Comparison of F-18 FET-PET with F-18 FDG-PET for biopsy planning of non-contrast-enhancing gliomas

Plotkin, Michail; Blechschmidt, Cristiane; Auf, Gregor; Nyuyki, Fonyuy; Geworski, Lilli; Denecke, Timm; Brenner, Winfried; Stockhammer, Florian

doi:10.1007/s00330-010-1819-2

Cited by 67 publications

(46 citation statements)

References 35 publications

(42 reference statements)

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“…Surprisingly, 18F-FET-PET was strongly inferior to 18F-FDG-PET in evaluating the amino acid analogue FET in peripheral tumors outside the brain or spinal cord, showing no or only minor uptake in most peripheral tumors such as colorectal, pancreatic, prostatic, ovarian cancer and lymphomas, with the only exception of squamous cell carcinomas (63). We found, however, in correlation with individual cases described in the literature (28,29,64), high metabolic rates in cerebral lymphoma and also in most brain metastases, even in those originating from peripheral 18F-FET negative tumors. These findings suggest that 18F-FET is transported via different amino acid transporters within the brain compared with the periphery.…”

Section: Pet Imaging and Its Relationship To Spinal Cord Tumorsmentioning

confidence: 38%

Current Molecular Imaging of Spinal Tumors in Clinical Practice

Sandu

Pöpperl²,

Toubert

et al. 2011

Mol Med

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Energy metabolism measurements in spinal cord tumors, as well as in osseous spinal tumors/metastasis in vivo, are rarely performed only with molecular imaging (MI) by positron emission tomography (PET). This imaging modality developed from a small number of basic clinical science investigations followed by subsequent work that influenced and enhanced the research of others. Apart from precise anatomical localization by coregistration of morphological imaging and quantification, the most intriguing advantage of this imaging is the opportunity to investigate the time course (dynamics) of disease-specific molecular events in the intact organism. Most importantly, MI represents one of the key technologies in translational molecular neuroscience research, helping to develop experimental protocols that may later be applied to human patients. PET may help monitor a patient at the vertebral level after surgery and during adjuvant treatment for recurrent or progressive disease. Common clinical indications for MI of primary or secondary CNS spinal tumors are: (i) tumor diagnosis, (ii) identification of the metabolically active tumor compartments (differentiation of viable tumor tissue from necrosis) and (iii) prediction of treatment response by measurement of tumor perfusion or ischemia. While spinal PET has been used under specific circumstances, a question remains as to whether the magnitude of biochemical alterations observed by MI in CNS tumors in general (specifically spinal tumors) can reveal any prognostic value with respect to survival. MI may be able to better identify early disease and to differentiate benign from malignant lesions than more traditional methods. Moreover, an adequate identification of treatment effectiveness may influence patient management. MI probes could be developed to image the function of targets without disturbing them or as treatment to modify the target's function. MI therefore closes the gap between in vitro and in vivo integrative biology of disease. At the spinal level, MI may help to detect progression or recurrence of metastatic disease after surgical treatment. In cases of nonsurgical treatments such as chemo-, hormone-or radiotherapy, it may better assess biological efficiency than conventional imaging modalities coupled with blood tumor markers. In fact, PET provides a unique possibility to correlate topography and specific metabolic activity, but it requires additional clinical and experimental experience and research to find new indications for primary or secondary spinal tumors.

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Section: Pet Imaging and Its Relationship To Spinal Cord Tumorsmentioning

confidence: 38%

Current Molecular Imaging of Spinal Tumors in Clinical Practice

Sandu

Pöpperl²,

Toubert

et al. 2011

Mol Med

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“…A limitation of that particular metaanalysis is the fact that the methods for the ROI definition and acquisition times varied among the different studies. Moreover, 7 of the 13 studies that focused on various clinical topics came from one center (2,(15)(16)(17)(18)(19)(20) and 2 from another center (21,22). In the patient populations of those studies, there appears to be an overlap that was not considered in the metaanalysis.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of ¹⁸F-FET PET in Newly Diagnosed Cerebral Lesions Suggestive of Glioma

