Is There a Place for FET PET in the Initial Evaluation of Brain Lesions with Unknown Significance?

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2010 Apr 17

PMID 20396883

Citations 33

Authors

Robert Pichler

Andreas Dunzinger

Gabriele Wurm

Josef Pichler

Serge Weis

Karin Nussbaumer

Raffi Topakian

Reingard M Aigner

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this study was to evaluate the clinical value of the use of O-(2-[(18)F]fluoroethyl)-L: -tyrosine (FET) positron emission tomography (PET)/computed tomography (CT) in patients of a neurological clinic for evaluation of brain lesions newly diagnosed by magnetic resonance imaging (MRI).

Methods: We evaluated 88 patients (44 women and 44 men) with a mean age of 50 +/- 19 years who were sent consecutively for evaluation of an intracerebral mass or lesion observed by MRI from 2006 to 2008. Hospitalization was necessary due to neurological clinical symptoms. Images were obtained by PET/CT 30 min after i.v. injection of 185 MBq FET. Coregistration with MRI was done by HERMES workstation.

Results: FET uptake above the cortical level was observed in 60 patients. Neurosurgery was performed in 60 patients (51 with FET-positive imaging); 36 high-grade and 19 low-grade tumours were verified histologically. The sensitivity of FET PET for high-grade tumours (WHO III-IV) was 94% in this setting. Among the low-grade brain tumours (WHO I-II) 13 of 19 were FET positive, which indicates a sensitivity of 68%. Five of ten (50%) astrocytomas I and II could not be visualized by FET. Histological data were not provided for 28 of 88 patients, so the diagnostic approach is based upon longitudinal observation. Radiological and/or clinical control was done at a median of 7 months later. Three patients (all FET positive) died a few months after the examination because of rapid progression of the malignant brain tumour. A malignant entity could be excluded in the other 25 patients. Considering the whole cohort of 88 patients, 43 patients with malignant tumour could be identified, including high-grade glioma, intracerebral lymphoma (n = 1) and metastasis (n = 3). The sensitivity of FET PET for detecting a malignant tumour entity was 93%. We observed two false-positive cases with postischaemic lesions. Remarkably, the two patients with cerebral gliomatosis were false-negative on FET PET imaging. The negative predictive value for a malignant entity was calculated to be 89%.

Conclusion: Our results indicate a high sensitivity of FET PET for detecting high-grade glioma in patients with neurological symptoms and recently observed brain lesions by MRI. In the setting of evaluating new brain lesions of unknown significance via FET PET a negative image can encourage a wait and see strategy-of course in accordance with the clinical picture and morphological imaging.

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References

Heiss P, Mayer S, Herz M, Wester H, Schwaiger M, Senekowitsch-Schmidtke R . Investigation of transport mechanism and uptake kinetics of O-(2-[18F]fluoroethyl)-L-tyrosine in vitro and in vivo. J Nucl Med. 1999; 40(8):1367-73. View

Weber D, Zilli T, Buchegger F, Casanova N, Haller G, Rouzaud M . [(18)F]Fluoroethyltyrosine- positron emission tomography-guided radiotherapy for high-grade glioma. Radiat Oncol. 2008; 3:44. PMC: 2628662. DOI: 10.1186/1748-717X-3-44. View

Vees H, Senthamizhchelvan S, Miralbell R, Weber D, Ratib O, Zaidi H . Assessment of various strategies for 18F-FET PET-guided delineation of target volumes in high-grade glioma patients. Eur J Nucl Med Mol Imaging. 2008; 36(2):182-93. DOI: 10.1007/s00259-008-0943-6. View

Popperl G, Goldbrunner R, Gildehaus F, Kreth F, Tanner P, Holtmannspotter M . O-(2-[18F]fluoroethyl)-L-tyrosine PET for monitoring the effects of convection-enhanced delivery of paclitaxel in patients with recurrent glioblastoma. Eur J Nucl Med Mol Imaging. 2005; 32(9):1018-25. DOI: 10.1007/s00259-005-1819-7. View

Jager P, Vaalburg W, Pruim J, De Vries E, Langen K, Piers D . Radiolabeled amino acids: basic aspects and clinical applications in oncology. J Nucl Med. 2001; 42(3):432-45. View

Langen K, Hamacher K, Weckesser M, Floeth F, Stoffels G, Bauer D . O-(2-[18F]fluoroethyl)-L-tyrosine: uptake mechanisms and clinical applications. Nucl Med Biol. 2006; 33(3):287-94. DOI: 10.1016/j.nucmedbio.2006.01.002. View

