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Galldiks N, Kaufmann TJ, Vollmuth P, Lohmann P, Smits M, Veronesi MC, Langen KJ, Rudà R, Albert NL, Hattingen E, Law I, Hutterer M, Soffietti R, Vogelbaum MA, Wen PY, Weller M, Tonn JC. Challenges, limitations, and pitfalls of PET and advanced MRI in patients with brain tumors: A report of the PET/RANO group. Neuro Oncol 2024; 26:1181-1194. [PMID: 38466087 PMCID: PMC11226881 DOI: 10.1093/neuonc/noae049] [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: 11/14/2023] [Indexed: 03/12/2024] Open
Abstract
Brain tumor diagnostics have significantly evolved with the use of positron emission tomography (PET) and advanced magnetic resonance imaging (MRI) techniques. In addition to anatomical MRI, these modalities may provide valuable information for several clinical applications such as differential diagnosis, delineation of tumor extent, prognostication, differentiation between tumor relapse and treatment-related changes, and the evaluation of response to anticancer therapy. In particular, joint recommendations of the Response Assessment in Neuro-Oncology (RANO) Group, the European Association of Neuro-oncology, and major European and American Nuclear Medicine societies highlighted that the additional clinical value of radiolabeled amino acids compared to anatomical MRI alone is outstanding and that its widespread clinical use should be supported. For advanced MRI and its steadily increasing use in clinical practice, the Standardization Subcommittee of the Jumpstarting Brain Tumor Drug Development Coalition provided more recently an updated acquisition protocol for the widely used dynamic susceptibility contrast perfusion MRI. Besides amino acid PET and perfusion MRI, other PET tracers and advanced MRI techniques (e.g. MR spectroscopy) are of considerable clinical interest and are increasingly integrated into everyday clinical practice. Nevertheless, these modalities have shortcomings which should be considered in clinical routine. This comprehensive review provides an overview of potential challenges, limitations, and pitfalls associated with PET imaging and advanced MRI techniques in patients with gliomas or brain metastases. Despite these issues, PET imaging and advanced MRI techniques continue to play an indispensable role in brain tumor management. Acknowledging and mitigating these challenges through interdisciplinary collaboration, standardized protocols, and continuous innovation will further enhance the utility of these modalities in guiding optimal patient care.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3, INM-4), Research Center Juelich, Juelich, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Germany
| | | | - Philipp Vollmuth
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, INM-4), Research Center Juelich, Juelich, Germany
| | - Marion Smits
- Department of Radiology and Nuclear Medicine and Brain Tumour Center, Erasmus MC, Rotterdam, The Netherlands
| | - Michael C Veronesi
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, INM-4), Research Center Juelich, Juelich, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Germany
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy
| | - Nathalie L Albert
- Department of Nuclear Medicine, LMU Hospital, Ludwig Maximilians-University of Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elke Hattingen
- Goethe University, Department of Neuroradiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Ian Law
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Markus Hutterer
- Department of Neurology with Acute Geriatrics, Saint John of God Hospital, Linz, Austria
| | - Riccardo Soffietti
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy
| | - Michael A Vogelbaum
- Department of Neuro-Oncology and Neurosurgery, Moffit Cancer Center, Tampa, Florida, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, and University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Joerg-Christian Tonn
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurosurgery, University Hospital of Munich (LMU), Munich, Germany
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Chaban A, Waschulzik B, Bernhardt D, Delbridge C, Schmidt-Graf F, Wagner A, Wiestler B, Weber W, Yakushev I. Amino acid PET vs. RANO MRI for prediction of overall survival in patients with recurrent high grade glioma under bevacizumab therapy. Eur J Nucl Med Mol Imaging 2024; 51:1698-1702. [PMID: 38228970 PMCID: PMC11043199 DOI: 10.1007/s00259-024-06601-4] [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: 09/20/2023] [Accepted: 01/01/2024] [Indexed: 01/18/2024]
Abstract
PURPOSE To summarize evidence on the comparative value of amino acid (AA) PET and conventional MRI for prediction of overall survival (OS) in patients with recurrent high grade glioma (rHGG) under bevacizumab therapy. METHODS Medical databases were screened for studies with individual data on OS, follow-up MRI, and PET findings in the same patient. MRI images were assessed according to the RANO criteria. A receiver operating characteristic curve analysis was used to predict OS at 9 months. RESULTS Five studies with a total of 72 patients were included. Median OS was significantly lower in the PET-positive than in the PET-negative group. PET findings predicted OS with a pooled sensitivity and specificity of 76% and 71%, respectively. Corresponding values for MRI were 32% and 82%. Area under the curve and sensitivity were significantly higher for PET than for MRI. CONCLUSION For monitoring of patients with rHGG under bevacizumab therapy, AA-PET should be preferred over RANO MRI.
