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Chuthip P, Sitthinamsuwan B, Witthiwej T, Tansirisithikul C, Khumpalikit I, Nunta-aree S. Predictors for the Differentiation between Glioblastoma, Primary Central Nervous System Lymphoma, and Metastasis in Patients with a Solitary Enhancing Intracranial Mass. Asian J Neurosurg 2024; 19:186-201. [PMID: 38974428 PMCID: PMC11226298 DOI: 10.1055/s-0044-1787051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Introduction Differentiation between glioblastoma (GBM), primary central nervous system lymphoma (PCNSL), and metastasis is important in decision-making before surgery. However, these malignant brain tumors have overlapping features. This study aimed to identify predictors differentiating between GBM, PCNSL, and metastasis. Materials and Methods Patients with a solitary intracranial enhancing tumor and a histopathological diagnosis of GBM, PCNSL, or metastasis were investigated. All patients with intracranial lymphoma had PCNSL without extracranial involvement. Demographic, clinical, and radiographic data were analyzed to determine their associations with the tumor types. Results The predictors associated with GBM were functional impairment ( p = 0.001), large tumor size ( p < 0.001), irregular tumor margin ( p < 0.001), heterogeneous contrast enhancement ( p < 0.001), central necrosis ( p < 0.001), intratumoral hemorrhage ( p = 0.018), abnormal flow void ( p < 0.001), and hypodensity component on noncontrast cranial computed tomography (CT) scan ( p < 0.001). The predictors associated with PCNSL comprised functional impairment ( p = 0.005), deep-seated tumor location ( p = 0.006), homogeneous contrast enhancement ( p < 0.001), absence of cystic appearance ( p = 0.008), presence of hypointensity component on precontrast cranial T1-weighted magnetic resonance imaging (MRI; p = 0.027), and presence of isodensity component on noncontrast cranial CT ( p < 0.008). Finally, the predictors for metastasis were an infratentorial ( p < 0.001) or extra-axial tumor location ( p = 0.035), smooth tumor margin ( p < 0.001), and presence of isointensity component on cranial fluid-attenuated inversion recovery MRI ( p = 0.047). Conclusion These predictors may be used to differentiate between GBM, PCNSL, and metastasis, and they are useful in clinical management.
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Affiliation(s)
- Pornthida Chuthip
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Surgery, Pattani Hospital, Pattani, Thailand
| | - Bunpot Sitthinamsuwan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Theerapol Witthiwej
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chottiwat Tansirisithikul
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Inthira Khumpalikit
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sarun Nunta-aree
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Ventura D, Dittmann M, Büther F, Schäfers M, Rahbar K, Hescheler D, Claesener M, Schindler P, Riemann B, Seifert R, Roll W. Diagnostic Performance of [ 18F]TFB PET/CT Compared with Therapeutic Activity [ 131I]Iodine SPECT/CT and [ 18F]FDG PET/CT in Recurrent Differentiated Thyroid Carcinoma. J Nucl Med 2024; 65:192-198. [PMID: 38164565 PMCID: PMC10858375 DOI: 10.2967/jnumed.123.266513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/01/2023] [Indexed: 01/03/2024] Open
Abstract
[18F]tetrafluoroborate ([18F]TFB) is an emerging PET tracer with excellent properties for human sodium iodide symporter (NIS)-based imaging in patients with differentiated thyroid cancer (DTC). The aim of this study was to compare [18F]TFB PET with high-activity posttherapeutic [131I]iodine whole-body scintigraphy and SPECT/CT in recurrent DTC and with [18F]FDG PET/CT in suspected dedifferentiation. Methods: Twenty-six patients treated with high-activity radioactive [131I]iodine therapy (range, 5.00-10.23 GBq) between May 2020 and November 2022 were retrospectively included. Thyroid-stimulating hormone was stimulated by 2 injections of recombinant thyroid-stimulating hormone (0.9 mg) 48 and 24 h before therapy. Before treatment, all patients underwent [18F]TFB PET/CT 40 min after injection of a median of 321 MBq of [18F]TFB. To study tracer kinetics in DTC lesions, 23 patients received an additional scan at 90 min. [131I]iodine therapeutic whole-body scintigraphy and SPECT/CT were performed at a median of 3.8 d after treatment. Twenty-five patients underwent additional [18F]FDG PET. Two experienced nuclear medicine physicians evaluated all imaging