Floeth F, Pauleit D, Sabel M, Stoffels G, Reifenberger G, Riemenschneider M . Prognostic value of O-(2-18F-fluoroethyl)-L-tyrosine PET and MRI in low-grade glioma. J Nucl Med. 2007; 48(4):519-27. DOI: 10.2967/jnumed.106.037895. View

Weckesser M, Langen K, Rickert C, Kloska S, Straeter R, Hamacher K . O-(2-[18F]fluorethyl)-L-tyrosine PET in the clinical evaluation of primary brain tumours. Eur J Nucl Med Mol Imaging. 2005; 32(4):422-9. DOI: 10.1007/s00259-004-1705-8. View

Potzi C, Becherer A, Marosi C, Karanikas G, Szabo M, Dudczak R . [11C] methionine and [18F] fluorodeoxyglucose PET in the follow-up of glioblastoma multiforme. J Neurooncol. 2007; 84(3):305-14. DOI: 10.1007/s11060-007-9375-6. View

10.

Stadlbauer A, Prante O, Nimsky C, Salomonowitz E, Buchfelder M, Kuwert T . Metabolic imaging of cerebral gliomas: spatial correlation of changes in O-(2-18F-fluoroethyl)-L-tyrosine PET and proton magnetic resonance spectroscopic imaging. J Nucl Med. 2008; 49(5):721-9. DOI: 10.2967/jnumed.107.049213. View

11.

Stadlbauer A, Polking E, Prante O, Nimsky C, Buchfelder M, Kuwert T . Detection of tumour invasion into the pyramidal tract in glioma patients with sensorimotor deficits by correlation of (18)F-fluoroethyl-L: -tyrosine PET and magnetic resonance diffusion tensor imaging. Acta Neurochir (Wien). 2009; 151(9):1061-9. DOI: 10.1007/s00701-009-0378-2. View

12.

Del Sole A, Moncayo R, Tafuni G, Lucignani G . Position of nuclear medicine techniques in the diagnostic work-up of brain tumors. Q J Nucl Med Mol Imaging. 2004; 48(2):76-81. View

13.

Pauleit D, Floeth F, Tellmann L, Hamacher K, Hautzel H, Muller H . Comparison of O-(2-18F-fluoroethyl)-L-tyrosine PET and 3-123I-iodo-alpha-methyl-L-tyrosine SPECT in brain tumors. J Nucl Med. 2004; 45(3):374-81. View

14.

Floeth F, Sabel M, Stoffels G, Pauleit D, Hamacher K, Steiger H . Prognostic value of 18F-fluoroethyl-L-tyrosine PET and MRI in small nonspecific incidental brain lesions. J Nucl Med. 2008; 49(5):730-7. DOI: 10.2967/jnumed.107.050005. View

15.

Pauleit D, Floeth F, Hamacher K, Riemenschneider M, Reifenberger G, Muller H . O-(2-[18F]fluoroethyl)-L-tyrosine PET combined with MRI improves the diagnostic assessment of cerebral gliomas. Brain. 2005; 128(Pt 3):678-87. DOI: 10.1093/brain/awh399. View

16.

Sadeghi N, Salmon I, Decaestecker C, Levivier M, Metens T, Wikler D . Stereotactic comparison among cerebral blood volume, methionine uptake, and histopathology in brain glioma. AJNR Am J Neuroradiol. 2007; 28(3):455-61. PMC: 7977817. View

17.

Floeth F, Pauleit D, Sabel M, Reifenberger G, Stoffels G, Stummer W . 18F-FET PET differentiation of ring-enhancing brain lesions. J Nucl Med. 2006; 47(5):776-82. View

18.

Popperl G, Kreth F, Herms J, Koch W, Mehrkens J, Gildehaus F . Analysis of 18F-FET PET for grading of recurrent gliomas: is evaluation of uptake kinetics superior to standard methods?. J Nucl Med. 2006; 47(3):393-403. View

19.

Rau F, Weber W, Wester H, Herz M, Becker I, Kruger A . O-(2-[(18)F]Fluoroethyl)- L-tyrosine (FET): a tracer for differentiation of tumour from inflammation in murine lymph nodes. Eur J Nucl Med Mol Imaging. 2002; 29(8):1039-46. DOI: 10.1007/s00259-002-0821-6. View

20.

Weber W, Wester H, Grosu A, Herz M, Dzewas B, Feldmann H . O-(2-[18F]fluoroethyl)-L-tyrosine and L-[methyl-11C]methionine uptake in brain tumours: initial results of a comparative study. Eur J Nucl Med. 2000; 27(5):542-9. DOI: 10.1007/s002590050541. View