Low-Grade Versus High-Grade Glioma… That Is the Question. 18F-Fluorocholine PET in the Detection of Anaplastic Focus

Abstract

Gliomas are characterized by intratumoral histological heterogeneity, coexisting foci of low and high grade. First, in low-grade gliomas, neoangiogenesis has not yet developed and cellularity is low, so alterations on perfusion MRI may not be present. Second, a non-negligible number of high-grade gliomas show none, patchy, or weak contrast enhancement on MRI, so they can be misdiagnosed as low-grade glioma, preventing their correct management. We present 4 cases of patients in which 18F-fluorocholine PET defined the anaplastic tumor component and therefore the tumor aggressiveness, solving the limitations of MRI.

Mapping glioma heterogeneity using multiparametric 18F-choline PET/MRI in childhood and teenage-young adults

“…Several previous studies have evaluated the role of 18 F-choline PET/CT in lowand high-grade gliomas [22][23][24][25] but few studies have examined intra-tumoural heterogeneity. In a recent series of four low-grade glioma patients, foci of increased 18 F-choline SUV defined the anaplastic tumour component [26].…”