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Affiliation(s)
- Artem Chaban
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Birgit Waschulzik
- Institute of AI and Informatics in Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Denise Bernhardt
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiation Oncology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claire Delbridge
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Pathology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Friederike Schmidt-Graf
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Neurology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Arthur Wagner
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Neurosurgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benedikt Wiestler
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wolfgang Weber
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Igor Yakushev
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
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The Use of 18F-FET-PET-MRI in Neuro-Oncology: The Best of Both Worlds—A Narrative Review. Diagnostics (Basel) 2022; 12:diagnostics12051202. [PMID: 35626357 PMCID: PMC9140561 DOI: 10.3390/diagnostics12051202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 02/05/2023] Open
Abstract
Gliomas are the most frequent primary tumors of the brain. They can be divided into grade II-IV astrocytomas and grade II-III oligodendrogliomas, based on their histomolecular profile. The prognosis and treatment is highly dependent on grade and well-identified prognostic and/or predictive molecular markers. Multi-parametric MRI, including diffusion weighted imaging, perfusion, and MR spectroscopy, showed increasing value in the non-invasive characterization of specific molecular subsets of gliomas. Radiolabeled amino-acid analogues, such as 18F-FET, have also been proven valuable in glioma imaging. These tracers not only contribute in the diagnostic process by detecting areas of dedifferentiation in diffuse gliomas, but this technique is also valuable in the follow-up of gliomas, as it can differentiate pseudo-progression from real tumor progression. Since multi-parametric MRI and 18F-FET PET are complementary imaging techniques, there may be a synergistic role for PET-MRI imaging in the neuro-oncological imaging of primary brain tumors. This could be of value for both primary staging, as well as during treatment and follow-up.
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Celli M, Caroli P, Amadori E, Arpa D, Gurrieri L, Ghigi G, Cenni P, Paganelli G, Matteucci F. Diagnostic and Prognostic Potential of 18F-FET PET in the Differential Diagnosis of Glioma Recurrence and Treatment-Induced Changes After Chemoradiation Therapy. Front Oncol 2021; 11:721821. [PMID: 34671551 PMCID: PMC8521061 DOI: 10.3389/fonc.2021.721821] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background MRI-based differential diagnosis of glioma recurrence (GR) and treatment-induced changes (TICs) remain elusive in up to 30% of treated glioma patients. We aimed to determine 18F-FET PET diagnostic performance in this clinical scenario, its outcome dependency on established prognostic factors, optimal 18F-FET semi-quantitative thresholds, and whether 18F-FET parameters may instantly predict progression-free survival (PFS) and overall survival (OS). Methods We retrospectively analyzed 45 glioma patients treated with chemoradiation therapy (32 males; mean age: 51 years, glioma grade: n=26 WHO4; n=15 WHO3; n=4 WHO2) who underwent 18F-FET PET to resolve differential diagnosis of GR and TICs raised by MRI performed in the preceding 2 weeks and depicting any of the following changes in their radiation field: volumetric increase of contrast-enhancing lesions; new contrast-enhancing lesion; significant increase in T2/FLAIR non-enhancing lesion without reducing corticosteroids. 18F-FET PET outcome relied on evaluation of maximum tumor-to-brain ratio (TBRmax), time-to-peak (TTP), and time-activity curve pattern (TAC). Metabolic tumor volume (MTV) and total tumor metabolism (TTM) were calculated for prognostic purposes. Standard of reference was repeat MRI performed 4–6 weeks after the previous MRI. Non-parametric statistics tested 18F-FET-based parameters for dependency on established prognostic markers. ROC curve analysis determined optimal cutoff values for 18F-FET semi-quantitative parameters. 18F-FET parameters and prognostic factors were evaluated for PFS and OS by Kaplan-Meier, univariate, and multivariate analyses. Results 18F-FET PET sensitivity, specificity, positive predictive value, negative predictive value were 86.2, 81.3, 89.3, 76.5%, respectively; higher diagnostic accuracy was yielded in IDH-wild-type glioma patients compared to IDH-mutant glioma patients (sensitivity: 81.8 versus 88.9%; specificity: 80.8 versus 81.8%). KPS was the only prognostic factor differing according to 18F-FET PET outcome (negative versus positive). Optimal 18F-FET cutoff values for GR were TBRmax ≥ 2.1, SUVmax ≥ 3.5, and TTP ≤ 29 min. PFS differed based on 18F-FET outcome and related metrics and according to KPS; a different OS was observed according to KPS only. On multivariate analysis, 18F-FET PET outcome was the only significant PFS factor; KPS and age the only significant OS factors. Conclusion 18F-FET PET demonstrated good diagnostic performance. 18F-FET PET outcome and metrics were significantly predictive only for PFS.
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Affiliation(s)
- Monica Celli
- Diagnostic Nuclear Medicine Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Paola Caroli
- Diagnostic Nuclear Medicine Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Elena Amadori
- Radiology MRI Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Donatella Arpa
- Radiation Therapy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Lorena Gurrieri
- Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giulia Ghigi
- Radiation Therapy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Patrizia Cenni
- Radiology MRI Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giovanni Paganelli
- Diagnostic Nuclear Medicine Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Federica Matteucci
- Diagnostic Nuclear Medicine Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
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Cecchin D, Garibotto V, Law I, Goffin K. PET Imaging in Neurodegeneration and Neuro-oncology: Variants and Pitfalls. Semin Nucl Med 2021; 51:408-418. [PMID: 33820651 DOI: 10.1053/j.semnuclmed.2021.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In neurodegenerative diseases, positron emission tomography (PET) imaging plays an important role in the early identification and differential diagnosis in particular in clinically challenging patients. 18F-FDG is still the most widely used and established tracer in this patient group, with different cortical and subcortical regions being preferentially affected in different neurodegenerative diseases, such as frontotemporal dementia, Alzheimer's disease or Lewy Body dementia, resulting in typical hypometabolic patterns. Over the last decades, however, the implementation of tracers specific for the pathological deposits characteristic of the different diseases, such as amyloid and tau, has revolutionized the way of classifying and reporting cases of cognitive impairment of neurodegenerative origin, providing complementary information to 18F-FDG PET. In neuro-oncology, PET imaging can be performed in several clinical indications, as highlighted in the joint European Association of Nuclear Medicine (EANM)/European Association of Neuro-Oncology (EANO)/Response assessment in neuro-oncology (RANO) practice guidelines on imaging in neuro-oncology. For assessment of glioma, amino-acid analogues, such as 11C-methionine or 18F-FET, are used whenever clinically available, as they offer excellent tumor-to-background ratios in malignant tumors. Moreover, dynamic acquisition of amino-acid analogue tracers and assessment of the shape of the time-activity curve can be used to perform noninvasive grading of brain gliomas, differentiating low from high grade presentations. In both settings, however, thorough knowledge of the normal physiological tracer distribution and the variants and pitfalls that can occur during image acquisition, processing and interpretation is mandatory in order to provide optimal diagnostic information to referring physicians and patients. Especially in neuro-oncology, this process can be aided by the active use of coregistered magnetic resonance imaging to accurately identify the imaging correlates of developmental origin, acute and chronic stroke, inflammation, infection and seizure related activity.
