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Beuriat PA, Flaus A, Portefaix A, Szathmari A, Janier M, Hermier M, Lorthois-Ninou S, Scheiber C, Isal S, Costes N, Merida I, Lancelot S, Vasiljevic A, Leblond P, Faure Conter C, Saunier C, Kassai B, Vinchon M, Di Rocco F, Mottolese C. Preoperative 11 C-Methionine PET-MRI in Pediatric Infratentorial Tumors. Clin Nucl Med 2024; 49:381-386. [PMID: 38498623 DOI: 10.1097/rlu.0000000000005174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
PURPOSE MRI is the main imaging modality for pediatric brain tumors, but amino acid PET can provide additional information. Simultaneous PET-MRI acquisition allows to fully assess the tumor and lower the radiation exposure. Although symptomatic posterior fossa tumors are typically resected, the patient management is evolving and will benefit from an improved preoperative tumor characterization. We aimed to explore, in children with newly diagnosed posterior fossa tumor, the complementarity of the information provided by amino acid PET and MRI parameters and the correlation to histopathological results. PATIENTS AND METHODS Children with a newly diagnosed posterior fossa tumor prospectively underwent a preoperative 11 C-methionine (MET) PET-MRI. Images were assessed visually and semiquantitatively. Using correlation, minimum apparent diffusion coefficient (ADC min ) and contrast enhancement were compared with MET SUV max . The diameter of the enhancing lesions was compared with metabolic tumoral volume. Lesions were classified according to the 2021 World Health Organization (WHO) classification. RESULTS Ten children were included 4 pilocytic astrocytomas, 2 medulloblastomas, 1 ganglioglioma, 1 central nervous system embryonal tumor, and 1 schwannoma. All lesions showed visually increased MET uptake. A negative moderate correlation was found between ADC min and SUV max values ( r = -0.39). Mean SUV max was 3.8 (range, 3.3-4.2) in WHO grade 4 versus 2.5 (range, 1.7-3.0) in WHO grade 1 lesions. A positive moderate correlation was found between metabolic tumoral volume and diameter values ( r = 0.34). There was no correlation between SUV max and contrast enhancement intensity ( r = -0.15). CONCLUSIONS Preoperative 11 C-MET PET and MRI could provide complementary information to characterize pediatric infratentorial tumors.
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Affiliation(s)
| | | | | | - Alexandru Szathmari
- From the Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon
| | | | - Marc Hermier
- Department of Neuroradiology, Hôpital Neurologique et Neurochirurgical P. Wertheimer, Hospices Civils de Lyon
| | - Sylvie Lorthois-Ninou
- Department of Pediatric Radiology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon
| | | | - Sibel Isal
- Department of Nuclear Medicine, Hospices Civils de Lyon
| | | | | | | | | | - Pierre Leblond
- Institut d'Hématologie et d'Oncologie Pédiatrique (IHOPe), Centre Léon Bérard, Lyon, France
| | - Cécile Faure Conter
- Institut d'Hématologie et d'Oncologie Pédiatrique (IHOPe), Centre Léon Bérard, Lyon, France
| | - Clarisse Saunier
- EPICIME-CIC 1407 de Lyon, Inserm, Département d'Épidémiologie Clinique, Hospices Civils de Lyon
| | | | - Matthieu Vinchon
- From the Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon
| | | | - Carmine Mottolese
- From the Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon
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Antkowiak L, Zimny M, Starszak K, Sordyl R, Mandera M. Surgical Treatment of Pediatric Incidentally Found Brain Tumors: A Single-Center Experience. Brain Sci 2023; 13:brainsci13050746. [PMID: 37239218 DOI: 10.3390/brainsci13050746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023] Open
Abstract
There remains much debate about the correct management of incidentally found brain tumors in the pediatric population. This study aimed to evaluate the efficacy and safety of surgical treatment of incidentally found pediatric brain tumors. A retrospective analysis of pediatric patients who underwent surgical resection of incidentally found brain tumors between January 2010 and April 2016 was performed. A total of seven patients were included. The median age at the time of diagnosis was 9.7 years. The reasons for performing neuroimaging were as follows: impeded speech development (n = 2), shunt control (n = 1), paranasal sinuses control (n = 1), behavior changes (n = 1), head trauma (n = 1), and preterm birth (n = 1). Five patients underwent gross total tumor resection (71.4%), while subtotal resection was performed in two patients (28.6%). There was no surgery-related morbidity. Patients were followed up for a mean of 79 months. One patient with atypical neurocytoma experienced tumor recurrence 45 months following primary resection. All patients remained neurologically intact. The majority of pediatric incidentally found brain tumors were histologically benign. Surgery remains a safe therapeutic approach associated with favorable long-term outcomes. Considering the expected long lifetime of pediatric patients, as well as the psychological burden associated with having a brain tumor as a child, surgical resection can be considered an initial approach.
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Affiliation(s)
- Lukasz Antkowiak
- Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Mikolaj Zimny
- Department of Neurosurgery, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Krzysztof Starszak
- Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- Department of Human Anatomy, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Ryszard Sordyl
- Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Marek Mandera
- Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
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Advanced Neuroimaging Approaches to Pediatric Brain Tumors. Cancers (Basel) 2022; 14:cancers14143401. [PMID: 35884462 PMCID: PMC9318188 DOI: 10.3390/cancers14143401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary After leukemias, brain tumors are the most common cancers in children, and early, accurate diagnosis is critical to improve patient outcomes. Beyond the conventional imaging methods of computed tomography (CT) and magnetic resonance imaging (MRI), advanced neuroimaging techniques capable of both structural and functional imaging are moving to the forefront to improve the early detection and differential diagnosis of tumors of the central nervous system. Here, we review recent developments in neuroimaging techniques for pediatric brain tumors. Abstract Central nervous system tumors are the most common pediatric solid tumors; they are also the most lethal. Unlike adults, childhood brain tumors are mostly primary in origin and differ in type, location and molecular signature. Tumor characteristics (incidence, location, and type) vary with age. Children present with a variety of symptoms, making early accurate diagnosis challenging. Neuroimaging is key in the initial diagnosis and monitoring of pediatric brain tumors. Conventional anatomic imaging approaches (computed tomography (CT) and magnetic resonance imaging (MRI)) are useful for tumor detection but have limited utility differentiating tumor types and grades. Advanced MRI techniques (diffusion-weighed imaging, diffusion tensor imaging, functional MRI, arterial spin labeling perfusion imaging, MR spectroscopy, and MR elastography) provide additional and improved structural and functional information. Combined with positron emission tomography (PET) and single-photon emission CT (SPECT), advanced techniques provide functional information on tumor metabolism and physiology through the use of radiotracer probes. Radiomics and radiogenomics offer promising insight into the prediction of tumor subtype, post-treatment response to treatment, and prognostication. In this paper, a brief review of pediatric brain cancers, by type, is provided with a comprehensive description of advanced imaging techniques including clinical applications that are currently utilized for the assessment and evaluation of pediatric brain tumors.
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A spatiotemporal multi-scale computational model for FDG PET imaging at different stages of tumor growth and angiogenesis. Sci Rep 2022; 12:10062. [PMID: 35710559 PMCID: PMC9203789 DOI: 10.1038/s41598-022-13345-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/09/2022] [Indexed: 01/07/2023] Open
Abstract
A deeper understanding of the tumor microenvironment (TME) and its role in metabolic activity at different stages of vascularized tumors can provide useful insights into cancer progression and better support clinical assessments. In this study, a robust and comprehensive multi-scale computational model for spatiotemporal transport of F-18 fluorodeoxyglucose (FDG) is developed to incorporate important aspects of the TME, spanning subcellular-, cellular-, and tissue-level scales. Our mathematical model includes biophysiological details, such as radiopharmaceutical transport within interstitial space via convection and diffusion mechanisms, radiopharmaceutical exchange between intracellular and extracellular matrices by glucose transporters, cellular uptake of radiopharmaceutical, as well as its intracellular phosphorylation by the enzyme. Further, to examine the effects of tumor size by varying microvascular densities (MVDs) on FDG dynamics, four different capillary networks are generated by angiogenesis modeling. Results demonstrate that as tumor grows, its MVD increases, and hence, the spatiotemporal distribution of total FDG uptake by tumor tissue changes towards a more homogenous distribution. In addition, spatiotemporal distributions in tumor with lower MVD have relatively smaller magnitudes, due to the lower diffusion rate of FDG as well as lower local intravenous FDG release. Since mean standardized uptake value (SUVmean) differs at various stages of microvascular networks with different tumor sizes, it may be meaningful to normalize the measured values by tumor size and the MVD prior to routine clinical reporting. Overall, the present framework has the potential for more accurate investigation of biological phenomena within TME towards personalized medicine.
