18F-fluoromethylcholine (FCho), 18F-fluoroethylthyrosine (FET), 18F-fluordeoxyglucose (FDG) PET for the discrimination between high-grade glioma (HGG) and radiation necrosis (RN): a µPET study
Julie BolcaenBenedicte DescampsKarel DeblaereTom BoterbergFilip De VosJean-Pierre Kalala OkitoCaroline Van den BroeckeChristian VanhoveIngeborg Goethals
0
Citation
0
Reference
20
Related Paper
Abstract:
1379 Objectives Discrimination between HGG and RN remains a diagnostic challenge because both entities have similar imaging characteristics on conventional MRI. Metabolic imaging, such as PET could aid in this diagnostic dilemma. In this study, we investigated the potential of F18-FDG, F18-FCho and F18-FET PET in discriminating HGG from RN. Methods On day 15 after inoculation of F98 glioblastoma (GB) cells in the rat brain, MRI showed a contrast-enhancing tumor. μPET was performed (dynamic F18-FDG PET at conventional intervals followed by a delayed (240 min p.i.) acquisition, dynamic F18-FCho and F18-FET PET, n=4). Induction of RN was achieved by irradiating the right frontal region with 60 Gy using 3 arcs of 3*3mm. Follow-up MRI scans revealed a contrast-enhancing RN lesion 6-7 months post-irradiation and μPET was performed (n=3). The time activity curves (TACs) of the mean standard uptake value (SUV) and the lesion-to-normal tissue uptake ratio (LNR) measured during the last time frame were compared between GB and RN (see figure). Results On conventional F18-FDG PET, mean LNR in GB (1.35±0.08) was higher compared to RN (1.04±0.08) and were significantly different (p=0.034). The difference in LNR was higher on the delayed F18-FDG scan (1.60±0.25 in GB and 1.06±0.01 in RN), however borderline significant (p=0.064) due to the small sample size (n=2). For F18-FCho, LNRs in GB and RN were 2.55±0.39 and 2.45±0.16, respectively and not significanlty different (p=1.000), meaning that 18F-FCho cannot discriminate between GB and RN. F18-FET uptake was higher in GB with a LNR of 2.19±0.16, while a LNR of 1.71±0.32 was shown in RN. F18-FET LNRs were significantly higher in GB than in RN (p=0.034). Conclusions Based on these results, F18-FDG and F18-FET PET were able to discriminate GB from RN whereas F18-FCho was not. However, because there was visible uptake of F18-FET in RN (not shown) , a threshold will be necessary.Keywords:
PET Imaging
Standardized uptake value
Cite
Objective: To evaluate the18F-FLT and18F-FDG uptake as an indicator of early tumor response after radiotherapy. Methods:18F-FLT and18F-FDG PET-CT imaging were performed before treatment, 24 h and 48 h after radiotherapy on Wistar rats bearing Walkar 256 tumor. Quantitative data were expressed as percent of injected dose per gram(%ID/g) and tumor to non-tumor radioactivity ratios(T/NT). Correlation between %ID/g and T/NT with proliferation index(Ki-67) were measured. Results:18F-FLT uptake in tumor decreased early after radiotherapy(P0.001), LI-Ki-67 decreased early after radiotherapy(P0.001) compared with controls.18F-FDG uptake in tumor not decreased significantly 24 h and 48 h after radiotherapy(P 0.05,P0.01),18F-FLT uptake was positively correlated with LI-Ki-67(r=0.889).18F-FDG uptake was not positively correlated with LI-Ki-67(r=0.379).18F-FLT and18F-FDG uptakes(T/NT) were positively correlated with %ID/g(r=0.807 and 0.813, respectively). Conclusion:18F-FLT uptake decreased early after radiotherapy, and the uptake correlated significantly with proliferation of tumor cells early after radiotherapy.18F-FDG uptake decreased slightly.18F-FLT is better than18F-FDG for the assessment of changes of cell proliferation early after radiotherapy.