modalities in consensus. Results: A total of 62 suspected lesions were identified; of these, 30 lesions were [131I]iodine positive, 32 lesions were [18F]TFB positive, and 52 were [18F]FDG positive. Three of the 30 [131I]iodine-positive lesions were retrospectively rated as false-positive iodide uptake. Tumor-to-background ratio measurements at the 40- and 90-min time points were closely correlated (e.g., for the tumor-to-background ratio for muscle, the Pearson correlation coefficient was 0.91; P < 0.001; n = 49). We found a significant negative correlation between [18F]TFB uptake and [18F]FDG uptake as a potential marker for dedifferentiation (Pearson correlation coefficient, -0.26; P = 0.041; n = 62). Conclusion: Pretherapeutic [18F]TFB PET/CT may help to predict the positivity of recurrent DTC lesions on [131I]iodine scans. Therefore, it may help in the selection of patients for [131I]iodine therapy. Future prospective trials for iodine therapy guidance are warranted. Lesion [18F]TFB uptake seems to be inversely correlated with [18F]FDG uptake and therefore might serve as a dedifferentiation marker in DTC.
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Affiliation(s)
- David Ventura
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany;
- West German Cancer Centre, Münster, Germany
| | - Matthias Dittmann
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- Department of Nuclear Medicine, St. Marien Hospital Lünen, Lünen, Germany
| | - Florian Büther
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Centre, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Centre, Münster, Germany
| | - Daniel Hescheler
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Centre, Münster, Germany
| | - Michael Claesener
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Philipp Schindler
- West German Cancer Centre, Münster, Germany
- Clinic for Radiology, University and University Hospital Münster, Münster, Germany
| | - Burkhard Riemann
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Centre, Münster, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Centre, Münster, Germany
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; and
- West German Cancer Centre, Essen, Germany
| | - Wolfgang Roll
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Centre, Münster, Germany
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Kim K, Kim DK, Moon JH, Kim EH, Kim SH, Ku CR, Lee EJ. Dexamethasone suppression for 18F-FDG PET/CT to localize ACTH-secreting pituitary tumors. Cancer Imaging 2023; 23:85. [PMID: 37700359 PMCID: PMC10496442 DOI: 10.1186/s40644-023-00600-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND 18Fluorine-Fluoro-deoxy-glucose (18F-FDG) positron emission tomography (PET) is widely used for diagnosing various malignant tumors and evaluating metabolic activities. Although the usefulness of 18F-FDG PET has been reported in several endocrine diseases, studies on pituitary disease are extremely limited. To evaluate whether dexamethasone (DEX) suppression can improve 18F-FDG PET for the localization of adrenocorticotropic hormone-secreting adenomas in the pituitary gland in Cushing's disease (CD). METHODS We included 22 patients with CD who underwent PET imaging before and after DEX administration. We compared the success rates of PET before and after DEX suppression, magnetic resonance imaging (MRI), and bilateral inferior petrosal sinus sampling (BIPSS). We determined the final locations of adenomas based on intraoperative multiple-staged resection and tumor tissue identification using frozen sections. Standardized uptake value (SUV) were analyzed to confirm the change of intensity of adenomas on PET. RESULTS Twenty-two patients were included (age at diagnosis: 37 [13-56] years), and most were women (90.91%). Pituitary adenomas compared to normal pituitaries showed increased maximum SUV after DEX suppression but without statistical significance (1.13 versus. 1.21, z=-0.765, P = 0.444). After DEX suppression, the mean and maximum SUV of adenomas showed a positive correlation with nadir cortisol levels in high-dose DEX suppression test (Rho = 0.554, P = 0.007 and Rho = 0.503, P = 0.017, respectively). In reference sites, mean SUV of cerebellum was significantly decreased (7.65 vs. 6.40, P = 0.006*), but those of the thalamus and gray matter was increased after DEX suppression (thalamus, 8.70 vs. 11.20, P = 0.010*; gray matter, 6.25 vs. 7.95, P = 0.010*). CONCLUSION DEX suppression did not improve 18F-FDG PET/CT localization in patients with CD.