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Synthetic 18F-FDG PET Image Generation Using a Combination of Biomathematical Modeling and Machine Learning. Cancers (Basel) 2022; 14:cancers14112786. [PMID: 35681767 PMCID: PMC9179454 DOI: 10.3390/cancers14112786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/21/2022] [Accepted: 06/01/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Training computer-assisted algorithms on medical images, particularly 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) due to its excellent diagnostic accuracy, is difficult, considering small/fragmented samples or privacy concerns. In computer-vision, deep learning-based models, unlike the conventional data augmentation methods, are highly sought after for creating massive medical samples. For this reason, we developed a multi-scale computational framework to generate synthetic 18F-FDG PET images similar to the real ones in different stages of solid tumor growth and angiogenesis. The framework is developed based on the bio-physiological phenomena of FDG radiotracer uptake in solid tumors using a biomathematical model and a generative adversarial network (GAN)-based architecture. The non-invasive augmented 18F-FDG PET images can be used in clinical practice without the need to manage the patient data. In addition, our spatiotemporal mathematical model can calculate the distribution of various radiopharmaceuticals in different tumor-associated vasculatures. Abstract No previous works have attempted to combine generative adversarial network (GAN) architectures and the biomathematical modeling of positron emission tomography (PET) radiotracer uptake in tumors to generate extra training samples. Here, we developed a novel computational model to produce synthetic 18F-fluorodeoxyglucose (18F-FDG) PET images of solid tumors in different stages of progression and angiogenesis. First, a comprehensive biomathematical model is employed for creating tumor-induced angiogenesis, intravascular and extravascular fluid flow, as well as modeling of the transport phenomena and reaction processes of 18F-FDG in a tumor microenvironment. Then, a deep convolutional GAN (DCGAN) model is employed for producing synthetic PET images using 170 input images of 18F-FDG uptake in each of 10 different tumor microvascular networks. The interstitial fluid parameters and spatiotemporal distribution of 18F-FDG uptake in tumor and healthy tissues have been compared against previously published numerical and experimental studies, indicating the accuracy of the model. The structural similarity index measure (SSIM) and peak signal-to-noise ratio (PSNR) of the generated PET sample and the experimental one are 0.72 and 28.53, respectively. Our results demonstrate that a combination of biomathematical modeling and GAN-based augmentation models provides a robust framework for the non-invasive and accurate generation of synthetic PET images of solid tumors in different stages.
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Piccardo A, Albert NL, Borgwardt L, Fahey FH, Hargrave D, Galldiks N, Jehanno N, Kurch L, Law I, Lim R, Lopci E, Marner L, Morana G, Young Poussaint T, Seghers VJ, Shulkin BL, Warren KE, Traub-Weidinger T, Zucchetta P. Joint EANM/SIOPE/RAPNO practice guidelines/SNMMI procedure standards for imaging of paediatric gliomas using PET with radiolabelled amino acids and [ 18F]FDG: version 1.0. Eur J Nucl Med Mol Imaging 2022; 49:3852-3869. [PMID: 35536420 PMCID: PMC9399211 DOI: 10.1007/s00259-022-05817-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/23/2022] [Indexed: 01/18/2023]
Abstract
Positron emission tomography (PET) has been widely used in paediatric oncology. 2-Deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) is the most commonly used radiopharmaceutical for PET imaging. For oncological brain imaging, different amino acid PET radiopharmaceuticals have been introduced in the last years. The purpose of this document is to provide imaging specialists and clinicians guidelines for indication, acquisition, and interpretation of [18F]FDG and radiolabelled amino acid PET in paediatric patients affected by brain gliomas. There is no high level of evidence for all recommendations suggested in this paper. These recommendations represent instead the consensus opinion of experienced leaders in the field. Further studies are needed to reach evidence-based recommendations for the applications of [18F]FDG and radiolabelled amino acid PET in paediatric neuro-oncology. These recommendations are not intended to be a substitute for national and international legal or regulatory provisions and should be considered in the context of good practice in nuclear medicine. The present guidelines/standards were developed collaboratively by the EANM and SNMMI with the European Society for Paediatric Oncology (SIOPE) Brain Tumour Group and the Response Assessment in Paediatric Neuro-Oncology (RAPNO) working group. They summarize also the views of the Neuroimaging and Oncology and Theranostics Committees of the EANM and reflect recommendations for which the EANM and other societies cannot be held responsible.
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Affiliation(s)
- Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, Italy
| | - Nathalie L Albert
- Department of Nuclear Medicine, University Hospital of LMU Munich, Munich, Germany
| | - Lise Borgwardt
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frederic H Fahey
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Darren Hargrave
- Department of Paediatric Oncology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
| | - Nina Jehanno
- Department of Nuclear Medicine, Institut Curie Paris, Paris, France
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany.
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Lim
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS-Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Lisbeth Marner
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Giovanni Morana
- Department of Neurosciences, University of Turin, Turin, Italy
| | - Tina Young Poussaint
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Victor J Seghers
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Barry L Shulkin
- Nuclear Medicine Department of Diagnostic Imaging St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Katherine E Warren
- Department of Pediatric Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine - DIMED, University Hospital of Padova, Padua, Italy
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7
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Djekidel M, Alsadi R, Bouhali O, Maaz AUR. Amino Acid PET Imaging with 18F-DOPA in the evaluation of Pediatric Brain Tumors. J Nucl Med Technol 2022; 50:jnmt.121.263050. [PMID: 35440479 DOI: 10.2967/jnmt.121.263050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Although MRI is the workhorse of brain tumor initial evaluation and follow-up, there is a growing amount of data recommending the incorporation of amino-acid PET imaging at different stages of the management of these patients. Recent nuclear medicine and neuro-oncology clinical practice recommendations support the use of amino-acid imaging in brain tumor imaging. Considering 18F-DOPA is FDA approved for the evaluation of parkinsonian syndromes, it could be used clinically for other valuable clinical indications such as brain tumor evaluations. This value seems to be well established in adults and has growing evidence for its use in pediatrics as well. We offer to present four pediatric brain tumor cases imaged with 18F-DOPA and review the literature.