Cite
Citations (0)
In this study, we evaluated the biodistribution of the (18)F(-)/(18)F-FDG administration, compared with separate (18)F-NaF and (18)F-FDG administrations. We also estimated the interaction of (18)F-NaF and (18)F-FDG in the (18)F(-)/(18)F-FDG administration by semiquantitative analysis.We retrospectively analyzed the data of 49 patients (39 men, 10 women; mean age ± SD, 59.3 ± 15.2 y) who underwent separate (18)F-FDG PET/CT and (18)F-NaF PET/CT scans as well as (18)F(-)/(18)F-FDG PET/CT sequentially. The most common primary diagnosis was prostate cancer (n = 28), followed by sarcoma (n = 9) and breast cancer (n = 6). The mean standardized uptake values (SUVs) were recorded for 18 organs in all patients, and maximum SUV and mean SUV were recorded for all the identified malignant lesions. We also estimated the (18)F(-)/(18)F-FDG uptake as the sum of (18)F-FDG uptake and adjusted (18)F-NaF uptake based on the ratio of (18)F-NaF injected dose in (18)F(-)/(18)F-FDG PET/CT. Lastly, we compared the results to explore the interaction of (18)F-FDG and (18)F-NaF uptake in the (18)F(-)/(18)F-FDG scan.The (18)F(-)/(18)F-FDG uptake in the cerebral cortex, cerebellum, parotid grand, myocardium, and bowel mostly reflected the (18)F-FDG uptake, whereas the uptake in the other analyzed structures was influenced by both the (18)F-FDG and the (18)F-NaF uptake. The (18)F(-)/(18)F-FDG uptake in extraskeletal lesions showed no significant difference when compared with the uptake from the separate (18)F-FDG scan. The (18)F(-)/(18)F-FDG uptake in skeletal lesions reflected mostly the (18)F-NaF uptake. The tumor-to-background ratio of (18)F(-)/(18)F-FDG in extraskeletal lesions showed no significant difference when compared with that from (18)F-FDG alone (P = 0.73). For skeletal lesions, the tumor-to-background ratio of (18)F(-)/(18)F-FDG was lower than that from (18)F-NaF alone (P < 0.001); however, this difference did not result in missed skeletal lesions on the (18)F(-)/(18)F-FDG scan.The understanding of the biodistribution of radiopharmaceuticals and the lesion uptake of the (18)F(-)/(18)F-FDG scan as well as the variations compared with the uptake on the separate (18)F-FDG PET/CT and (18)F-NaF PET/CT are valuable for more in-depth evaluation of the combined scanning technique.
Cite
Citations (13)
The aim of this study was to compare the grading and prognostic value of l-[methyl-11C]-methionine (11C-MET) PET in glioma patients with 18F-FDG PET and contrast-enhanced MRI. Methods: Patients (n = 102) with histopathologically confirmed gliomas were followed up for an average of 34.6 ± 3.8 mo after PET. The median survival was 18 ± 4.7 mo in the high-grade glioma group and 58 ± 27 mo in the low-grade glioma group. Patients underwent 18F-FDG PET, 11C-MET PET, and MRI in the diagnostic and preoperative stage. The ratio of the mean standardized uptake value in the tumor to mean standardized uptake value in contralateral normal cortex (T/N ratio) was calculated. Kaplan–Meier survival analysis and ANOVA were performed. Results: T/N ratios for 11C-MET PET and 18F-FDG PET were significantly higher in high-grade gliomas than in low-grade gliomas (2.15 ± 0.77 vs. 1.56 ± 0.74, P < 0.001, and 0.85 ± 0.61 vs. 0.63 ± 0.37, P < 0.01, respectively). Median survival was 19 ± 5.4 mo in patients with a T/N ratio greater than 1.51 for 11C-MET PET and 58 ± 26.7 mo in those with a T/N ratio less than 1.51 (P = 0.03). Among the LGGs, median survival was lower in patients with a mean T/N ratio greater than 1.51 for 11C-MET PET (16 ± 10 mo; 95% confidence interval, 1–36 mo) than in those with a T/N ratio less than 1.51 (P = 0.04). No significant difference in survival in LGGs was based on 18F-FDG uptake and MRI contrast enhancement. Conclusion:11C-MET PET can predict prognosis in gliomas and is better than 18F-FDG PET and MRI in predicting survival in LGGs.