Heinzel²,

et al. 2012

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The aim of this study was to assess the clinical value of O-(2-18 F-fluoroethyl)-L-tyrosine ( 18 F-FET) PET in the initial diagnosis of cerebral lesions suggestive of glioma. Methods: In a retrospective study, we analyzed the clinical, radiologic, and neuropathologic data of 174 patients (77 women and 97 men; mean age, 45 6 15 y) who had been referred for neurosurgical assessment of unclear brain lesions and had undergone 18 F-FET PET. Initial histology (n 5 168, confirmed after surgery or biopsy) and the clinical course and follow-up MR imaging in 2 patients revealed 66 high-grade gliomas (HGG), 77 low-grade gliomas (LGG), 2 lymphomas, and 25 nonneoplastic lesions (NNL). In a further 4 patients, initial histology was unspecific, but during the course of the disease all patients developed an HGG. The diagnostic value of maximum and mean tumor-tobrain ratios (TBR max/ TBR mean ) of 18 F-FET uptake was assessed using receiver-operating-characteristic (ROC) curve analyses to differentiate between neoplastic lesions and NNL, between HGG and LGG, and between high-grade tumor (HGG or lymphoma) and LGG or NNL. Results: Neoplastic lesions showed significantly higher 18 F-FET uptake than NNL (TBR max , 3.0 6 1.3 vs. 1.8 6 0.5; P , 0.001). ROC analysis yielded an optimal cutoff of 2.5 for TBR max to differentiate between neoplastic lesions and NNLs (sensitivity, 57%; specificity, 92%; accuracy, 62%; area under the curve [AUC], 0.76; 95% confidence interval [CI], 0.68-0.84). The positive predictive value (PPV) was 98%, and the negative predictive value (NPV) was 27%. ROC analysis for differentiation between HGG and LGG (TBR max , 3.6 6 1.4 vs. 2.4 6 1.0; P , 0.001) yielded an optimal cutoff of 2.5 for TBR max (sensitivity, 80%; specificity, 65%; accuracy, 72%; AUC, 0.77; PPV, 66%; NPV, 79%; 95% CI, 0.68-0.84). Best differentiation between high-grade tumors (HGG or lymphoma) and both NNL and LGG was achieved with a TBR max cutoff of 2.5 (sensitivity, 79%; specificity, 72%; accuracy, 75%; AUC, 0.79; PPV, 65%; NPV, 84%; 95% CI, 0.71-0.86). The results for TBR mean were similar with a cutoff of 1.9. Conclusion:18 F-FET uptake ratios provide valuable additional information for the differentiation of cerebral lesions and the grading of gliomas. TBR max of 18 F-FET uptake beyond the threshold of 2.5 has a high PPV for detection of a neoplastic lesion and supports the necessity of an invasive procedure, for example, biopsy or surgical resection. Low 18 F-FET uptake (TBR max , 2.5) excludes a high-grade tumor with high probability.

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“…High-grade glioma cells are not always limited and may extend beyond the contrast-enhanced area in MRI T1-Gd images [9,10], and T2 changes could incorporate both tumour tissue and perifocal oedema [11]. Conversely, planning of neurosurgical interventions in those patients who present with non-contrast-enhancing brain masses in the MRI is especially challenging, taking into consideration that it implies removal of all of the hyperintense regions on T2 or T2-FLAIR images and that 40-45% of these tumours contain anaplastic areas [6,12].…”

Section: Introductionmentioning

confidence: 96%

Quantitative volumetric analysis of gliomas with sequential MRI and 11C-methionine PET assessment: patterns of integration in therapy planning

Arbizu

Tejada

Martí-Climent

et al. 2012

Eur J Nucl Med Mol Imaging

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Comparison of F-18 FET-PET with F-18 FDG-PET for biopsy planning of non-contrast-enhancing gliomas

Abstract: FET-PET appears to be superior to FDG-PET for biopsy planning in non-contrast-enhancing brain tumours. FDG-PET does not provide any additional information in this issue.

Cited by 67 publications

References 35 publications

Current Molecular Imaging of Spinal Tumors in Clinical Practice

Current Molecular Imaging of Spinal Tumors in Clinical Practice

Diagnostic Performance of ¹⁸F-FET PET in Newly Diagnosed Cerebral Lesions Suggestive of Glioma

Quantitative volumetric analysis of gliomas with sequential MRI and 11C-methionine PET assessment: patterns of integration in therapy planning

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Comparison of F-18 FET-PET with F-18 FDG-PET for biopsy planning of non-contrast-enhancing gliomas

Abstract: FET-PET appears to be superior to FDG-PET for biopsy planning in non-contrast-enhancing brain tumours. FDG-PET does not provide any additional information in this issue.

Cited by 67 publications

References 35 publications

Current Molecular Imaging of Spinal Tumors in Clinical Practice

Current Molecular Imaging of Spinal Tumors in Clinical Practice

Diagnostic Performance of 18F-FET PET in Newly Diagnosed Cerebral Lesions Suggestive of Glioma

Quantitative volumetric analysis of gliomas with sequential MRI and 11C-methionine PET assessment: patterns of integration in therapy planning

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Diagnostic Performance of ¹⁸F-FET PET in Newly Diagnosed Cerebral Lesions Suggestive of Glioma