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Affiliation(s)
- Kyungwon Kim
- Endocrinology, Institute of Endocrine Research, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Kyu Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eui Hyun Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun Ho Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheol Ryong Ku
- Endocrinology, Institute of Endocrine Research, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Eun Jig Lee
- Endocrinology, Institute of Endocrine Research, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Urso L, Bonatto E, Nieri A, Castello A, Maffione AM, Marzola MC, Cittanti C, Bartolomei M, Panareo S, Mansi L, Lopci E, Florimonte L, Castellani M. The Role of Molecular Imaging in Patients with Brain Metastases: A Literature Review. Cancers (Basel) 2023; 15:cancers15072184. [PMID: 37046845 PMCID: PMC10093739 DOI: 10.3390/cancers15072184] [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: 02/28/2023] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
Over the last several years, molecular imaging has gained a primary role in the evaluation of patients with brain metastases (BM). Therefore, the "Response Assessment in Neuro-Oncology" (RANO) group recommends amino acid radiotracers for the assessment of BM. Our review summarizes the current use of positron emission tomography (PET) radiotracers in patients with BM, ranging from present to future perspectives with new PET radiotracers, including the role of radiomics and potential theranostics approaches. A comprehensive search of PubMed results was conducted. All studies published in English up to and including December 2022 were reviewed. Current evidence confirms the important role of amino acid PET radiotracers for the delineation of BM extension, for the assessment of response to therapy, and particularly for the differentiation between tumor progression and radionecrosis. The newer radiotracers explore non-invasively different biological tumor processes, although more consistent findings in larger clinical trials are necessary to confirm preliminary results. Our review illustrates the role of molecular imaging in patients with BM. Along with magnetic resonance imaging (MRI), the gold standard for diagnosis of BM, PET is a useful complementary technique for processes that otherwise cannot be obtained from anatomical MRI alone.
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Affiliation(s)
- Luca Urso
- Department of Nuclear Medicine PET/CT Centre, S. Maria della Misericordia Hospital, 45100 Rovigo, Italy
| | - Elena Bonatto
- Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alberto Nieri
- Nuclear Medicine Unit, Oncological Medical and Specialist Department, University Hospital of Ferrara, 44124 Cona, Italy
| | - Angelo Castello
- Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Anna Margherita Maffione
- Department of Nuclear Medicine PET/CT Centre, S. Maria della Misericordia Hospital, 45100 Rovigo, Italy
| | - Maria Cristina Marzola
- Department of Nuclear Medicine PET/CT Centre, S. Maria della Misericordia Hospital, 45100 Rovigo, Italy
| | - Corrado Cittanti
- Nuclear Medicine Unit, Oncological Medical and Specialist Department, University Hospital of Ferrara, 44124 Cona, Italy
- Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Mirco Bartolomei
- Nuclear Medicine Unit, Oncological Medical and Specialist Department, University Hospital of Ferrara, 44124 Cona, Italy
| | - Stefano Panareo
- Nuclear Medicine Unit, Oncology and Haematology Department, University Hospital of Modena, 41125 Modena, Italy
| | - Luigi Mansi
- Interuniversity Research Center for the Sustainable Development (CIRPS), 00152 Rome, Italy
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS-Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Luigia Florimonte
- Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Massimo Castellani
- Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Zhang G, Li J, Hui X. Use of 18F-FDG-PET/CT in differential diagnosis of primary central nervous system lymphoma and high-grade gliomas: A meta-analysis. Front Neurol 2022; 13:935459. [PMID: 36061992 PMCID: PMC9428250 DOI: 10.3389/fneur.2022.935459] [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: 05/04/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Primary central nervous system lymphoma (PCNSL) and high-grade glioma (HGG) appear similar under imaging. However, since the two tumors vary in their treatment methods, their differential diagnosis is crucial. The use of 18F-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG-PET/CT) imaging to effectively distinguish between the two tumors is not clear; therefore, a meta-analysis was carried out to determine its effectiveness. Materials and methods The databases PubMed, EMBASE, Cochrane, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, China Science, and Technology Journal Database (CQVIP) were exhaustively searched using stringent inclusion and exclusion criteria to select high-quality literature. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) was used for the qualitative assessment of the included literature. The bivariate effect model was used to combine statistics such as sensitivity (SEN) and specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) [95% confidence intervals (CI)], plot summary receiver operating characteristic (SROC) curve, and calculate the area under the curve (AUC) value. Sensitivity analysis was used to evaluate the stability of the results, and Deek's test was used to assess publication bias. Meta-regression and subgroup analysis was used to determine the sources of heterogeneity. Results A total of nine studies were included in this study. For differential diagnosis of PCNSL and HGG, the combined SEN was 0.91 (95% CI: 0.80–0.96; I2 = 46.73%), combined SPE was 0.88 (95% CI: 0.82–0.93; I2 = 56.30%), the combined PLR was 7.83 (95% CI: 4.96–12.37; I2 = 15.57%), combined NLR was 0.10 (95% CI: 0.05–0.23; I2 = 31.99%), combined DOR was 77.36 (95% CI: 32.74–182.77; I2 = 70.70%). The AUC of SROC was 0.95 (95% CI: 0.93–0.97). No publication bias was found and the sample size and different parameters were the primary reason for heterogeneity. Conclusion The 18F-FDG-PET/CT imaging technique has a high diagnostic accuracy in the differential diagnosis of PNCSL and HGG. Patients suspected to have the above two tumors are suggested to be examined by 18F-FDG-PET / CT to help in the clinical distinction and further treatment modalities.
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Affiliation(s)
- Guisheng Zhang
- Department of Neurosurgery of West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurosurgery, Minda Hospital of Hubei Minzu University, Enshi, China
| | - Jiuhong Li
- Department of Neurosurgery of West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xuhui Hui
- Department of Neurosurgery of West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xuhui Hui
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Ora M, Soni N, Nazar AH, Mehrotra A, Mishra P, Gambhir S. Effect of Whole-body [18F]Fluoro-2-deoxy-2-d-glucose Positron Emission Tomography in Patients with Suspected Brain Metastasis. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0042-1743398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Background and Purpose [18F]Fluoro-2-deoxy-2-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) has a promising role in the workup and management of carcinoma of unknown primary (CUP). We have evaluated the effect of whole-body FDG PET/CT in assessing the patients presented with suspected brain metastasis (CUP-BM) on brain magnetic resonance imaging (MRI) or computed tomography (CT).
Materials and Methods This retrospective study included FDG PET/CT of 50 patients (24 males, mean: 58 ± 12.2 years old) with a CUP-BM diagnosis based on MRI and CT imaging. The final diagnosis of primary brain neoplasm (BP) or brain metastases (BM) was based on FDG PET/CT findings and/or histopathology (HPE).
Results On FDG PET/CT, 52% (26/50) of patients did not have any systemic lesion apart from a brain lesion. Out of these, 50% (13/26) had HPE confirmation of primary brain neoplasm (BP). FDG PET/CT identified multiple systemic lesions apart from brain lesions in the remaining 48% (24/50) of patients. They were categorized as the brain metastases (BM) group. The primary lesions were located in the lungs (n = 20), kidneys (n = 1), prostate (n = 1), esophagus (n = 1), and tongue (n = 1).
