A Prospective Clinical Study of the Influence of Oral Protein Intake on [F]FET-PET Uptake and Test-retest Repeatability in Glioma

Overview

Journal EJNMMI Res

Date 2024 Jun 26

PMID 38922458

Authors

Sarah Chehri

Otto Molby Henriksen

Lisbeth Marner

Mette Christensen

Aida Muhic

Hans Skovgaard Poulsen

Ian Law

Affiliations

Soon will be listed here.

Abstract

Background: O-(2-[F]fluoroethyl)-L-tyrosine positron emission tomography ([F]FET PET) scanning is used in routine clinical management and evaluation of gliomas with a recommended 4 h prior fasting. Knowledge of test-retest variation of [F]FET PET imaging uptake metrics and the impact of accidental protein intake can be critical for interpretation. The aim of this study was to investigate the repeatability of [F]FET-PET metrics and to assess the impact of protein-intake prior to [F]FET PET scanning of gliomas.

Results: Test-retest variability in the non-protein group was good with absolute (and relative) upper and lower limits of agreement of + 0.15 and - 0.13 (+ 9.7% and - 9.0%) for mean tumour-to-background ratio (TBR), + 0.43 and - 0.28 (+ 19.6% and - 11.8%) for maximal tumour-to-background ratio (TBR), and + 2.14 cm and - 1.53 ml (+ 219.8% and - 57.3%) for biological tumour volume (BTV). Variation was lower for uptake ratios than for BTV. Protein intake was associated with a 27% increase in the total sum of plasma concentration of the L-type amino acid transporter 1 (LAT1) relevant amino acids and with decreased standardized uptake value (SUV) in both healthy appearing background brain tissue (mean SUV - 25%) and in tumour (maximal SUV - 14%). Oral intake of 24 g of protein 1 h prior to injection of tracer tended to increase variability, but the effects on derived tumour metrics TBR and TBR were only borderline significant, and changes generally within the variability observed in the group with no protein intake.

Conclusion: The test-retest repeatability was found to be good, and better for TBR and TBR than BTV, with the methodological limitation that tumour growth may have influenced results. Oral intake of 24 g of protein one hour before a [F]FET PET scan decreases uptake of [F]FET in both tumour and in healthy appearing brain, with no clinically significant difference on the most commonly used tumour metrics.

Citing Articles

Magnetic resonance imaging and o-(2-[F]fluoroethyl)-l-tyrosine positron emission tomography for early response assessment of nivolumab and bevacizumab in patients with recurrent high-grade astrocytic glioma.

Henriksen O, Maarup S, Hasselbalch B, Poulsen H, Christensen I, Madsen K Neurooncol Adv. 2024; 6(1):vdae178.

PMID: 39659835 PMC: 11630048. DOI: 10.1093/noajnl/vdae178.

References

Suchorska B, Jansen N, Linn J, Kretzschmar H, Janssen H, Eigenbrod S . Biological tumor volume in 18FET-PET before radiochemotherapy correlates with survival in GBM. Neurology. 2015; 84(7):710-9. DOI: 10.1212/WNL.0000000000001262. View

Jansen N, Suchorska B, Wenter V, Schmid-Tannwald C, Todica A, Eigenbrod S . Prognostic significance of dynamic 18F-FET PET in newly diagnosed astrocytic high-grade glioma. J Nucl Med. 2014; 56(1):9-15. DOI: 10.2967/jnumed.114.144675. View

Albert N, Weller M, Suchorska B, Galldiks N, Soffietti R, Kim M . Response Assessment in Neuro-Oncology working group and European Association for Neuro-Oncology recommendations for the clinical use of PET imaging in gliomas. Neuro Oncol. 2016; 18(9):1199-208. PMC: 4999003. DOI: 10.1093/neuonc/now058. View

Vettermann F, Diekmann C, Weidner L, Unterrainer M, Suchorska B, Ruf V . L-type amino acid transporter (LAT) 1 expression in F-FET-negative gliomas. EJNMMI Res. 2021; 11(1):124. PMC: 8671595. DOI: 10.1186/s13550-021-00865-9. View

Louis D, Ohgaki H, Wiestler O, Cavenee W, Burger P, Jouvet A . The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007; 114(2):97-109. PMC: 1929165. DOI: 10.1007/s00401-007-0243-4. View

Leenders K, Poewe W, Palmer A, Brenton D, Frackowiak R . Inhibition of L-[18F]fluorodopa uptake into human brain by amino acids demonstrated by positron emission tomography. Ann Neurol. 1986; 20(2):258-62. DOI: 10.1002/ana.410200212. View