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Affiliation(s)
- Mehdi Djekidel
- Department of Diagnostic Imaging, Division of Nuclear Medicine and Molecular Imaging, Sidra Medicine, Qatar
| | - Rahaf Alsadi
- Department of Science, Texas A&M University at Qatar
| | | | - Ata Ur Rehman Maaz
- Department of Pediatrics, Division of Hematology Oncology, Sidra Medicine, Qatar
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8
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Chiaravalloti A, Cimini A, Ricci M, Quartuccio N, Arnone G, Filippi L, Calabria F, Leporace M, Bagnato A, Schillaci O. Positron emission tomography imaging in primary brain tumors. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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9
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Brendle C, Maier C, Bender B, Schittenhelm J, Paulsen F, Renovanz M, Roder C, Castaneda-Vega S, Tabatabai G, Ernemann U, la Fougère C. Impact of 18F-FET PET/MR on clinical management of brain tumor patients. J Nucl Med 2021; 63:522-527. [PMID: 34353870 PMCID: PMC8973289 DOI: 10.2967/jnumed.121.262051] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/15/2021] [Indexed: 11/25/2022] Open
Abstract
Multiparametric PET/MRI with the amino-acid analog O-(2-18F-fluoroethyl)-l-tyrosine (18F-FET) enables the simultaneous assessment of molecular, morphologic, and functional brain tumor characteristics. Although it is considered the most accurate noninvasive approach in brain tumors, its relevance for patient management is still under debate. Here, we report the diagnostic performance of 18F-FET PET/MRI and its impact on clinical management in a retrospective patient cohort. Methods: We retrospectively analyzed brain tumor patients who underwent 18F-FET PET/MRI between 2017 and 2018. 18F-FET PET/MRI examinations were indicated clinically because of equivocal standard imaging results or the clinical course. Histologic confirmation or clinical and standard imaging follow-up served as the reference standard. We evaluated 18F-FET PET/MRI accuracy in identifying malignancy in untreated suspected lesions (category, new diagnosis) and true progression during adjuvant treatment (category, detection of progression) in a clinical setting. Using multiple regression, we also estimated the contribution of single modalities to produce an optimal PET/MRI outcome. We assessed the recommended and applied therapies before and after 18F-FET PET/MRI and noted whether the treatment changed on the basis of the 18F-FET PET/MRI outcome. Results: We included 189 patients in the study. 18F-FET PET/MRI allowed the identification of malignancy at new diagnosis with an accuracy of 85% and identified true progression with an accuracy of 93%. Contrast enhancement, 18F-FET PET uptake, and tracer kinetics were the major contributors to an optimal PET/MRI outcome. In the previously equivocal patients, 18F-FET PET/MRI changed the clinical management in 33% of the untreated lesions and 53% of the cases of tumor progression. Conclusion: Our results suggest that 18F-FET PET/MRI helps clarify equivocal conditions and profoundly supports the clinical management of brain tumor patients. The optimal modality setting for 18F-FET PET/MRI and the clinical value of a simultaneous examination need further exploration. At a new diagnosis, multiparametric 18F-FET PET/MRI might help prevent unnecessary invasive procedures by ruling out malignancy; however, adding static 18F-FET PET to an already existing MRI examination seems to be of equal value. At detection of progression, multiparametric 18F-FET PET/MRI may increase therapy effectiveness by distinguishing between tumor progression and therapy-related imaging alterations.
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10
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Marner L, Lundemann M, Sehested A, Nysom K, Borgwardt L, Mathiasen R, Wehner PS, Henriksen OM, Thomsen C, Skjøth-Rasmussen J, Broholm H, Østrup O, Forman JL, Højgaard L, Law I. Diagnostic Accuracy and Clinical Impact of [ 18F]FET PET in Childhood CNS tumors. Neuro Oncol 2021; 23:2107-2116. [PMID: 33864083 DOI: 10.1093/neuonc/noab096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Central nervous system (CNS) tumors cause the highest death rates among childhood cancers, and survivors frequently have severe late effects. Magnetic resonance imaging (MRI) is the imaging modality of choice, but its specificity can be challenged by treatment-induced signal changes. In adults, O-(2-[ 18F]fluoroethyl)-L-tyrosine ([ 18F]FET) PET can assist in interpreting MRI findings. We assessed the clinical impact and diagnostic accuracy of adding [ 18F]FET PET to MRI in children with CNS tumors. METHODS A total of 169 [ 18F]FET PET scans were performed in 97 prospectively and consecutively included patients with known or suspected childhood CNS tumors. Scans were performed at primary diagnosis, before or after treatment, or at relapse. RESULTS Adding [ 18F]FET PET to MRI impacted clinical management in 8% [95% confidence interval (CI): 4-13%] of all scans (n=151) and in 33% [CI: 17-53%] of scans deemed clinically indicated due to difficult decision-making on MRI alone (n=30). Using pathology or follow-up as reference standard, the addition of [ 18F]FET PET increased specificity (1.00 [0.82-1.00] vs. 0.48 [0.30-0.70], p=0.0001) and accuracy (0.91 [CI: 0.87-0.96] vs. 0.81 [CI: 0.75-0.89], p=0.04) in 83 treated lesions and accuracy in 58 untreated lesions (0.96 [CI:0.91-1.00] vs 0.90 [CI:0.82-0.92], p<0.001). Further, in a subset of patients (n=15) [ 18F]FET uptake correlated positively with genomic proliferation index. CONCLUSIONS The addition of [ 18F]FET PET to MRI helped discriminate tumor from non-tumor lesions in the largest consecutive cohort of pediatric CNS tumor patients presented to date.
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Affiliation(s)
- Lisbeth Marner
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark.,Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Denmark
| | - Michael Lundemann
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Astrid Sehested
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Karsten Nysom
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Lise Borgwardt
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Peder S Wehner
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark
| | - Otto M Henriksen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Carsten Thomsen
- Department of Diagnostic Radiology, Copenhagen University Hospital Rigshospitalet, Denmark.,Department of Radiology, Zealand University Hospital, Denmark
| | | | - Helle Broholm
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Olga Østrup
- Department of Genomic Medicine, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Julie L Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Liselotte Højgaard
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
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11
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Chiaravalloti A, Filippi L, Ricci M, Cimini A, Schillaci O. Molecular Imaging in Pediatric Brain Tumors. Cancers (Basel) 2019; 11:cancers11121853. [PMID: 31771237 PMCID: PMC6966547 DOI: 10.3390/cancers11121853] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/16/2019] [Accepted: 11/19/2019] [Indexed: 02/07/2023] Open
Abstract
In the last decade, several radiopharmaceuticals have been developed and investigated for imaging in vivo of pediatric brain tumors with the aim of exploring peculiar metabolic processes as glucose consumption, amino-acid metabolism, and protein synthesis with nuclear medicine techniques. Although the clinical shreds of evidence are limited, preliminary results are encouraging. In this review, we performed web-based and desktop research summarizing the most relevant findings of the literature published to date on this topic. Particular attention was given to the wide spectrum of nuclear medicine advances and trends in pediatric neurooncology and neurosurgery. Furthermore, the role of somatostatin receptor imaging through single-photon emission computed tomography (SPECT) and positron emission tomography (PET) probes, with reference to their potential therapeutic implications, was examined in the peculiar context. Preliminary results show that functional imaging in pediatric brain tumors might lead to significant improvements in terms of diagnostic accuracy and it could be of help in the management of the disease.
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Affiliation(s)
- Agostino Chiaravalloti
- Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy (O.S.)
- Nuclear Medicine Section, IRCCS Neuromed, 86077 Pozzilli, Italy
- Correspondence: or ; Tel.: +39-062-090-2457
| | - Luca Filippi
- Nuclear Medicine Section, “Santa Maria Goretti” Hospital, 04100 Latina, Italy;
| | - Maria Ricci
- Department of Radiological, Oncological and Pathological Sciences, Faculty of Medicine and Surgery, La Sapienza University, 00161 Rome, Italy;
| | - Andrea Cimini
- Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy (O.S.)
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy (O.S.)
- Nuclear Medicine Section, IRCCS Neuromed, 86077 Pozzilli, Italy
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12
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Reimold M, la Fougère C. Molekulare Bildgebung bei neurologischen Erkrankungen. Radiologe 2016; 56:580-7. [DOI: 10.1007/s00117-016-0124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Suchorska B, Albert NL, Tonn JC. Usefulness of PET Imaging to Guide Treatment Options in Gliomas. Curr Treat Options Neurol 2016; 18:4. [PMID: 26815310 DOI: 10.1007/s11940-015-0384-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OPINION STATEMENT Magnetic resonance imaging (MRI) is the gold standard guiding diagnostic and therapeutic management in glioma with its high resolution and possibility to depict blood-brain-barrier disruption when contrast medium is applied. In light of the shifting paradigms revealing distinct tumor subtypes based on the molecular and genetic characterization and increasing knowledge about the variability of glioma biology, additional imaging modalities such as positron emission tomography (PET) depicting metabolic processes gain further importance in the management of glioma.