Conclusion FDG PET/CT could suggest a diagnosis of BM based on the presence of systemic lesions. It also provides an easily accessible peripheral site for biopsy and systemic disease burden in a single scan. FDG PET/CT's up-front use in suspected CUP-BM on CT and/or MRI could differentiate the BM from BP in most cases and avoid brain biopsy in the BM group.
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Affiliation(s)
- Manish Ora
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neetu Soni
- Department of Neuroradiology, University of Iowa Health and Clinic, Iowa, Iowa, United States
| | - Aftab Hasan Nazar
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhakar Mishra
- Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Gambhir
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Bonomi R, John F, Patel S, Barger G, Robinette N, Amit-Yousif AJ, Dominello M, Juhasz C. Multimodal neuroimaging of gliomatosis cerebri: a case series of four patients. Acta Radiol Open 2020; 9:2058460120942789. [PMID: 32913666 PMCID: PMC7444143 DOI: 10.1177/2058460120942789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/23/2020] [Indexed: 01/18/2023] Open
Abstract
In the latest World Health Organization classification of brain tumors, gliomatosis cerebri has been redefined to varying subsets of diffuse gliomas; however, the term is still used to describe gliomas with infiltrative growth into three or more cerebral lobes. These tumors are frequently misdiagnosed and difficult to treat due to their atypical presentation using structural imaging modalities including computed tomography and T1/T2-weighted magnetic resonance imaging (MRI). In this retrospective case series, we compared clinical MRI to amino acid positron emission tomography (PET) to assess the potential value of PET in the assessment of the extent of tumor involvement and in monitoring disease progression. We report the clinical course and serial multimodal imaging findings of four patients. Each patient presented at varying points in disease progression with widespread glioma brain involvement and was evaluated at least once by amino acid PET using alpha-[11C]methyl-L-tryptophan ([11C]-AMT). Increased uptake of [11C]-AMT was detected in a subset of non-enhancing brain lesions and detected tumor invasion before MRI signs of tumor in some regions. Increased uptake of [11C]-AMT was also detected in tumorous regions not detected by perfusion MRI or MR spectroscopy. Metabolic response to treatment was also observed in two patients. Overall, these data are consistent with and expand upon previous reports using other amino acid PET tracers in gliomatosis and show the potential added value of this imaging modality to clinical MRI in the detection and monitoring of these diffusely infiltrative tumors.
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Affiliation(s)
- Robin Bonomi
- Departments of Pediatrics, Neurology, Radiology, Oncology, Wayne State University, Detroit, MI, USA
| | - Flora John
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, MI, USA
| | | | | | | | | | | | - Csaba Juhasz
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, MI, USA
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The Role of Dual-Phase FDG PET/CT in the Diagnosis and Follow-Up of Brain Tumors. AJR Am J Roentgenol 2020; 215:985-996. [PMID: 32841063 DOI: 10.2214/ajr.19.22571] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE. FDG PET/CT of brain tumors is limited by background activity. Dual-phase FDG PET/CT can eliminate this limitation and allow discernment of viable tumors. Our aim was to assess the diagnostic capability of dual-phase FDG PET/CT qualitatively and quantitatively and to determine cutoff values for dual-phase FDG PET/CT in brain tumor imaging. MATERIALS AND METHODS. Retrospectively, 51 malignant brain tumors were evaluated with dual-phase FDG PET/CT in 32 patients. Acquisitions were performed 30 minutes (time 1) and 3 hours (time 2) after administration of 10 mCi (370 MBq) FDG and 6 hours of fasting. Two observers independently and qualitatively evaluated lesions. A weighted Cohen kappa was used to calculate interrater reliability and accuracy. Quantitatively, maximum standardized uptake value (SUVmax) was measured in the lesions, contralateral white matter (CWM), contralateral caudate nucleus head, and ipsilateral cerebellar cortex (CC). Lesion-to-CWM SUVmax, lesion-to-contralateral caudate nucleus head SUVmax, and lesion-to-ipsilateral CC SUVmax ratios at time 1 and time 2 were calculated. ROC analysis was used to determine optimum cutoff values, and AUC ratios were compared among quantitative parameters. Lesion outcome was determined by