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Affiliation(s)
- Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine DIMED, Padua University Hospital, Padua, Italy
| | - Valentina Garibotto
- Nuclear Medicine and Molecular Imaging Division, Diagnostic Department, University Hospitals of Geneva and NIMTLab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark
| | - Karolien Goffin
- Department of Nuclear Medicine, University Hospital Leuven, Division of Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium.
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Renard D, Collombier L, Laurent-Chabalier S, Mura T, Le Floch A, Fertit HE, Thouvenot E, Guillamo JS. 18F-FDOPA-PET in pseudotumoral brain lesions. J Neurol 2020; 268:1266-1275. [PMID: 33084938 DOI: 10.1007/s00415-020-10269-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION 3,4-Dihydroxy-6-[18F]-fluoro-L-phenylalanine (FDOPA) positron emission tomography (PET) is sensitive for identifying primary brain tumors. However, increased FDOPA uptake has been reported in pseudotumoral brain lesions. Our aim was to analyse FDOPA-PET in patients with pseudotumoral brain lesions and to compare them with patients with brain tumors. METHODS We retrospectively analysed consecutively recruited patients with suspected primary brain tumor (based on clinical and magnetic resonance imaging findings) referred for FDOPA-PET in our centre between November 2013 and June 2019 (n = 74). FDOPA-PET parameters (maximum and mean lesion standardised uptake values [SUV] and ratios comparing lesion with different background uptake SUV) and thresholds were evaluated to determine which offered optimal discrimination between pseudotumoral and tumoral lesions. RESULTS Overlapping PET values were observed between pseudotumoral (n = 26) and tumoral (n = 48) lesion, particularly for low-grade tumors. Based on receiver operating characteristic (ROC) analyses, the optimal PET parameters to discriminate pseudotumoral from tumoral lesions were SUVmax lesion/basal ganglia, SUVmax lesion/grey matter, SUVmean lesion/grey matter, and SUVmax lesion/mirror area in contralateral hemisphere (all ratios showing area under the curve [AUC] 0.85, 95% CI). The narrowest 95% sensitivity-95% specificity window was observed for SUVmax lesion/basal ganglia ratio, with ratio values of 0.79 and 1.35 corresponding to 95% sensitivity and 95% specificity, respectively. CONCLUSION FDOPA-PET uptake should be interpreted with caution in patients with suspected primary brain tumor, especially in patients showing low or intermediate SUV values and ratios. CLINICAL TRIAL REGISTRATION-URL: https://www.clinicaltrials.gov . Unique identifier: NCT04306484.
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Affiliation(s)
- Dimitri Renard
- Department of Neurology, CHU Nîmes, University Montpellier, Nîmes, France.
| | - Laurent Collombier
- Department of Nuclear Medicine, CHU Nîmes, University Montpellier, Nîmes, France
| | - Sabine Laurent-Chabalier
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nîmes, University Montpellier, Nîmes, France
| | - Thibault Mura
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nîmes, University Montpellier, Nîmes, France
| | - Anne Le Floch
- Department of Neurology, CHU Nîmes, University Montpellier, Nîmes, France
| | - Hassan El Fertit
- Department of Neurosurgery, CHU Nîmes, University Montpellier, Nîmes, France
| | - Eric Thouvenot
- Department of Neurology, CHU Nîmes, University Montpellier, Nîmes, France.,Institut de Génomique Fonctionnelle, UMR5203, INSERM 1191, University Montpellier, Montpellier, France
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Abstract
OBJECTIVE. Diagnosing brain tumor recurrence, especially with changes that occur after treatment, is a challenge. MRI has an exceptional structural resolution, which is important from the perspective of treatment planning. However, its reliability in diagnosing recurrence is relatively lower, when compared to metabolic imaging. The latter is more sensitive to the early changes associated with recurrence and relatively immune to confounding by treatment related changes. CONCLUSION. There is no one-stop shop for the diagnosis of recurrence in brain tumors. The sensitivity of metabolic imaging is not a substitute for the resolution of the MRI, making a multi-modal approach the only way forward.