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Affiliation(s)
- Bogdana Suchorska
- Department of Neurosurgery, University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | | | - Jörg-Christian Tonn
- Department of Neurosurgery, University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
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Misch M, Guggemos A, Driever PH, Koch A, Grosse F, Steffen IG, Plotkin M, Thomale UW. (18)F-FET-PET guided surgical biopsy and resection in children and adolescence with brain tumors. Childs Nerv Syst 2015; 31:261-7. [PMID: 25231277 DOI: 10.1007/s00381-014-2552-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 09/03/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE MRI alone has its limitations for target selection in biopsy or resection in newly diagnosed and pretreated pediatric brain tumor patients. (18)F-FET-PET imaging is considered to identify metabolically active tumor tissue and to differentiate it from therapy-associated changes. We retrospectively analyzed our experience with (18)F-FET-PET in targeted surgical interventions for pediatric brain tumors. METHODS In 26 cases with lesions suspicious of a growing brain tumor on MRI, either newly diagnosed or after antitumoral treatment led to (18)F-FET-PET imaging for target selection prior to stereotactic biopsy, navigated open biopsy or navigated microsurgical tumor resection. Indications for (18)F-FET-PET imaging were visualization of metabolic active tumor tissue within diffuse tumors or pretreated lesions as well as depicting their extent. RESULTS (18)F-FET-PET integration in surgery was feasible in all patients using stereotaxy or neuronavigation. Sensitivity for tumor detection was 20/24. (18)F-FET-PET was false positive in two pretreated patients. CONCLUSION (18)F-FET-PET imaging is helpful for target selection and can be integrated in surgical guidance. (18)F-FET-PET image-guided surgical targeting yielded histological diagnosis with decent specificity and high sensitivity in our cohort of pediatric brain tumor patients. Our results warrant further evaluation of (18)F-FET-PET imaging for surgical guidance.
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Affiliation(s)
- Martin Misch
- Department of Neurosurgery, Charité Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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15
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Dunkl V, Cleff C, Stoffels G, Judov N, Sarikaya-Seiwert S, Law I, Bøgeskov L, Nysom K, Andersen SB, Steiger HJ, Fink GR, Reifenberger G, Shah NJ, Coenen HH, Langen KJ, Galldiks N. The usefulness of dynamic O-(2-18F-fluoroethyl)-L-tyrosine PET in the clinical evaluation of brain tumors in children and adolescents. J Nucl Med 2014; 56:88-92. [PMID: 25525183 DOI: 10.2967/jnumed.114.148734] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Experience regarding O-(2-(18)F-fluoroethyl)-L-tyrosine ((18)F-FET) PET in children and adolescents with brain tumors is limited. METHODS Sixty-nine (18)F-FET PET scans of 48 children and adolescents (median age, 13 y; range, 1-18 y) were analyzed retrospectively. Twenty-six scans to assess newly diagnosed cerebral lesions, 24 scans for diagnosing tumor progression or recurrence, 8 scans for monitoring of chemotherapy effects, and 11 scans for the detection of residual tumor after resection were obtained. Maximum and mean tumor-to-brain ratios (TBRs) were determined at 20-40 min after injection, and time-activity curves of (18)F-FET uptake were assigned to 3 different patterns: constant increase; peak at greater than 20-40 min after injection, followed by a plateau; and early peak (≤ 20 min), followed by a constant descent. The diagnostic accuracy of (18)F-FET PET was assessed by receiver-operating-characteristic curve analyses using histology or clinical course as a reference. RESULTS In patients with newly diagnosed cerebral lesions, the highest accuracy (77%) to detect neoplastic tissue (19/26 patients) was obtained when the maximum TBR was 1.7 or greater (area under the curve, 0.80 ± 0.09; sensitivity, 79%; specificity, 71%; positive predictive value, 88%; P = 0.02). For diagnosing tumor progression or recurrence, the highest accuracy (82%) was obtained when curve patterns 2 or 3 were present (area under the curve, 0.80 ± 0.11; sensitivity, 75%; specificity, 90%; positive predictive value, 90%; P = 0.02). During chemotherapy, a decrease of TBRs was associated with a stable clinical course, and in 2 patients PET detected residual tumor after presumably complete tumor resection. CONCLUSION Our findings suggest that (18)F-FET PET can add valuable information for clinical decision making in pediatric brain tumor patients.
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Affiliation(s)
- Veronika Dunkl
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany Department of Neurology, University of Cologne, Cologne, Germany
| | - Corvin Cleff
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Natalie Judov
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | | | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark
| | - Lars Bøgeskov
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Karsten Nysom
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Sofie B Andersen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Gereon R Fink
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany Department of Neurology, University of Cologne, Cologne, Germany
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Nadim J Shah
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Heinz H Coenen
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany Department of Nuclear Medicine, University of Aachen, Aachen, Germany; and
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany Department of Neurology, University of Cologne, Cologne, Germany Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany
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Ramos A, Hilario A, Lagares A, Salvador E, Perez-Nuñez A, Sepulveda J. Brainstem gliomas. Semin Ultrasound CT MR 2013; 34:104-12. [PMID: 23522775 DOI: 10.1053/j.sult.2013.01.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Historically, brainstem gliomas have been considered as a single entity. Since the introduction of magnetic resonance (MR) imaging in the late 1980s, these tumors are now regarded as a heterogeneous group of neoplasms with different age of onset, clinical and radiologic presentation, and varying behavior and natural history. This article describes the different subtypes of brainstem gliomas in children and adults. We focus on recent advances in MR such as MR spectroscopy, MR perfusion, and diffusion tensor imaging that often strongly suggest the histopathologic diagnosis of the lesion.
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Affiliation(s)
- Ana Ramos
- Neuroradiology, Department of Radiology, Hospital 12 de Octubre, Madrid, Spain.
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Stanescu L, Ishak GE, Khanna PC, Biyyam DR, Shaw DW, Parisi MT. FDG PET of the Brain in Pediatric Patients: Imaging Spectrum with MR Imaging Correlation. Radiographics 2013; 33:1279-303. [DOI: 10.1148/rg.335125152] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Feasibility, safety, and indications for surgical biopsy of intrinsic brainstem tumors in children. Childs Nerv Syst 2013; 29:1313-9. [PMID: 23666401 DOI: 10.1007/s00381-013-2101-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 04/03/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Diffuse intrinsic pontine gliomas (DIPGs) are rapidly progressive and aggressive tumors that usually arise in children. Their anatomic location makes gross total surgical resection impossible, and fewer than 10% of patients survive more than 2 years after diagnosis. Often, these lesions are treated based on imaging characteristics alone. However, despite aggressive chemotherapy and radiation treatments available, prognosis remains poor. There is therefore a need for new therapies directed by biologic profiling. This necessitates a tissue diagnosis and, therefore, surgical biopsy. We have reviewed the results of biopsy for DIPGs in children at a single institution and compared our results to those available in the literature to elucidate the utility of biopsy for DIPGs. METHODS A historical cohort study was performed using medical records of patients under the age of 18 who underwent surgical biopsy of a DIPG at a single institution. RESULTS Nine patients were included, four males and five females. Age at presentation ranged from 8 months to 10 years (average 5.7 years). Pathologic diagnoses included five high grade (WHO grade III or IV) gliomas and four low grade (WHO grade II) astrocytomas. There were no intraoperative complications, and only one patient developed a new postoperative neurologic deficit. CONCLUSIONS Stereotactic biopsy of DIPGs is essential to obtain a pathologic diagnosis and is associated with low morbidity. This technique is important to elucidate biological characteristics of these tumors in order to direct multidisciplinary treatment plans possibly involving chemotherapy, radiation therapy, or other future clinical trial interventions for children with DIPGs.