pathologic results (available in 15 lesions), lesion stability on serial MRI examinations (representing nonviable tumor), or decreased tumor size on serial MRI examinations after new treatment (representing viable tumor). RESULTS. Thirty-seven viable and 14 nonviable lesions were evaluated. Qualitatively, the diagnostic accuracy (first observer: κ = 0.45 to κ = 0.59; second observer: κ = 0.41 to κ = 0.66) and interrater reliability (at time 1: κ = 0.51; at time 2: κ = 0.83) improved with delayed imaging. AUC and ROC analysis showed comparably high sensitivity, specificity, and accuracy profiles for early and delayed dual-phase FDG PET/CT. Some of the proposed cutoff values were as follows: lesion SUVmax at time 1, 7.20 (sensitivity, 89.2%; specificity, 85.7%); lesion SUVmax at time 2, 7.80 (sensitivity, 97.3%; specificity, 71.4%); lesion-to-CWM SUVmax at time 1, 2.05 (sensitivity, 78.4%; specificity, 92.9%); and lesion-to-CWM SUVmax at time 2, 2.36 (sensitivity, 81.1%; specificity, 85.7%). CONCLUSION. Dual-phase FDG PET/CT improves lesion detection and diagnostic accuracy in malignant brain tumors.
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Galldiks N, Langen KJ, Albert NL, Chamberlain M, Soffietti R, Kim MM, Law I, Le Rhun E, Chang S, Schwarting J, Combs SE, Preusser M, Forsyth P, Pope W, Weller M, Tonn JC. PET imaging in patients with brain metastasis-report of the RANO/PET group. Neuro Oncol 2020; 21:585-595. [PMID: 30615138 DOI: 10.1093/neuonc/noz003] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/11/2018] [Accepted: 01/03/2019] [Indexed: 12/23/2022] Open
Abstract
Brain metastases (BM) from extracranial cancer are associated with significant morbidity and mortality. Effective local treatment options are stereotactic radiotherapy, including radiosurgery or fractionated external beam radiotherapy, and surgical resection. The use of systemic treatment for intracranial disease control also is improving. BM diagnosis, treatment planning, and follow-up is most often based on contrast-enhanced magnetic resonance imaging (MRI). However, anatomic imaging modalities including standard MRI have limitations in accurately characterizing posttherapeutic reactive changes and treatment response. Molecular imaging techniques such as positron emission tomography (PET) characterize specific metabolic and cellular features of metastases, potentially providing clinically relevant information supplementing anatomic MRI. Here, the Response Assessment in Neuro-Oncology working group provides recommendations for the use of PET imaging in the clinical management of patients with BM based on evidence from studies validated by histology and/or clinical outcome.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine 3, 4, Research Center Juelich, Juelich, Germany.,Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine 3, 4, Research Center Juelich, Juelich, Germany.,Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany
| | - Marc Chamberlain
- Departments of Neurology and Neurological Surgery, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Michelle M Kim
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Denmark
| | - Emilie Le Rhun
- Department of Neurosurgery, University Hospital Lille, Lille, France
| | - Susan Chang
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Julian Schwarting
- Department of Neurosurgery, Ludwig Maximilians-University of Munich, Munich, Germany.,German Cancer Consortium, Partner Site Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University Munich, Munich, Germany
| | - Matthias Preusser
- Department of Medicine I and Comprehensive Cancer Centre CNS Tumours Unit, Medical University of Vienna, Vienna, Austria
| | - Peter Forsyth
- Moffitt Cancer Center, University of South Florida, Tampa, Florida, USA
| | - Whitney Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California , USA
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jörg C Tonn
- Department of Neurosurgery, Ludwig Maximilians-University of Munich, Munich, Germany.,German Cancer Consortium, Partner Site Munich, Germany
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10
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Abstract
PET holds potential to provide additional information about tumour metabolic processes, which could aid brain tumour differential diagnosis, grading, molecular subtyping and/or the distinction of therapy effects from disease recurrence. This review discusses PET techniques currently in use for untreated and treated glioma characterization and aims to critically assess the evidence for different tracers ([F]Fluorodeoxyglucose, choline and amino acid tracers) in this context.