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Stegmayr C, Willuweit A, Lohmann P, Langen KJ. O-(2-[18F]-Fluoroethyl)-L-Tyrosine (FET) in Neurooncology: A Review of Experimental Results. Curr Radiopharm 2020; 12:201-210. [PMID: 30636621 DOI: 10.2174/1874471012666190111111046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 11/22/2022]
Abstract
In recent years, PET using radiolabelled amino acids has gained considerable interest as an additional tool besides MRI to improve the diagnosis of cerebral gliomas and brain metastases. A very successful tracer in this field is O-(2-[18F]fluoroethyl)-L-tyrosine (FET) which in recent years has replaced short-lived tracers such as [11C]-methyl-L-methionine in many neuro-oncological centers in Western Europe. FET can be produced with high efficiency and distributed in a satellite concept like 2- [18F]fluoro-2-deoxy-D-glucose. Many clinical studies have demonstrated that FET PET provides important diagnostic information regarding the delineation of cerebral gliomas for therapy planning, an improved differentiation of tumor recurrence from treatment-related changes and sensitive treatment monitoring. In parallel, a considerable number of experimental studies have investigated the uptake mechanisms of FET on the cellular level and the behavior of the tracer in various benign lesions in order to clarify the specificity of FET uptake for tumor tissue. Further studies have explored the effects of treatment related tissue alterations on tracer uptake such as surgery, radiation and drug therapy. Finally, the role of blood-brain barrier integrity for FET uptake which presents an important aspect for PET tracers targeting neoplastic lesions in the brain has been investigated in several studies. Based on a literature research regarding experimental FET studies and corresponding clinical applications this article summarizes the knowledge on the uptake behavior of FET, which has been collected in more than 30 experimental studies during the last two decades and discusses the role of these results in the clinical context.
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Affiliation(s)
- Carina Stegmayr
- Institute of Neuroscience and Medicine 4, Forschungszentrum Juelich, Juelich, Germany
| | - Antje Willuweit
- Institute of Neuroscience and Medicine 4, Forschungszentrum Juelich, Juelich, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine 4, Forschungszentrum Juelich, Juelich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine 4, Forschungszentrum Juelich, Juelich, Germany.,Department of Nuclear Medicine, University of Aachen, Aachen, Germany.,Juelich-Aachen Research Alliance (JARA) - Section JARA-Brain, Juelich, Germany
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Verhoeven J, Baguet T, Piron S, Pauwelyn G, Bouckaert C, Descamps B, Raedt R, Vanhove C, De Vos F, Goethals I. 2-[ 18F]FELP, a novel LAT1-specific PET tracer, for the discrimination between glioblastoma, radiation necrosis and inflammation. Nucl Med Biol 2019; 82-83:9-16. [PMID: 31841816 DOI: 10.1016/j.nucmedbio.2019.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Considering the need for rapid change of treatment in recurrent glioblastoma (GB), it is of utmost importance to characterize PET radiopharmaceuticals that allow early discrimination of tumor from therapy-related effects. In this study, we examined the value of 2-[18F]FELP as a LAT1 tumor-specific PET tracer in comparison with [18F]FDG and [18F]FET in a combined orthotopic rat radiation necrosis and glioblastoma model. A second experiment compared 2-[18F]FELP to [18F]FDG in a mouse glioblastoma - inflammation model. METHODS Using the small animal radiation research platform (SARRP), radiation necrosis (RN) was induced in the left frontal lobe of the rat brain. When radiation-induced changes were visible on MRI, F98 rat glioblastoma cells were stereotactically inoculated in the contralateral right frontal lobe. When tumor growth was confirmed on MRI, 2-[18F]FELP, [18F]FET and [18F]FDG PET scans were acquired on three consecutive days. In an inflammation experiment, mice were inoculated in the left thigh with U87 human glioblastoma cells. After heterotopic tumor growth was confirmed macroscopically, inflammation was induced by injection of turpentine subcutaneously in the right thigh. Subsequently, 2-[18F]FELP and [18F]FDG scans were acquired on two consecutive days. RESULTS The in vivo PET images demonstrated that 2-[18F]FELP could differentiate glioblastoma and radiation necrosis using SUVmean (p = 0.0016) and LNRmean (p = 0.009), while [18F]FET was only able to differentiate both lesions by means of the SUVmean. (p = 0.047) Delayed [18F]FDGlate PET (4 h postinjection) was also able to distinguish glioblastoma from radiation necrosis, but smaller lesion-to-normal brain ratios were observed (SUVmean: p = 0.009; LNRmean: p = 0.028). In the inflammation study, 2-[18F]FELP showed no significant uptake in the inflammation lesion when compared to the control group (SUVmean: p = 0.149; LNRmean: p = 0.083). In contrast, both conventional and delayed [18F]FDG displayed significant uptake in the turpentine-invoked lesion (SUVmean: p = 0.021; LNRmean: p = 0.021). CONCLUSION This study suggests that the 2-[18F]FELP PET is able to differentiate glioblastoma from radiation necrosis and that the 2-[18F]FELP uptake is less likely to be contaminated by the presence of inflammation than the [18F]FDG signal. ADVANCES IN KNOWLEDGE These results are clinically relevant for the differential diagnosis between tumor and radiation necrosis because radiation necrosis always contains a certain amount of inflammatory cells. Hence, 2-[18F]FELP is preferred to discriminate tumor from radiation necrosis.