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Hipp SJ, Steffen-Smith EA, Patronas N, Herscovitch P, Solomon JM, Bent RS, Steinberg SM, Warren KE. Molecular imaging of pediatric brain tumors: comparison of tumor metabolism using ¹⁸F-FDG-PET and MRSI. J Neurooncol 2012; 109:521-7. [PMID: 22760419 DOI: 10.1007/s11060-012-0918-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 06/19/2012] [Indexed: 01/21/2023]
Abstract
Magnetic resonance spectroscopic imaging (MRSI) and (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) are non-invasive imaging techniques routinely used to evaluate tumor malignancy in adults with brain tumors. We compared the metabolic activity of pediatric brain tumors using FDG-PET and MRSI. Children (n = 37) diagnosed with a primary brain tumor underwent FDG-PET and MRSI within two weeks of each other. Tumor metabolism was classified as inactive, active or highly active using the maximum choline:N-acetyl-asparate (Cho:NAA) on MRSI and the highest tumor uptake on FDG-PET. A voxel-wise comparison was used to evaluate the area with the greatest abnormal metabolism. Agreement between methods was assessed using the percent agreement and the kappa statistic (κ). Pediatric brain tumors were metabolically heterogeneous on FDG-PET and MRSI studies. Active tumor metabolism was observed more frequently using MRSI compared to FDG-PET, and agreement in tumor classification was weak (κ = 0.16, p = 0.12), with 42 % agreement (95 % CI = 25-61 %). Voxel-wise comparison for identifying the area of greatest metabolic activity showed overlap in the majority (62 %) of studies, though exact agreement between techniques was low (29.4 %, 95 % CI = 15.1-47.5 %). These results indicate that FDG-PET and MRSI detect similar but not always identical regions of tumor activity, and there is little agreement in the degree of tumor metabolic activity between the two techniques.
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Affiliation(s)
- Sean J Hipp
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
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Choi BD, Mehta AI, Batich KA, Friedman AH, Sampson JH. The Use of Motor Mapping to Aid Resection of Eloquent Gliomas. Neurosurg Clin N Am 2012; 23:215-25, vii. [DOI: 10.1016/j.nec.2012.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kekhia H, Rigolo L, Norton I, Golby AJ. Special surgical considerations for functional brain mapping. Neurosurg Clin N Am 2011; 22:111-32, vii. [PMID: 21435565 DOI: 10.1016/j.nec.2011.01.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The development of functional mapping techniques gives neurosurgeons many options for preoperative planning. Integrating functional and anatomic data can inform patient selection and surgical planning and makes functional mapping more accessible than when only invasive studies were available. However, the applications of functional mapping to neurosurgical patients are still evolving. Functional imaging remains complex and requires an understanding of the underlying physiologic and imaging characteristics. Neurosurgeons must be accustomed to interpreting highly processed data. Successful implementation of functional image-guided procedures requires efficient interactions between neurosurgeon, neurologist, radiologist, neuropsychologist, and others, but promises to enhance the care of patients.
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Affiliation(s)
- Hussein Kekhia
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Use of positron emission tomography in the evaluation of diffuse intrinsic brainstem gliomas in children. J Pediatr Hematol Oncol 2011; 33:369-73. [PMID: 21602725 DOI: 10.1097/mph.0b013e31820ad915] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diffuse intrinsic brainstem gliomas (DIBSGs) in children remain difficult tumors to treat and have a very poor prognosis. Intensifying both chemotherapy and radiation programs have been attempted without success. Positron emission tomography (PET) has been used to differentiate benign from malignant tumors and may predict outcome. OBJECTIVES To determine whether PET can characterize a specific metabolic pattern of DIBSGs and correlate this with patient survival. METHODS We conducted a retrospective review of patients with DIBSGs and PET scans at diagnosis. Data for ¹⁸[F] fluorodeoxyglucose (FDG) and ¹¹C-methionine (CMET) PET scans were collected. Treatment and survival were reviewed. RESULTS We identified 30 patients with DIBSGs, 25 of whom had FDG and/or CMET PET scans. Scans showed both focal and generalized metabolic activity, and the patterns showed no correlation with survival. Patients with both FDG and CMET positive scans had a mean survival of 380 days, whereas those negative for both isotopes had a mean survival of 446 days. CONCLUSIONS There was no specific PET pattern identified in this DIBSG cohort but a trend toward improved survival was noted with absence of FDG and CMET metabolism. Metabolically active areas may suggest potential sites for biopsy. We believe that biopsy is essential for improving therapy for this patient population.
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Abstract
For most cancers, PET is essentially a diagnostic tool. For brain tumors, PET has got its main contribution at the level of the therapeutic management. Indeed, specific reasons render the therapeutic management of brain tumors, especially gliomas, a real challenge. Although some gliomas may appear well-delineated on conventional neuroimaging such as CT and MRI, they are by nature infiltrating neoplasms and the interface between tumor and normal brain tissue may not be accurately defined. Moreover, gliomas may present as ill-defined lesions for which various MRI sequences combination does not provide a unique contour for tumor delineation. Also, gliomas are often histologically heterogeneous with anaplastic areas evolving within a low-grade tumor, and contrast-enhancement on CT or MRI does not represent a good marker for anaplastic tissue detection. Finally, assessment of tumor residue, recurrence, or progression, may be altered by different signals related to inflammation or adjuvant therapies, and contrast enhancement on CT and MRI is not an appropriate marker at the postoperative or posttherapeutic stage. These limitations of conventional neuroimaging in detecting tumor tissue, delineating tumor extent and evidencing anaplastic changes, lead to potential inaccuracy in lesion targeting at different steps of the management (diagnostic, surgical, postoperative, and posttherapeutic stages). Molecular information provided by PET has proved helpful to supplement morphological imaging data in this context. F-18 FDG and amino-acid tracers such as C-11 methionine (C-11 MET) provide complementary metabolic data that are independent from the anatomical MR information. These tracers help in the definition of glioma extension, detection of anaplastic areas, and postoperative follow-up. Additionally, PET data have a prognostic value independently of histology. To take advantage of PET data in glioma treatment, PET might be integrated in the planning of image-guided biopsy, resection, and radiosurgery.
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Affiliation(s)
- Serge Goldman
- PET-Biomedical Cyclotron Unit, ERASME Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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An interindividual comparison of O-(2-[18F]fluoroethyl)-L-tyrosine (FET)- and L-[methyl-11C]methionine (MET)-PET in patients with brain gliomas and metastases. Int J Radiat Oncol Biol Phys 2011; 81:1049-58. [PMID: 21570201 DOI: 10.1016/j.ijrobp.2010.07.002] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 06/30/2010] [Accepted: 07/02/2010] [Indexed: 11/22/2022]
Abstract
PURPOSE L-[methyl-(11)C]methionine (MET)-positron emission tomography (PET) has a high sensitivity and specificity for imaging of gliomas and metastatic brain tumors. The short half-life of (11)C (20 minutes) limits the use of MET-PET to institutions with onsite cyclotron. O-(2-[(18)F]fluoroethyl)-L-tyrosine (FET) is labeled with (18)F (half-life, 120 minutes) and could be used much more broadly. This study compares the uptake of FET and MET in gliomas and metastases, as well as treatment-induced changes. Furthermore, it evaluates the gross tumor volume (GTV) of gliomas defined on PET and magnetic resonance imaging (MRI). METHODS AND MATERIALS We examined 42 patients with pretreated gliomas (29 patients) or brain metastases (13 patients) prospectively by FET- and MET-PET on the same day. Uptake of FET and MET was quantified by standardized uptake values. Imaging contrast was assessed by calculating lesion-to-gray matter ratios. Tumor extension was quantified by contouring GTV in 17 patients with brain gliomas. Gross tumor volume on PET was compared with GTV on MRI. Sensitivity and specificity of MET- and FET-PET for differentiation of viable tumor from benign changes were evaluated by comparing the PET result with histology or clinical follow-up. RESULTS There was a strong linear correlation between standardized uptake values calculated for both tracers in cortex and lesions: r = 0.78 (p = 0.001) and r = 0.84 (p < 0.001), respectively. Image contrast was similar for MET- and FET-PET (lesion-to-gray matter ratios of 2.36 ± 1.01 and 2.33 ± 0.77, respectively). Mean GTV in 17 glioma patients was not significantly different on MET- and FET-PET. Both MET- and FET-PET delineated tumor tissue outside of MRI changes. Both tracers provided differentiated tumor tissue and treatment-related changes with a sensitivity of 91% at a specificity of 100%. CONCLUSIONS O-(2-[(18)F]fluoroethyl)-L-tyrosine-PET and MET-PET provide comparable diagnostic information on gliomas and brain metastases. Like MET-PET, FET-PET can be used for differentiation of residual or recurrent tumor from treatment-related changes/pseudoprogression, as well as for delineation of gliomas.