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11
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Albatly AA, Alsamarah AT, Alhawas A, Veit-Haibach P, Buck A, Stolzmann P, Burger IA, Kollias SS, Huellner MW. Value of 18F-FET PET in adult brainstem glioma. Clin Imaging 2018; 51:68-75. [DOI: 10.1016/j.clinimag.2018.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/25/2018] [Accepted: 01/29/2018] [Indexed: 12/17/2022]
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12
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Albano D, Bosio G, Bertoli M, Giubbini R, Bertagna F. 18F-FDG PET/CT in primary brain lymphoma. J Neurooncol 2017; 136:577-583. [PMID: 29147860 DOI: 10.1007/s11060-017-2686-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/12/2017] [Indexed: 11/28/2022]
Abstract
The actual role of 18F-FDG PET/CT in evaluating primary brain lymphoma is still an open issue. Brain lymphoma usually show elevated 18F-FDG uptake, often higher than other brain tumors or inflammatory processes, but the metabolic behavior of this lymphoma is not still understood. Our aim was to investigate the particular metabolic behavior of this lymphoma. Forty six patients (21 female, 25 male) with histologically-confirmed brain lymphoma who underwent 18F-FDG PET/CT from vertex to the mid-thigh for initial staging were retrospectively evaluated. The PET images were analyzed visually and semi-quantitatively by measuring the maximum standardized uptake value (SUVmax), lesion-to-liver SUVmax ratio, lesion-to-blood pool SUVmax ratio and the tumor to normal brain uptake ratio (T/N ratio) and compared with epidemiological (age, sex, HIV infection) and morphological (tumor size, MRI appearance) characteristics. Thirty-eight patients (83%) had positive 18F-FDG PET/CT (average SUVmax was 15.6 ± 9.2; lesion-to-liver SUVmax ratio 5.8 ± 2.8; lesion-to-blood pool SUVmax ratio 7.1 ± 3.8, T/N ratio 3.1 ± 1.7) at the corresponding brain lesion; the remaining 8 (17%) were not 18F-FDG avid. 18F-FDG avidity was significantly associated with morphological appearance and tumor size and not correlated with other features. 18F-FDG PET/CT detected extracranial disease in two cases (4%) with negative bone marrow biopsies and CT. In conclusion, brain lymphomas are 18F-FDG avid in 83% of cases showing high 18F-FDG uptake and 18F-FDG avidity is correlated with tumor size and morphological appearance of the lesion. PET/CT helped to recognize extracranial disease in two patients.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, Spedali Civili Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
| | - Giovanni Bosio
- Nuclear Medicine, Spedali Civili Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Mattia Bertoli
- Nuclear Medicine, Spedali Civili Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
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13
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Yamauchi M, Okada T, Okada T, Yamamoto A, Fushimi Y, Arakawa Y, Miyamoto S, Togashi K. Differential diagnosis of posterior fossa brain tumors: Multiple discriminant analysis of Tl-SPECT and FDG-PET. Medicine (Baltimore) 2017; 96:e7767. [PMID: 28816956 PMCID: PMC5571693 DOI: 10.1097/md.0000000000007767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study investigated the combined capability of thallium-201 (Tl)-SPECT and fluorine-18-fluoro-deoxy-glucose (FDG)-PET for differential diagnosis of posterior fossa brain tumors using multiple discriminant analysis.This retrospective study was conducted under approval of the institutional review board. In the hospital information system, 27 patients with posterior fossa intra-axial tumor between January 2009 and June 2015 were enrolled and grouped as the following 7 entities: low grade glioma (LGG) 6, anaplastic astrocytoma (AA) 2, glioblastoma (GBM) 3, medulloblastoma (MB) 3, hemangioblastoma (HB) 6, metastatic tumor (Mets) 3, and malignant lymphoma (ML) 4. Tl and FDG uptakes were measured at the tumors and control areas, and several indexes were derived. Using indexes selected by the stepwise method, discriminant analysis was conducted with leave-one-out cross-validation.The predicted accuracy for tumor classification was 70.4% at initial analysis and 55.6% at cross-validation to differentiate 7 tumor entities. HB, LGG, and ML were well-discriminated, but AA was located next to LGG. GBM, MB, and Mets largely overlapped and could not be well distinguished even applying multiple discriminant analysis. Correct classification in the original and cross-validation analyses was 44.4% and 33.3% for Tl-SPECT and 55.6% and 48.1% for FDG-PET.
