Direct comparison of [11C] choline and [18F] FET PET to detect glioma infiltration: a diagnostic accuracy study in eight patients

Abstract

Background Positron emission tomography (PET) is increasingly used to guide local treatment in glioma. The purpose of this study was a direct comparison of two potential tracers for detecting glioma infiltration, O-(2-[ 18 F]-fluoroethyl)- l -tyrosine ([ 18 F] FET) and [ 11 C] choline. Methods Eight consecutive patients with newly diagnosed diffuse glioma underwent dynamic [ 11 C] choline and [ 18 F] FET PET scans. Preceding craniotomy, multiple stereotactic biopsies were obtained from regions inside and outside PET abnormalities. Biopsies were assessed independently for tumour presence by two neuropathologists. Imaging measurements were derived at the biopsy locations from 10 to 40 min [ 11 C] choline and 20–40, 40–60 and 60–90 min [ 18 F] FET intervals, as standardized uptake value (SUV) and tumour-to-brain ratio (TBR). Diagnostic accuracies of both tracers were compared using receiver operating characteristic analysis and generalized linear mixed modelling with consensus histopathological assessment as reference. Results Of the 74 biopsies, 54 (73%) contained tumour. [ 11 C] choline SUV and [ 18 F] FET SUV and TBR at all intervals were higher in tumour than in normal samples. For [ 18 F] FET, the diagnostic accuracy of TBR was higher than that of SUV for intervals 40–60 min (area under the curve: 0.88 versus 0.81, p = 0.026) and 60–90 min (0.90 versus 0.81, p = 0.047). The diagnostic accuracy of [ 18 F] FET TBR 60–90 min was higher than that of [ 11 C] choline SUV 20–40 min (0.87 versus 0.67, p = 0.005). Conclusions [ 18 F] FET was more accurate than [ 11 C] choline for detecting glioma infiltration. Highest accuracy was found for [ 18 F] FET TBR for the interval 60–90 min post-injection. Electronic supplementary material The online version of this article (10.1186/s13550-019-0523-8) contains supplementary material, which is available to authorized users.

18F-fluoro-ethyl-tyrosine PET co-registered with MRI in patients with persisting acromegaly

“…(29) However, a key rationale for its use is the fact that FET and MET share the same uptake mechanism and a close correlation has been found between FET and MET uptake in primary brain tumors (e.g. gliomas and metastases), (22)(23)(24). Although FET and MET share the same molecular mechanism to enter the cell (via the L-type amino acid transporter 1 (LAT1)),( 21) in contrast to MET, FET is neither metabolized nor incorporated into proteins.…”

“…Comparative clinical studies have shown a strong correlation between FET and MET uptake in brain tumors (e.g. gliomas, metastases), (22)(23)(24) indicating that the utility of MET might be extrapolated to FET for patients with pituitary adenomas.…”

Larger 18F-fluoroboronotyrosine (FBY) active volume beyond MRI contrast enhancement in diffuse gliomas than in circumscribed brain tumors

“…Currently, the extent of tumor remains delineated on MRI, with GTR defined by the T1-weighted contrast-enhanced regions for significant contrast-enhanced tumors [ 10 ]. However, biopsy-based studies indicated that tumor infiltrates beyond contrast enhancement [ 3 , 13 , 14 ], and a large-scale retrospective report suggested that the maximum resection of both contrast-enhanced and noncontrast-enhanced regions contributes to survival benefits in certain populations [ 15 ]. The identification of tumor infiltration beyond GTR is crucial for surgery, radiation planning and drug treatment [ 15 , 16 ].…”

18F-FET and 18F-choline PET-CT in patients with MRI-suspected low-grade gliomas: a pilot study

“…PET was performed 20 minutes after 18 F-FET injection. A recently published study from Amsterdam suggested that 18 F-FET/PET 60-90-min interval might have a higher diagnostic accuracy than the 20-40-min interval ( 22 ). Other authors have also reported better detection of diffuse glioma at intervals longer than 60 min compared with shorter intervals ( 23 ).…”