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Are stereotactic sample biopsies still of value in the modern management of pineal region tumours? Lessons from a single-department, retrospective series. Acta Neurochir (Wien) 2011; 153:1111-21; discussion 1121-2. [PMID: 21331478 DOI: 10.1007/s00701-010-0936-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Recent improvements in imaging-based diagnosis, the broader application of neuroendoscopic techniques and advances in open surgery techniques mean that the need for stereotactic biopsies in the management of pineal region tumours must be reevaluated. The primary aim of this retrospective study was to establish whether stereotactic biopsy is still of value in the modern management of pineal region tumours. METHODS From 1985 to 2009, 88 consecutive patients underwent a stereotactic biopsy in our institution (51 males and 37 females; median age at presentation 30; range 2-74). RESULTS Accurate tissue diagnoses were obtained in all but one case (i.e. 99%). In one case (1%), three distinct stereotactic procedures were necessary to obtain a tissue diagnosis. There was no mortality or permanent morbidity associated with stereotactic biopsy. One patient (1%) presented an intra-parenchymal hematoma but no related clinical symptoms. Five patients (6%) presented transient morbidity, which lasted for between 2 days and 3 weeks after the biopsy. CONCLUSIONS To guide subsequent treatment, we believe that histological diagnosis is paramount. Stereotactic biopsies are currently the safest and the most efficient way of obtaining this essential information. Recent improvements in stereotactic technology (particularly robotic techniques) appear to be very valuable, with almost no permanent morbidity or mortality risk and no decrease in the accuracy rate. In our opinion, other available neurosurgical techniques (such as endoscopic neurosurgery, stereotactic neurosurgery and open microsurgery) are complementary and not competitive.
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Kumar R, Shandal V, Shamim SA, Halanaik D, Malhotra A. Clinical applications of PET and PET/CT in pediatric malignancies. Expert Rev Anticancer Ther 2011; 10:755-68. [PMID: 20470007 DOI: 10.1586/era.10.12] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The common childhood cancers are leukemia, CNS tumors, lymphomas, soft-tissue tumors (such as rhabdomyosarcoma and fibrosarcoma), neuroblastoma, malignant bone tumors, germ cell tumors with neoplasms of gonads and hepatic tumors. Usually the conventional imaging modalities, such as x-ray, ultrasound, computed tomography (CT) and MRI, are being routinely used for the management of these pediatric malignancies. However, most of these modalities provide structural information and are lacking in functional/metabolic status of these malignancies. Recently, PET and PET/CT have emerged as a functional diagnostic imaging modality for the management of various cancers in adult population. Up to now most of the data published in the literature are on PET alone. PET used in conjunction with CT is useful as it provides an enhanced view of the anatomical details and the malignant focus then can be located with highest accuracy. PET and PET/CT has been found to be useful in, for example, CNS tumors, lymphomas, soft-tissue tumors, neuroblastoma, malignant bone tumors and germ cell tumors. PET/CT has a limited role in early diagnosis, however, it plays an important role in initial staging, treatment response evaluation and detection of metastatic disease in these cancers. Despite the fact that PET/CT has better diagnostic value when compared with conventional imaging, such as CT and MRI, in the management of many pediatric cancers, there are certain limitations. PET/CT has a limited role in detection of lesions smaller than 5 mm, well-differentiated tumors and tumors with low metabolic rate. Many infections and inflammation can lead to false-positive PET/CT results. In the present review we will discuss the various clinical indications of PET and PET/CT in pediatric cancers.
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Affiliation(s)
- Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari nagar, New Delhi, 110029, India.
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Zukotynski KA, Fahey FH, Kocak M, Alavi A, Wong TZ, Treves ST, Shulkin BL, Haas-Kogan DA, Geyer JR, Vajapeyam S, Boyett JM, Kun LE, Poussaint TY. Evaluation of 18F-FDG PET and MRI associations in pediatric diffuse intrinsic brain stem glioma: a report from the Pediatric Brain Tumor Consortium. J Nucl Med 2011; 52:188-95. [PMID: 21233173 DOI: 10.2967/jnumed.110.081463] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The purpose of this study was to assess (18)F-FDG uptake in children with a newly diagnosed diffuse intrinsic brain stem glioma (BSG) and to investigate associations with progression-free survival (PFS), overall survival (OS), and MRI indices. METHODS Two Pediatric Brain Tumor Consortium (PBTC) therapeutic trials in children with newly diagnosed BSG were designed to test radiation therapy combined with molecularly targeted agents (PBTC-007: phase I/II study of gefitinib; PBTC-014: phase I/II study of tipifarnib). Baseline brain (18)F-FDG PET scans were obtained in 40 children in these trials. Images were evaluated by consensus between 2 PET experts for intensity and uniformity of tracer uptake. Associations of (18)F-FDG uptake intensity and uniformity with both PFS and OS, as well as associations with tumor MRI indices at baseline (tumor volume on fluid-attenuated inversion recovery, baseline intratumoral enhancement, diffusion and perfusion values), were evaluated. RESULTS In most of the children, BSG (18)F-FDG uptake was less than gray-matter uptake. Survival was poor, irrespective of intensity of (18)F-FDG uptake, with no association between intensity of (18)F-FDG uptake and PFS or OS. However, hyperintense (18)F-FDG uptake in the tumor, compared with gray matter, suggested poorer survival rates. Patients with (18)F-FDG uptake in 50% or more of the tumor had shorter PFS and OS than did patients with (18)F-FDG uptake in less than 50% of the tumor. There was some evidence that tumors with higher (18)F-FDG uptake were more likely to show enhancement, and when the diffusion ratio was lower, the uniformity of (18)F-FDG uptake appeared higher. CONCLUSION Children with BSG for which (18)F-FDG uptake involves at least half the tumor appear to have poorer survival than children with uptake in less than 50% of the tumor. A larger independent study is needed to verify this hypothesis. Intense tracer uptake in the tumors, compared with gray matter, suggests decreased survival. Higher (18)F-FDG uptake within the tumor was associated with enhancement on MR images. Increased tumor cellularity as reflected by restricted MRI diffusion may be associated with increased (18)F-FDG uniformity throughout the tumor.
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Portwine C, Marriott C, Barr RD. PET imaging for pediatric oncology: an assessment of the evidence. Pediatr Blood Cancer 2010; 55:1048-61. [PMID: 20979168 DOI: 10.1002/pbc.22747] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Positron emission tomography (PET) has shown potential benefits when used in therapeutic clinical trials for children with cancer. However, existing trials are limited in scope with small numbers of patients and varied observations, making accurate conclusions about the usefulness of PET scanning impossible. This review examines PET and its applications in pediatric oncology. While evidence is limited, there appears to be a basis for rigorous evaluation of this imaging modality before widespread application without validation from clinical trials.
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Affiliation(s)
- Carol Portwine
- Division of Pediatric Hematology/Oncology, McMaster University, Hamilton, Ontario, Canada.