Grading (engineering)
Standardized uptake value
Cite
Citations (131)
For PET imaging of mantle cell lymphoma (MCL), [18F]FDG (2-deoxy-2-[18F]fluoro-D-glucose) is the currently recommended radiotracer, although uptake is variable and bone marrow evaluation is limited. In this prospective study, we evaluated the novel CXCR4 (G-protein-coupled C-X-C chemokine receptor type 4) tracer [68Ga]Pentixafor in MCL patients, and compared it to [18F]FDG. Methods: MCL patients underwent [68Ga]Pentixafor-PET/MRI, and, if required for routine purposes, also [18F]FDG-PET/MRI, before treatment. PET was evaluated separately for 23 anatomic regions (12 lymph node stations and 11 organs/tissues), using MRI as the main reference standard. Standardized uptake values (SUVmax and SUVmean) and tumor-to-background ratios (TBRblood and TBRliver) were calculated. General Estimation Equations (GEE) were used to compare [68Ga]Pentixafor-PET and [18F]FDG-PET sensitivities and positive predictive values (PPV). For bone marrow involvement, where biopsy served as the main reference standard, and splenic involvement, receiver operating characteristic curves were used to determine the optimal SUV and TBR cut-off values, and areas under the curve (AUC) were calculated. Results: Twenty-two MCL patients were included. [68Ga]Pentixafor-PET sensitivity (100%) was significantly higher than for [18F]FDG-PET (75.2%) (P<0.001), and PPV was slightly, but not significantly lower (94.0%.vs. 96.5%; P=0.21). SUVs and TBRs were significantly higher for [68Ga]Pentixafor-PET than for [18F]FDG-PET (P<0.001 in all cases); the greatest difference was observed for mean TBRblood, with 4.9 for [68Ga]Pentixafor-PET and 2.0 for [18F]FDG-PET. For bone marrow involvement, [68Ga]Pentixafor-PET SUVmean showed an AUC of 0.92; and for splenic involvement, TBRblood showed an AUC of 0.81. Conclusion: [68Ga]Pentixafor-PET may become an alternative to [18F]FDG-PET in MCL patients, showing clearly higher detection rates and better tumor-to-background contrast.
Standardized uptake value
Cite
Citations (37)
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-[18F]-fluoroethyl)-L-tyrosine ([18F] FET) and [11C] choline.Eight consecutive patients with newly diagnosed diffuse glioma underwent dynamic [11C] choline and [18F] 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 [11C] choline and 20-40, 40-60 and 60-90 min [18F] 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.Of the 74 biopsies, 54 (73%) contained tumour. [11C] choline SUV and [18F] FET SUV and TBR at all intervals were higher in tumour than in normal samples. For [18F] 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 [18F] FET TBR 60-90 min was higher than that of [11C] choline SUV 20-40 min (0.87 versus 0.67, p = 0.005).[18F] FET was more accurate than [11C] choline for detecting glioma infiltration. Highest accuracy was found for [18F] FET TBR for the interval 60-90 min post-injection.
Choline
Standardized uptake value
Stereotactic biopsy
Infiltration (HVAC)
Cite
Citations (10)
Fluorodeoxyglucose
Cite
Citations (183)
In this pilot study, we evaluated 3′-deoxy-3′-18F-fluorothymidine (FLT) PET for the detection of gastric cancer and compared the diagnostic accuracy with that of 18F-FDG PET. Methods: Forty-five patients (31 male and 14 female) with histologically proven locally advanced gastric cancer underwent attenuation-corrected whole-body 18F-FLT PET and 18F-FDG PET/CT (low-dose CT). 18F-FLT emission images were acquired on a full-ring PET scanner 45 min after the injection of 270–340 MBq of 18F-FLT. 18F-FDG PET/CT was performed 60 min after the injection of 300–370 MBq of 18F-FDG. Mean standardized uptake values for 18F-FLT and 18F-FDG were calculated using circular ROIs (diameter, 1.5 cm) in the primary tumor manifestation site, in a reference segment of the liver, and in the bone marrow and were compared on a lesion-by-lesion basis. Results: According to the Lauren classification, 15 tumors (33%) were of the intestinal subtype and 30 (67%) of the nonintestinal subtype. 18F-FLT PET images showed high contrast for the primary tumor and proliferating bone marrow. In all patients (45/45), focal 18F-FLT uptake could be detected in the primary tumor. In contrast, 14 primary tumors were negative for 18F-FDG uptake, with lesional 18F-FDG uptake lower than or similar to background activity. The mean standardized uptake value for 18F-FLT in malignant primaries was 6.0 ± 2.5 (range, 2.4–12.7). In the subgroup of 18F-FDG–positive patients, the mean value for 18F-FDG was 8.4 ± 4.1 (range, 3.8/19.0), versus 6.8 ± 2.6 for 18F-FLT (Wilcoxon test: P = 0.03). Comparison of mean 18F-FLT and 18F-FDG uptake in tumors with signet ring cells revealed no statistically significant difference between the tracers (6.2 ± 2.1 for 18F-FLT vs. 6.4 ± 2.8 for 18F-FDG; Wilcoxon test: P = 0.94). Conclusion: The results of this study indicate that imaging gastric cancer with the proliferation marker 18F-FLT is feasible. 18F-FLT PET was more sensitive than 18F-FDG PET, especially in tumors frequently presenting without or with low 18F-FDG uptake, and may improve early evaluation of response to neoadjuvant treatment.