Poulsen S, Urup T, Grunnet K, Christensen I, Larsen V, Jensen M . The prognostic value of FET PET at radiotherapy planning in newly diagnosed glioblastoma. Eur J Nucl Med Mol Imaging. 2016; 44(3):373-381. PMC: 5281673. DOI: 10.1007/s00259-016-3494-2. View

Habermeier A, Graf J, Sandhofer B, Boissel J, Roesch F, Closs E . System L amino acid transporter LAT1 accumulates O-(2-fluoroethyl)-L-tyrosine (FET). Amino Acids. 2014; 47(2):335-44. DOI: 10.1007/s00726-014-1863-3. View

Landvogt C, Mengel E, Bartenstein P, Buchholz H, Schreckenberger M, Siessmeier T . Reduced cerebral fluoro-L-dopamine uptake in adult patients suffering from phenylketonuria. J Cereb Blood Flow Metab. 2007; 28(4):824-31. DOI: 10.1038/sj.jcbfm.9600571. View

10.

Jansen N, Suchorska B, Wenter V, Eigenbrod S, Schmid-Tannwald C, Zwergal A . Dynamic 18F-FET PET in newly diagnosed astrocytic low-grade glioma identifies high-risk patients. J Nucl Med. 2014; 55(2):198-203. DOI: 10.2967/jnumed.113.122333. View

11.

Fougere C, Suchorska B, Bartenstein P, Kreth F, Tonn J . Molecular imaging of gliomas with PET: opportunities and limitations. Neuro Oncol. 2011; 13(8):806-19. PMC: 3145468. DOI: 10.1093/neuonc/nor054. View

12.

Stegmayr C, Schoneck M, Oliveira D, Willuweit A, Filss C, Galldiks N . Reproducibility of O-(2-(18)F-fluoroethyl)-L-tyrosine uptake kinetics in brain tumors and influence of corticoid therapy: an experimental study in rat gliomas. Eur J Nucl Med Mol Imaging. 2015; 43(6):1115-23. DOI: 10.1007/s00259-015-3274-4. View

13.

Albert N, Galldiks N, Ellingson B, van den Bent M, Chang S, Cicone F . PET-based response assessment criteria for diffuse gliomas (PET RANO 1.0): a report of the RANO group. Lancet Oncol. 2024; 25(1):e29-e41. PMC: 11787868. DOI: 10.1016/S1470-2045(23)00525-9. View

14.

Stockhammer F, Plotkin M, Amthauer H, van Landeghem F, Woiciechowsky C . Correlation of F-18-fluoro-ethyl-tyrosin uptake with vascular and cell density in non-contrast-enhancing gliomas. J Neurooncol. 2008; 88(2):205-10. DOI: 10.1007/s11060-008-9551-3. View

15.

Lahoutte T, Caveliers V, Camargo S, Franca R, Ramadan T, Veljkovic E . SPECT and PET amino acid tracer influx via system L (h4F2hc-hLAT1) and its transstimulation. J Nucl Med. 2004; 45(9):1591-6. View

16.

Rachinger W, Goetz C, Popperl G, Gildehaus F, Kreth F, Holtmannspotter M . Positron emission tomography with O-(2-[18F]fluoroethyl)-l-tyrosine versus magnetic resonance imaging in the diagnosis of recurrent gliomas. Neurosurgery. 2005; 57(3):505-11. DOI: 10.1227/01.neu.0000171642.49553.b0. View

17.

Langen K, Roosen N, Coenen H, Kuikka J, Kuwert T, Herzog H . Brain and brain tumor uptake of L-3-[123I]iodo-alpha-methyl tyrosine: competition with natural L-amino acids. J Nucl Med. 1991; 32(6):1225-9. View

18.

Law I, Albert N, Arbizu J, Boellaard R, Drzezga A, Galldiks N . Joint EANM/EANO/RANO practice guidelines/SNMMI procedure standards for imaging of gliomas using PET with radiolabelled amino acids and [F]FDG: version 1.0. Eur J Nucl Med Mol Imaging. 2018; 46(3):540-557. PMC: 6351513. DOI: 10.1007/s00259-018-4207-9. View

19.

Pauwels E, McCready V, Stoot J, van Deurzen D . The mechanism of accumulation of tumour-localising radiopharmaceuticals. Eur J Nucl Med. 1998; 25(3):277-305. DOI: 10.1007/s002590050229. View

20.

Laique S, Egrise D, Monclus M, Schmitz F, Garcia C, Lemaire C . L-amino acid load to enhance PET differentiation between tumor and inflammation: an in vitro study on (18)F-FET uptake. Contrast Media Mol Imaging. 2006; 1(5):212-20. DOI: 10.1002/cmmi.107. View