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Affiliation(s)
| | - Tristan Baguet
- Laboratory for Radiopharmacy, Ghent University, Ghent, Belgium
| | - Sarah Piron
- Laboratory for Radiopharmacy, Ghent University, Ghent, Belgium
| | - Glenn Pauwelyn
- Laboratory for Radiopharmacy, Ghent University, Ghent, Belgium
| | - Charlotte Bouckaert
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Ghent University Hospital, Ghent, Belgium
| | - Benedicte Descamps
- IBiTech-MEDISIP, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Robrecht Raedt
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Ghent University Hospital, Ghent, Belgium
| | - Christian Vanhove
- IBiTech-MEDISIP, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Filip De Vos
- Laboratory for Radiopharmacy, Ghent University, Ghent, Belgium
| | - Ingeborg Goethals
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
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Geisler S, Stegmayr C, Niemitz N, Lohmann P, Rapp M, Stoffels G, Willuweit A, Galldiks N, Filss C, Sabel MC, Coenen HH, Shah NJ, Langen KJ. Treatment-Related Uptake of O-(2-18F-Fluoroethyl)-l-Tyrosine and l-[Methyl-3H]-Methionine After Tumor Resection in Rat Glioma Models. J Nucl Med 2019; 60:1373-1379. [DOI: 10.2967/jnumed.119.225680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/20/2019] [Indexed: 12/20/2022] Open
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Lohmann P, Piroth MD, Sellhaus B, Weis J, Geisler S, Oros-Peusquens AM, Mohlberg H, Amunts K, Shah NJ, Galldiks N, Langen KJ. Correlation of Dynamic O-(2-[ 18F]Fluoroethyl)-L-Tyrosine Positron Emission Tomography, Conventional Magnetic Resonance Imaging, and Whole-Brain Histopathology in a Pretreated Glioblastoma: A Postmortem Study. World Neurosurg 2018; 119:e653-e660. [PMID: 30077752 DOI: 10.1016/j.wneu.2018.07.232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Amino acid positron emission tomography (PET) using O-(2-[18F]fluoroethyl)-L-tyrosine (FET) provides important additional information on the extent of viable tumor tissue of glioblastoma compared with magnetic resonance imaging (MRI). Especially after radiochemotherapy, progression of contrast enhancement in MRI is equivocal and may represent either tumor progression or treatment-related changes. Here, the first case comparing postmortem whole-brain histology of a patient with pretreated glioblastoma with dynamic in vivo FET PET and MRI is presented. METHODS A 61-year-old patient with glioblastoma initially underwent partial tumor resection and died 11 weeks after completion of chemoradiation with concurrent temozolomide. Three days before the patient died, a follow-up FET PET and MRI scan indicated tumor progression. Autopsy was performed 48 hours after death. After formalin fixation, a 7-cm bihemispherical segment of the brain containing the entire tumor mass was cut into 3500 consecutive 20μm coronal sections. Representative sections were stained with hematoxylin and eosin stain, cresyl violet, and glial fibrillary acidic protein immunohistochemistry. An experienced neuropathologist identified areas of dense and diffuse neoplastic infiltration, astrogliosis, and necrosis. In vivo FET PET, MRI datasets, and postmortem histology were co-registered and compared by 3 experienced physicians. RESULTS Increased uptake of FET in the area of equivocal contrast enhancement on MRI correlated very well with dense infiltration by vital tumor cells and showed tracer kinetics typical for malignant gliomas. An area of predominantly reactive astrogliosis showed only moderate uptake of FET and tracer kinetics usually observed in benign lesions. CONCLUSIONS This case report impressively documents the correct imaging of a progressive glioblastoma by FET PET.
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Affiliation(s)
- Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-1, -3, -4, -11), Forschungszentrum Juelich, Juelich, Germany.
| | - Marc D Piroth
- Department of Radiation Oncology, HELIOS Hospital Wuppertal, Wuppertal, Germany; Department of Radiation Oncology, University Hospital RWTH Aachen, Aachen, Germany
| | - Bernd Sellhaus
- Institute of Neuropathology, University Hospital RWTH Aachen, Aachen, Germany
| | - Joachim Weis
- Institute of Neuropathology, University Hospital RWTH Aachen, Aachen, Germany
| | - Stefanie Geisler
- Institute of Neuroscience and Medicine (INM-1, -3, -4, -11), Forschungszentrum Juelich, Juelich, Germany
| | - Ana-Maria Oros-Peusquens
- Institute of Neuroscience and Medicine (INM-1, -3, -4, -11), Forschungszentrum Juelich, Juelich, Germany
| | - Hartmut Mohlberg
- Institute of Neuroscience and Medicine (INM-1, -3, -4, -11), Forschungszentrum Juelich, Juelich, Germany
| | - Katrin Amunts
- Institute of Neuroscience and Medicine (INM-1, -3, -4, -11), Forschungszentrum Juelich, Juelich, Germany
| | - Nadim J Shah
- Institute of Neuroscience and Medicine (INM-1, -3, -4, -11), Forschungszentrum Juelich, Juelich, Germany; Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-1, -3, -4, -11), Forschungszentrum Juelich, Juelich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-1, -3, -4, -11), Forschungszentrum Juelich, Juelich, Germany; Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
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12
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Imaging of amino acid transport in brain tumours: Positron emission tomography with O-(2-[ 18 F]fluoroethyl)- L -tyrosine (FET). Methods 2017; 130:124-134. [DOI: 10.1016/j.ymeth.2017.05.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/08/2017] [Accepted: 05/21/2017] [Indexed: 01/01/2023] Open
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13
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Poulsen SH, Urup T, Grunnet K, Christensen IJ, Larsen VA, Jensen ML, Af Rosenschöld PM, Poulsen HS, Law I. The prognostic value of FET PET at radiotherapy planning in newly diagnosed glioblastoma. Eur J Nucl Med Mol Imaging 2017; 44:373-381. [PMID: 27554774 PMCID: PMC5281673 DOI: 10.1007/s00259-016-3494-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/10/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Glioblastoma patients show a great variability in progression free survival (PFS) and overall survival (OS). To gain additional pretherapeutic information, we explored the potential of O-(2-18F-fluoroethyl)-L-tyrosine (FET) PET as an independent prognostic biomarker. METHODS We retrospectively analyzed 146 consecutively treated, newly diagnosed glioblastoma patients. All patients were treated with temozolomide and radiation therapy (RT). CT/MR and FET PET scans were obtained postoperatively for RT planning. We used Cox proportional hazards models with OS and PFS as endpoints, to test the prognostic value of FET PET biological tumor volume (BTV). RESULTS Median follow-up time was 14 months, and median OS and PFS were 16.5 and 6.5 months, respectively. In the multivariate analysis, increasing BTV (HR = 1.17, P < 0.001), poor performance status (HR = 2.35, P < 0.001), O(6)-methylguanine-DNA methyltransferase protein status (HR = 1.61, P = 0.024) and higher age (HR = 1.32, P = 0.013) were independent prognostic factors of poor OS. For poor PFS, only increasing BTV (HR = 1.18; P = 0.002) was prognostic. A prognostic index for OS was created based on the identified prognostic factors. CONCLUSION Large BTV on FET PET is an independent prognostic factor of poor OS and PFS in glioblastoma patients. With the introduction of FET PET, we obtain a prognostic index that can help in glioblastoma treatment planning.
