PET/MRI. The future of PET imaging to differentiate between radionecrosis and tumor recurrence could be represented by a third-generation PET tracer already used to reveal the spatial extent of brain inflammation. The aim of the following review is to analyze the effect of ionizing radiations on CNS with specific regard to effect of radiotherapy, focusing the attention on the mechanism underling the radionecrosis and the brain damage, and show the role of nuclear medicine techniques to distinguish necrosis from recurrence and to early detect of cognitive decline after treatment.

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“…Brain tumors can originate from different cells both from within the brain and from systemic tumors that have metastasized to the brain. Primary brain tumors most commonly arise from glial cells [ 1 ]. With an annual age-adjusted incidence rate of 28 per 100,000 in adults, gliomas account for approximately 27.2% of all brain and other central nervous system tumors, and approximately 81.3% of all malignant tumors [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Current Radiopharmaceuticals for Positron Emission Tomography of Brain Tumors

Jung

Ahn

2018

Brain Tumor Res Treat

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Brain tumors represent a diverse spectrum of histology, biology, prognosis, and treatment options. Although MRI remains the gold standard for morphological tumor characterization, positron emission tomography (PET) can play a critical role in evaluating disease status. This article focuses on the use of PET with radiolabeled glucose and amino acid analogs to aid in the diagnosis of tumors and differentiate between recurrent tumors and radiation necrosis. The most widely used tracer is 18F-fluorodeoxyglucose (FDG). Although the intensity of FDG uptake is clearly associated with tumor grade, the exact role of FDG PET imaging remains debatable. Additionally, high uptake of FDG in normal grey matter limits its use in some low-grade tumors that may not be visualized. Because of their potential to overcome the limitation of FDG PET of brain tumors, 11C-methionine and 18F-3,4-dihydroxyphenylalanine (FDOPA) have been proposed. Low accumulation of amino acid tracers in normal brains allows the detection of low-grade gliomas and facilitates more precise tumor delineation. These amino acid tracers have higher sensitivity and specificity for detecting brain tumors and differentiating recurrent tumors from post-therapeutic changes. FDG and amino acid tracers may be complementary, and both may be required for assessment of an individual patient. Additional tracers for brain tumor imaging are currently under development. Combinations of different tracers might provide more in-depth information about tumor characteristics, and current limitations may thus be overcome in the near future. PET with various tracers including FDG, 11C-methionine, and FDOPA has improved the management of patients with brain tumors. To evaluate the exact value of PET, however, additional prospective large sample studies are needed.

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18F-Fluorodeoxyglucose PET/Computed Tomography for Primary Brain Tumors

Cited by 23 publications

References 57 publications

Prognostic Implications of Total Hemispheric Glucose Metabolism Ratio in Cerebrocerebellar Diaschisis

Prognostic Implications of Total Hemispheric Glucose Metabolism Ratio in Cerebrocerebellar Diaschisis

The Molecular Effects of Ionizing Radiations on Brain Cells: Radiation Necrosis vs. Tumor Recurrence

Current Radiopharmaceuticals for Positron Emission Tomography of Brain Tumors

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