Standardized uptake value
Cite
Citations (127)
Background Discrimination between glioblastoma (GB) and radiation necrosis (RN) post-irradiation remains challenging but has a large impact on further treatment and prognosis. In this study, the uptake mechanisms of 18F-fluorodeoxyglucose (18F-FDG), 18F-fluoroethyltyrosine (18F-FET) and 18F-fluoromethylcholine (18F-FCho) positron emission tomography (PET) tracers were investigated in a F98 GB and RN rat model applying kinetic modeling (KM) and graphical analysis (GA) to clarify our previous results. Methods Dynamic 18F-FDG (GB n = 6 and RN n = 5), 18F-FET (GB n = 5 and RN n = 5) and 18F-FCho PET (GB n = 5 and RN n = 5) were acquired with continuous arterial blood sampling. Arterial input function (AIF) corrections, KM and GA were performed. Results The influx rate (Ki) of 18F-FDG uptake described by a 2-compartmental model (CM) or using Patlak GA, showed more trapping (k3) in GB (0.07 min-1) compared to RN (0.04 min-1) (p = 0.017). K1 of 18F-FET was significantly higher in GB (0.06 ml/ccm/min) compared to RN (0.02 ml/ccm/min), quantified using a 1-CM and Logan GA (p = 0.036). 18F-FCho was rapidly oxidized complicating data interpretation. Using a 1-CM and Logan GA no clear differences were found to discriminate GB from RN. Conclusions Based on our results we concluded that using KM and GA both 18F-FDG and 18F-FET were able to discriminate GB from RN. Using a 2-CM model more trapping of 18F-FDG was found in GB compared to RN. Secondly, the influx of 18F-FET was higher in GB compared to RN using a 1-CM model. Important correlations were found between SUV and kinetic or graphical measures for 18F-FDG and 18F-FET. 18F-FCho PET did not allow discrimination between GB and RN.
Fluorodeoxyglucose
Blood sampling
Cite
Citations (20)
Translocator protein
PET Imaging
Cite
Citations (59)
To determine the diagnostic reliability of (18)F-FDOPA, (13)N-Ammonia and F18-FDG PET/CT in primary brain tumors. We evaluated the amino acid and glucose metabolism of brain tumors by using PET with (18)F-FDOPA, (13)N-Ammonia and F18-FDG PET/CT.Nine patients undergoing evaluation for brain tumors were studied. Tracer uptake was quantified by the use of standardized uptake values and the ratio of tumor uptake to normal identical area of contra lateral hemisphere (T/N). In addition, PET uptake with (18)F-FDOPA was quantified by use of ratio of tumor uptake to striatum uptake (T/S). The results were correlated with the patient's clinical profile.Both high-grade and low-grade tumors were well visualized with (18)F-FDOPA. The sensitivity for identifying tumors was substantially higher with (18)F-FDOPA PET than with F18-FDG and (13)N-Ammonia PET as determined by simple visual inspection. The sensitivity for identifying recurrence in low grade gliomas is higher with (13)N-Ammonia than with F18-FDG.(18)F-FDOPA PET is more reliable than F18-FDG and (13)N-Ammonia PET for evaluating brain tumors.
PET Imaging
Brain tumor
Cite
Citations (9)