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Pirotte BJM, Lubansu A, Massager N, Wikler D, Van Bogaert P, Levivier M, Brotchi J, Goldman S. Clinical impact of integrating positron emission tomography during surgery in 85 children with brain tumors. J Neurosurg Pediatr 2010; 5:486-99. [PMID: 20433263 DOI: 10.3171/2010.1.peds09481] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECT In this paper, the authors' goal was to evaluate the impact of PET information on brain tumor surgery in children. METHODS Between 1995 and 2007, 442 children were referred to the authors' institution for a newly diagnosed brain lesion. Of these, 85 were studied with FDG-PET and/or L-(methyl-(11)C)-methionine -PET in cases in which MR images were unable to assist in selecting accurate biopsy targets (35 patients) or to delineate tumors for maximal resection (50 patients). In surgical cases, PET and MR images were combined in image fusion planning for stereotactic biopsies or navigation-based resections. The preoperative planning images were compared postoperatively with MR imaging and PET findings and histological data for evaluating the clinical impact on the diagnostic yield and tumor resection. RESULTS The PET data influenced surgical decisions or procedures in all cases. The use of PET helped to better differentiate indolent from active components in complex lesions (in 12 patients); improved target selection and diagnostic yield of stereotactic biopsies without increasing the sampling; provided additional prognostic information; reduced the amount of tissue needed for biopsy sampling in brainstem lesions (in 20 cases); better delineated lesions that were poorly delineated on MR imaging and that infiltrated functional cortex (in 50 cases); significantly increased the amount of tumor tissue removed in cases in which total resection influenced survival (in 20 cases); guided resection in hypermetabolic areas (in 15 cases); improved early postoperative detection of residual tumor (in 20 cases); avoided unnecessary reoperation (in 5 cases); and supported the decision to undertake early second-look resection (in 8 cases). CONCLUSIONS The authors found that PET has a significant impact on the surgical decisions and procedures for managing pediatric brain tumors. Further studies may demonstrate whether PET improves outcomes in children.
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Affiliation(s)
- Benoit J M Pirotte
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, 808, route de Lennik, B-1070 Brussels, Belgium.
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Pirotte BJM, Lubansu A, Massager N, Wikler D, Van Bogaert P, Levivier M, Brotchi J, Goldman S. Clinical interest of integrating positron emission tomography imaging in the workup of 55 children with incidentally diagnosed brain lesions. J Neurosurg Pediatr 2010; 5:479-85. [PMID: 20433262 DOI: 10.3171/2010.1.peds08336] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In this paper, the authors' goal was to evaluate the impact of PET data on the clinical management of incidental brain lesions in children. METHODS Between 1995 and 2007, 442 children with a newly diagnosed brain lesion were referred to the authors' department. Of these, 55 presented with an incidental brain lesion and were selected for study because MR imaging sequences revealed limitations in assessing the tumor, its evolving nature, and/or the malignant potential of the lesion diagnosed. Thirteen children were studied using FDG-PET and 42 with L-(methyl-(11)C)-methionine (MET)-PET; 3 children underwent both FDG-PET and MET-PET but only the MET-PET results were used in the analysis. The PET and MR images were combined in image fusion navigation planning. Drawing on their experience with PET in adults, the authors proposed the following treatment plans: 1) surgery in children with imaging evidence of increased PET tracer uptake, which is highly specific of tumor and/or malignant tumor tissue; or 2) conservative treatment in children in whom there was little or no tracer uptake on PET. The authors compared the PET data with the MR imaging-based diagnosis and either 1) the results of histological examination in surgically treated cases, or 2) the long-term outcome in untreated cases. They studied PET and MR imaging sensitivity and specificity in detecting tumor and malignant tissues, and evaluated whether PET data altered their clinical management. RESULTS Seventeen children had increased PET tracer uptake and underwent surgery. Tumor diagnosis was confirmed in all cases (that is, there were no false-positive findings). Cases in which there was little or no PET tracer uptake supported conservative treatment in 38 children. However, because PET was under evaluation, 16 of 38 lesions that were judged accessible for resection were surgically treated. Histological examination results demonstrated neither malignant nor evolving tumor tissue but yielded 9 indolent tumors (6 dysembryoplastic neuroectodermal tumors, 2 low-grade astrocytomas, and 1 low-grade astrocytoma and dysplasia) and 7 nontumoral lesions (3 cases of vasculitis, 3 of gliosis, and 1 of sarcoidosis). In 22 of the untreated 38 children, stable disease was noted during follow-up (range 18-136 months). Although an absence of PET tracer uptake might not exclude tumor tissue, PET did not reveal any false-negative findings in malignant or evolving tumor tissue detection in cases in which MR imaging showed false-positive and -negative cases in > 35 and 25% of the cases, respectively. CONCLUSIONS These data confirmed the high sensitivity and specificity of PET to detect tumor as well as malignant tissue. Regarding the treatment of the incidental brain lesions, the PET findings enabled the authors to make more appropriate decisions regarding treatment than those made on MR imaging findings alone. Therefore, the risk of surgically treating a nontumoral lesion was reduced as well as that for conservatively managing a malignant tumor. Nowadays, it is estimated that these data justify conservative management in incidental lesions with low or absent PET tracer uptake.
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Affiliation(s)
- Benoit J M Pirotte
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, 808, route de Lennik, B-1070 Brussels, Belgium.
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Rokes C, Ketonen LM, Fuller GN, Weinberg J, Slopis JM, Wolff JEA. Imaging and spectroscopic findings in meningioangiomatosis. Pediatr Blood Cancer 2009; 53:672-4. [PMID: 19544396 DOI: 10.1002/pbc.22148] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Meningioangiomatosis (MA) is an uncommon brain tumor. The role of imaging techniques is underscored in cases where the tumor location makes resection (or even biopsy) dangerous. We report the case of a child with an MA tumor located deep in the right sylvian fissure. A computed tomography (CT) scan showed calcifications in a highly vascular lesion with surrounding edema. Magnetic resonance spectroscopy (MRS) showed a distinct choline (Cho) peak, which usually suggests a proliferating tumor. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed the lesion lacked hypermetabolic features. These radiological features should put MA in the differential diagnosis.
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Affiliation(s)
- Christopher Rokes
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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Galldiks N, Kracht LW, Berthold F, Miletic H, Klein JC, Herholz K, Jacobs AH, Heiss WD. [11C]-L-methionine positron emission tomography in the management of children and young adults with brain tumors. J Neurooncol 2009; 96:231-9. [PMID: 19575148 PMCID: PMC2808525 DOI: 10.1007/s11060-009-9953-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 06/22/2009] [Indexed: 12/22/2022]
Abstract
Only a few Methyl-[11C]-l-methionine (MET) positron emission tomography (PET) studies have focused on children and young adults with brain neoplasm. Due to radiation exposure, long scan acquisition time, and the need for sedation in young children MET-PET studies should be restricted to this group of patients when a decision for further therapy is not possible from routine diagnostic procedures alone, e.g., structural imaging. We investigated the diagnostic accuracy of MET-PET for the differentiation between tumorous and non-tumorous lesions in this group of patients. Forty eight MET-PET scans from 39 patients aged from 2 to 21 years (mean 15 ± 5.0 years) were analyzed. The MET tumor-uptake relative to a corresponding control region was calculated. A receiver operating characteristic (ROC) was performed to determine the MET-uptake value that best distinguishes tumorous from non-tumorous brain lesions. A differentiation between tumorous (n = 39) and non-tumorous brain lesions (n = 9) was possible at a threshold of 1.48 of relative MET-uptake with a sensitivity of 83% and a specificity of 92%, respectively. A differentiation between high grade malignant lesions (mean MET-uptake = 2.00 ± 0.46) and low grade tumors (mean MET-uptake = 1.84 ± 0.31) was not possible. There was a significant difference in MET-uptake between the histologically homogeneous subgroups of astrocytoma WHO grade II and anaplastic astrocytoma WHO grade III (P = 0.02). MET-PET might be a useful tool to differentiate tumorous from non-tumorous lesions in children and young adults when a decision for further therapy is difficult or impossible from routine structural imaging procedures alone.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, University of Cologne, Kerpener Str. 62, 50924 Cologne, Germany.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to determine if recent advances in diagnostic and treatment modalities result in improvement in the pattern of care of brainstem gliomas. RECENT FINDINGS New MRI techniques may contribute to differential diagnosis and aid neurosurgeons in removing resectable brainstem tumors. A better radiological analysis of these heterogeneous tumors improves their classification and helps to better distinguish prognosis subgroups. However, biopsy remains indicated in many contrast enhancing brainstem masses in adults because of the great variety of differential diagnosis. SUMMARY Diffuse brainstem glioma is the most common subtype of brainstem tumor and remains a devastating malignancy in children. Conventional radiotherapy is the standard of care and chemotherapy has been disappointing to date. Given the lack of efficacy of conventional drugs, a better understanding of the biology of this tumor is the key to more targeted therapy.