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Affiliation(s)
- Sidsel Højklint Poulsen
- Department of Radiation Biology, The Finsen Center, Rigshospitalet, Section 6321, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
- Department of Clinical Physiology, Nuclear Medicine and PET, Center of Diagnostic Investigation, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Thomas Urup
- Department of Radiation Biology, The Finsen Center, Rigshospitalet, Section 6321, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Department of Oncology, The Finsen Center, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Kirsten Grunnet
- Department of Radiation Biology, The Finsen Center, Rigshospitalet, Section 6321, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Department of Oncology, The Finsen Center, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Ib Jarle Christensen
- Laboratory of Gastroenterology, University of Copenhagen, Hvidovre Hospital, Kettegård Allé 30, DK-2650, Copenhagen, Denmark
| | - Vibeke Andrée Larsen
- Department of Radiology, Center of Diagnostic Investigation, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Michael Lundemann Jensen
- Department of Oncology, The Finsen Center, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Section of Radiotherapy, The Finsen Center, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Per Munck Af Rosenschöld
- Department of Oncology, The Finsen Center, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Section of Radiotherapy, The Finsen Center, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Hans Skovgaard Poulsen
- Department of Radiation Biology, The Finsen Center, Rigshospitalet, Section 6321, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Department of Oncology, The Finsen Center, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Center of Diagnostic Investigation, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
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14
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Zinnhardt B, Pigeon H, Thézé B, Viel T, Wachsmuth L, Fricke IB, Schelhaas S, Honold L, Schwegmann K, Wagner S, Faust A, Faber C, Kuhlmann MT, Hermann S, Schäfers M, Winkeler A, Jacobs AH. Combined PET Imaging of the Inflammatory Tumor Microenvironment Identifies Margins of Unique Radiotracer Uptake. Cancer Res 2017; 77:1831-1841. [PMID: 28137769 DOI: 10.1158/0008-5472.can-16-2628] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 11/16/2022]
Abstract
The tumor microenvironment is highly heterogeneous. For gliomas, the tumor-associated inflammatory response is pivotal to support growth and invasion. Factors of glioma growth, inflammation, and invasion, such as the translocator protein (TSPO) and matrix metalloproteinases (MMP), may serve as specific imaging biomarkers of the glioma microenvironment. In this study, noninvasive imaging by PET with [18F]DPA-714 (TSPO) and [18F]BR-351 (MMP) was used for the assessment of localization and quantification of the expression of TSPO and MMP. Imaging was performed in addition to established clinical imaging biomarker of active tumor volume ([18F]FET) in conjunction with MRI. We hypothesized that each imaging biomarker revealed distinct areas of the heterogeneous glioma tissue in a mouse model of human glioma. Tracers were found to be increased 1.4- to 1.7-fold, with [18F]FET showing the biggest volume as depicted by a thresholding-based, volumes of interest analysis. Tumor areas, which could not be detected by a single tracer and/or MRI parameter alone, were measured. Specific compartments of [18F]DPA-714 (14%) and [18F]BR-351 (11%) volumes along the tumor rim could be identified. [18F]DPA-714 (TSPO) and [18F]BR-351 (MMP) matched with histology. Glioma-associated microglia/macrophages (GAM) were identified as TSPO and MMP sources. Multitracer and multimodal molecular imaging approaches may allow us to gain important insights into glioma-associated inflammation (GAM, MMP). Moreover, this noninvasive technique enables characterization of the glioma microenvironment with respect to the disease-driving cellular compartments at the various disease stages. Cancer Res; 77(8); 1831-41. ©2017 AACR.
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Affiliation(s)
- Bastian Zinnhardt
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-University Münster, Münster, Germany.