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Affiliation(s)
| | | | - Tsutomu Okada
- Department of Diagnostic Imaging and Nuclear Medicine
| | | | | | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine
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14
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Kenny C, Healy GM, Redmond CE, Farrell M, Connaghan G, McGuigan C, Killeen RP. FDG PET diagnosis of primary intracranial lymphoma: radiology-pathology correlation. QJM 2017; 110:317-318. [PMID: 28340028 DOI: 10.1093/qjmed/hcx054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- C Kenny
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - G M Healy
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - C E Redmond
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - M Farrell
- Department of Pathology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - G Connaghan
- Department of Haematology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - C McGuigan
- Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - R P Killeen
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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15
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Abstract
A previous review published in 2012 demonstrated the role of clinical PET for diagnosis and management of brain tumors using mainly FDG, amino acid tracers, and 18F-fluorothymidine. This review provides an update on clinical PET studies, most of which are motivated by prediction of prognosis and planning and monitoring of therapy in gliomas. For FDG, there has been additional evidence supporting late scanning, and combination with 13N ammonia has yielded some promising results. Large neutral amino acid tracers have found widespread applications mostly based on 18F-labeled compounds fluoroethyltyrosine and fluorodopa for targeting biopsies, therapy planning and monitoring, and as outcome markers in clinical trials. 11C-alpha-methyltryptophan (AMT) has been proposed as an alternative to 11C-methionine, and there may also be a role for cyclic amino acid tracers. 18F-fluorothymidine has shown strengths for tumor grading and as an outcome marker. Studies using 18F-fluorocholine (FCH) and 68Ga-labeled compounds are promising but have not yet clearly defined their role. Studies on radiotherapy planning have explored the use of large neutral amino acid tracers to improve the delineation of tumor volume for irradiation and the use of hypoxia markers, in particular 18F-fluoromisonidazole. Many studies employed the combination of PET with advanced multimodal MR imaging methods, mostly demonstrating complementarity and some potential benefits of hybrid PET/MR.
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Affiliation(s)
- Karl Herholz
- The University of Manchester, Division of Neuroscience and Experimental Psychology Wolfson Molecular Imaging Centre, Manchester, England, United Kingdom.
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16
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Hahn A, Gryglewski G, Nics L, Hienert M, Rischka L, Vraka C, Sigurdardottir H, Vanicek T, James GM, Seiger R, Kautzky A, Silberbauer L, Wadsak W, Mitterhauser M, Hacker M, Kasper S, Lanzenberger R. Quantification of Task-Specific Glucose Metabolism with Constant Infusion of 18F-FDG. J Nucl Med 2016; 57:1933-1940. [DOI: 10.2967/jnumed.116.176156] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/07/2016] [Indexed: 11/16/2022] Open
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