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Pirotte BJ, Levivier M, Goldman S, Massager N, Wikler D, Dewitte O, Bruneau M, Rorive S, David P, Brotchi J. POSITRON EMISSION TOMOGRAPHY-GUIDED VOLUMETRIC RESECTION OF SUPRATENTORIAL HIGH-GRADE GLIOMAS. Neurosurgery 2009; 64:471-81; discussion 481. [DOI: 10.1227/01.neu.0000338949.94496.85] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Integrating positron emission tomographic (PET) images into the image-guided resection of high-grade gliomas (HGG) has shown that metabolic information on tumor heterogeneity and distribution are useful for planning surgery, improve tumor delineation, and provide a final target contour different from that obtained with magnetic resonance imaging (MRI) alone in about 80% of the procedures. Moreover, PET guidance helps to increase the amount of tumor removed and to target image-guided resection to anaplastic tissue areas. The present study aims to evaluate whether PET-guided volumetric resection (VR) in supratentorial HGG might add benefit to the patient's outcome.
METHODS
PET images using [18F]fluorodeoxyglucose (n=23) and [11C]methionine (n=43) were combined with MRI scans in the planning of VR procedures performed at the initial stage in 66 consecutive patients (43 M/23 F) with supratentorial HGG according to the technique previously described. In all cases (35 anaplastic gliomas [20 astrocytomas, 10 oligoastrocytomas, 5 oligodendrogliomas] and 31 glioblastomas [GBM]), level and distribution of PET tracer uptake were analyzed to define a PET contour projected on MRI scans to define a final target contour for VR. Maximal tumor resection was accomplished in each case, with the intention to remove the entire abnormal metabolic area comprised in the surgical planning. Early postoperative MRI and PET assessed tumor resection. Survival analysis was performed separately in anaplastic gliomas and glioblastoma multiforme according to the presence or absence of residual tracer uptake on postoperative PET and according to the presence or absence of residual contrast enhancement on postoperative MRI.
RESULTS
Preoperatively, metabolic information helped the surgical planning. In all procedures, PET contributed to define a final target contour different from that obtained with MRI alone. Postoperatively, 46 of 66 patients had no residual PET tracer uptake (total PET resection), 23 of 66 had no residual MRI contrast enhancement. No additional neurological morbidity due to the technique was reported. A total PET tracer uptake resection was associated with a significantly longer survival in anaplastic gliomas (P = 0.0071) and in glioblastoma multiforme (P = 0.0001), respectively. A total MRI contrast enhancement resection was not correlated with a significantly better survival, neither in anaplastic gliomas (P = 0.6089) nor in glioblastoma multiforme (P = 0.6806).
CONCLUSIONS
Complete resection of the increased PET tracer uptake prolongs the survival of HGG patients. Because PET information represents a more specific marker than MRI enhancement for detecting anaplastic tumor tissue, PET-guidance increases the amount of anaplastic tissue removed in HGG.
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Affiliation(s)
- Benoit J.M. Pirotte
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Levivier
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge Goldman
- PET-Cyclotron Biomedical Unit, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Massager
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - David Wikler
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Dewitte
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Michael Bruneau
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Sandrine Rorive
- Department of Neuropathology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe David
- Department of Neuroradiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Brotchi
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Pirotte BJ, Levivier M, Goldman S, Massager N, Wikler D, Dewitte O, Bruneau M, Rorive S, David P, Brotchi J. POSITRON EMISSION TOMOGRAPHY-GUIDED VOLUMETRIC RESECTION OF SUPRATENTORIAL HIGH-GRADE GLIOMAS. Neurosurgery 2009. [DOI: 10.1227/01.neu.0000338949.94496.85 pubmed: 19240609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Pirotte BJM, Lubansu A, Massager N, Wikler D, Goldman S, Levivier M. Results of positron emission tomography guidance and reassessment of the utility of and indications for stereotactic biopsy in children with infiltrative brainstem tumors. J Neurosurg 2009; 107:392-9. [PMID: 18459902 DOI: 10.3171/ped-07/11/392] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Most intrinsic infiltrative brainstem lesions diagnosed in children are gliomas, and these carry a very bad prognosis. Although the utility and risk of stereotactically guided biopsy procedures in intrinsic infiltrative brainstem lesions have been widely questioned, the neuroimaging diagnosis may be inaccurate in approximately 25% of cases, and the consequences of empirical therapy should not be underestimated. Stereotactic biopsy sampling is still performed in many centers, but the reported diagnostic yield ranges from 83 to 96%. The authors integrated positron emission tomography (PET) images into the planning for stereotactic biopsy procedures to direct the biopsy needle's trajectory to hypermetabolic foci of intrinsic infiltrative brainstem lesions. Their aim was to assess the benefit of the technique in terms of target selection and diagnostic yield. METHODS Twenty children with newly diagnosed intrinsic infiltrative brainstem lesions underwent a PET-guided stereotactic biopsy procedure. The PET tracer was(18)F-2-fluoro-2-deoxy-D-glucose (FDG) in six cases, (11)C-methionine in eight, and both agents were used in six. A single biopsy target was selected in the area of highest PET tracer uptake in all cases. The PET data were compared with diagnoses and outcome. RESULTS Use of PET guidance improved target selection and provided tumor diagnosis in all trajectories and in all children (high-grade glioma was diagnosed in 10, low-grade glioma in five, and nonglial tumor in five). The PET-guided trajectories provided a higher diagnostic yield than those guided by magnetic resonance imaging alone, which allowed the sampling to be reduced to a single trajectory. The PET data might also carry a prognostic value that could be useful for oncological management. CONCLUSIONS These data support the suggestion that PET guidance improves the diagnostic yield of stereotactic biopsy sampling, allows the practitioner to reduce the number of sampling procedures, and might lead to a reassessment of the utility of and indications for stereotactic biopsy in children with intrinsic infiltrative brainstem lesions.
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Affiliation(s)
- Benoit J M Pirotte
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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Abstract
While rare in adults, central nervous system tumor is the most common solid tumor in childhood and is the leading cause of cancer death in children. Childhood brain tumors are different from those in adults in epidemiology, histologic features, and responses to treatment. Gliomas make up over one-half of all childhood brain tumors. Clinical application of PET imaging in brain tumors has demonstrated that it is helpful in tumor grading, establishing prognosis, defining targets for biopsy, and planning resection. This article emphasizes PET applications in childhood brain tumors, focusing on mainly gliomas with regard to tumor-grading and prognosis, distinguishing tumor recurrence from radiation necrosis, and PET guided diagnosis and treatment.
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Affiliation(s)
- Wei Chen
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA 90095, USA; Department of Radiology, Kaiser Permanente Woodland Hills Medical Center, 5601 De Soto Ave, Woodland Hills, CA 91367, USA.
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