| | - Hayet Pigeon
- Imagerie Moléculaire In Vivo, Inserm, CEA, Univ. Paris Sud, CNRS, Université Paris Saclay, CEA - Service Hospitalier Frédéric Joliot, Orsay, France
| | - Benoit Thézé
- Imagerie Moléculaire In Vivo, Inserm, CEA, Univ. Paris Sud, CNRS, Université Paris Saclay, CEA - Service Hospitalier Frédéric Joliot, Orsay, France
| | - Thomas Viel
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-University Münster, Münster, Germany.,PARCC INSERM-U970, Université Paris Descartes, Paris, France
| | - Lydia Wachsmuth
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Inga B Fricke
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-University Münster, Münster, Germany
| | - Sonja Schelhaas
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-University Münster, Münster, Germany
| | - Lisa Honold
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-University Münster, Münster, Germany
| | - Katrin Schwegmann
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-University Münster, Münster, Germany
| | - Stefan Wagner
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Andreas Faust
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-University Münster, Münster, Germany
| | - Cornelius Faber
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany.,DFG EXC 1003 Cluster of Excellence 'Cells in Motion', University of Münster, Münster, Germany
| | - Michael T Kuhlmann
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-University Münster, Münster, Germany
| | - Sven Hermann
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-University Münster, Münster, Germany.,DFG EXC 1003 Cluster of Excellence 'Cells in Motion', University of Münster, Münster, Germany
| | - Michael Schäfers
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-University Münster, Münster, Germany.,Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.,DFG EXC 1003 Cluster of Excellence 'Cells in Motion', University of Münster, Münster, Germany
| | - Alexandra Winkeler
- Imagerie Moléculaire In Vivo, Inserm, CEA, Univ. Paris Sud, CNRS, Université Paris Saclay, CEA - Service Hospitalier Frédéric Joliot, Orsay, France
| | - Andreas H Jacobs
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-University Münster, Münster, Germany.,DFG EXC 1003 Cluster of Excellence 'Cells in Motion', University of Münster, Münster, Germany.,Department of Geriatrics, Johanniter Hospital, Evangelische Kliniken, Bonn, Germany
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15
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Lundemann M, Costa JC, Law I, Engelholm SA, Muhic A, Poulsen HS, Munck Af Rosenschold P. Patterns of failure for patients with glioblastoma following O-(2-[ 18F]fluoroethyl)-L-tyrosine PET- and MRI-guided radiotherapy. Radiother Oncol 2017; 122:380-386. [PMID: 28110959 DOI: 10.1016/j.radonc.2017.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/29/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the patterns of failure following clinical introduction of amino-acid O-(2-[18F]fluoroethyl)-L-tyrosine (FET)-PET-guided target definition for radiotherapy (RT) of glioblastoma patients. MATERIALS AND METHODS The first 66 consecutive patients with confirmed histology, scanned using FET-PET/CT and MRI were selected for evaluation. Chemo-radiotherapy was delivered to a volume based on both MRI and FET-PET (PETvol). The volume of recurrence (RV) was defined on MRI data collected at the time of progression according to RANO criteria. RESULTS Fifty patients were evaluable, with median follow-up of 45months. Central, in-field, marginal and distant recurrences were observed for 82%, 10%, 2%, and 6% of the patients, respectively. We found a volumetric overlap of 26%, 31% and 39% of the RV with the contrast-enhancing MR volume, PETvol and the composite MRPETvol, respectively. MGMT-methylation (p=0.03), larger PETvol (p<0.001), and less extensive surgery (p<0.001), were associated with larger PETvol overlap. CONCLUSION The combined MRPETvol had a stronger association with the recurrence volume than either of the modalities alone. Larger overlap of PETvol and RV was observed for patients with MGMT-methylation, less extensive surgery, and large PETvol on the RT-planning scans.
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Affiliation(s)
- Michael Lundemann
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark; Niels Bohr Institute, Department of Science, University of Copenhagen, København Ø, Denmark.
| | - Junia Cardoso Costa
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark; Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark
| | - Svend Aage Engelholm
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark
| | - Aida Muhic
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark
| | - Hans Skovgaard Poulsen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark
| | - Per Munck Af Rosenschold
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark; Niels Bohr Institute, Department of Science, University of Copenhagen, København Ø, Denmark
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16
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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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17
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Stegmayr C, Bandelow U, Oliveira D, Lohmann P, Willuweit A, Filss C, Galldiks N, Lübke JHR, Shah NJ, Ermert J, Langen KJ. Influence of blood-brain barrier permeability on O-(2- 18F-fluoroethyl)-L-tyrosine uptake in rat gliomas. Eur J Nucl Med Mol Imaging 2016; 44:408-416. [PMID: 27613541 DOI: 10.1007/s00259-016-3508-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/29/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) is an established tracer for the diagnosis of brain tumors with PET. This study investigates the influence of blood-brain barrier (BBB) permeability on 18F-FET uptake in two rat glioma models and one human xenograft model. METHODS F98 glioma, 9L gliosarcoma or human U87 glioblastoma cells were implanted into the striatum of 56 Fischer or RNU rats. Thereafter, animals were divided into a control group and a group receiving injections of the glucocorticoid dexamethasone (Dex). After 12-13 days of tumor growth animals received injection of Evans blue dye (EBD) to visualize BBB disturbance and underwent 18F-FET PET followed by autoradiography. Time activity curves, standardized uptake values (SUV) and Tumor-to-brain ratios (TBR) of 18F-FET uptake [18-61 min post injection (p.i.)] were evaluated using a volume-of-Interest (VOI) analysis. BBB disturbance was quantitatively evaluated by EBD fluorescence. The membrane gaps of blood vessel endothelial tight junctions were measured using electron microscopy to visualize ultrastructural BBB alterations in one untreated and one Dex treated F98 glioma. Data were analyzed by two-way ANOVAs. RESULTS In Dex treated animals EBD extravasation was significantly reduced in 9L (P < 0.001) and U87 (P = 0.008) models and showed a trend in F98 models (P = 0.053). In contrast, no significant differences of 18F-FET uptake were observed between Dex treated animals and control group except a decrease of the TBR in the 9L tumor model in PET (P < 0.01). Ultrastructural evaluation of tumor blood vessel endothelia revealed significant reduction of the cleft diameter between endothelial cells after Dex treatment in F98 model (P = 0.010). CONCLUSION Despite a considerable reduction of BBB permeability in rat gliomas after Dex treatment, no relevant changes of 18F-FET uptake were noted in this experimental study. Thus, 18F-FET uptake in gliomas appears to be widely independent of the permeability of the BBB.
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Affiliation(s)
- Carina Stegmayr
- Forschungszentrum Jülich, Institute of Neuroscience and Medicine, D-52425, Jülich, Germany.
| | - Ulrike Bandelow
- Forschungszentrum Jülich, Institute of Neuroscience and Medicine, D-52425, Jülich, Germany
| | - Dennis Oliveira
- Forschungszentrum Jülich, Institute of Neuroscience and Medicine, D-52425, Jülich, Germany
| | - Philipp Lohmann
- Forschungszentrum Jülich, Institute of Neuroscience and Medicine, D-52425, Jülich, Germany
| | - Antje Willuweit
- Forschungszentrum Jülich, Institute of Neuroscience and Medicine, D-52425, Jülich, Germany
| | - Christian Filss
- Forschungszentrum Jülich, Institute of Neuroscience and Medicine, D-52425, Jülich, Germany.,Department of Nuclear Medicine and Neurology, RWTH/University Hospital Aachen, Aachen, Germany
| | - Norbert Galldiks
- Forschungszentrum Jülich, Institute of Neuroscience and Medicine, D-52425, Jülich, Germany
| | - Joachim H R Lübke
- Forschungszentrum Jülich, Institute of Neuroscience and Medicine, D-52425, Jülich, Germany
| | - N Jon Shah
- Forschungszentrum Jülich, Institute of Neuroscience and Medicine, D-52425, Jülich, Germany.,Department of Nuclear Medicine and Neurology, RWTH/University Hospital Aachen, Aachen, Germany.,Jülich-Aachen Research Alliance (JARA) - Section JARA-Brain, Aachen, Germany
| | - Johannes Ermert
- Forschungszentrum Jülich, Institute of Neuroscience and Medicine, D-52425, Jülich, Germany.,Department of Nuclear Medicine and Neurology, RWTH/University Hospital Aachen, Aachen, Germany
| | - Karl-Josef Langen
- Forschungszentrum Jülich, Institute of Neuroscience and Medicine, D-52425, Jülich, Germany. .,Department of Nuclear Medicine and Neurology, RWTH/University Hospital Aachen, Aachen, Germany.
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18
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Harat M, Małkowski B, Makarewicz R. Pre-irradiation tumour volumes defined by MRI and dual time-point FET-PET for the prediction of glioblastoma multiforme recurrence: A prospective study. Radiother Oncol 2016; 120:241-7. [PMID: 27378734 DOI: 10.1016/j.radonc.2016.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 06/07/2016] [Accepted: 06/12/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE The diagnostic accuracy of magnetic resonance imaging (MRI) for glioblastoma multiforme (GBM) is suboptimal. We analysed pre-treatment MRI- and dual time-point 18F-fluoroethylthyrosine-PET (FET-PET)-based target volumes and GBM recurrence patterns following radiotherapy with temozolomide. MATERIALS AND METHODS Thirty-four patients with primary GBM were treated according to MRI-based treatment volumes (GTVRM). Patients underwent dual time-point FET-PET scans prior to treatment, and biological tumour volumes (GTVPET) were contoured but not used for target definition. Progressions were classified based on location of primary GTVs. Volume and uniformity of MRI- vs. FET-PET/CT-derived GTVs and progression patterns assessed by MRI were analysed. RESULTS FET-based GTVs measured 10min after radionuclide injection (a.r.i.; median 37.3cm(3)) were larger than GTVs measured 60min a.r.i. (median 27.7cm(3)). GTVPET volumes were significantly larger than corresponding MRI-based GTVs. MRI and PET concordance for the identification of glioblastoma GTVs was poor (mean uniformity index 0.4). 74% of failures were inside primary GTVPET volumes, with no solitary progressions inside the MRI-defined margin +20mm but outside the GTVPET detected. CONCLUSIONS The size and geometry of GTVs differed in the majority of patients. The GTVPET volume depends on time after radionuclide injection. FET-PET better defined failure site than MRI alone.
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Affiliation(s)
- Maciej Harat
- Department of Radiotherapy, The Franciszek Lukaszczyk Oncology Center, Bydgoszcz, Poland; Department of Oncology and Brachytherapy, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland.
| | - Bogdan Małkowski
- Department of Positron Emission Tomography and Molecular Imaging, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland; Department of Nuclear Medicine, The Franciszek Lukaszczyk Oncology Center, Bydgoszcz, Poland
| | - Roman Makarewicz
- Department of Oncology and Brachytherapy, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland; Department of Oncology and Brachytherapy, The Franciszek Lukaszczyk Oncology Center, Bydgoszcz, Poland
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19
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Persico MG, Buroni FE, Pasi F, Lodola L, Aprile C, Nano R, Hodolic M. (18)F-FET and (18)F-FCH uptake in human glioblastoma T98G cell lines. Radiol Oncol 2016; 50:153-8. [PMID: 27247547 PMCID: PMC4852969 DOI: 10.1515/raon-2016-0022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/18/2016] [Indexed: 11/15/2022] Open
Abstract
Background Despite complex treatment of surgery, radiotherapy and chemotherapy, high grade gliomas often recur. Differentiation between post-treatment changes and recurrence is difficult. 18F-methyl-choline (18F-FCH) is frequently used in staging and detection of recurrent prostate cancer disease as well as some brain tumours; however accumulation in inflammatory tissue limits its specificity. The 18F-ethyl-tyrosine (18F-FET) shows a specific uptake in malignant cells, resulting from increased expression of amino acid transporters or diffusing through the disrupted blood-brain barrier. 18F-FET exhibits lower uptake in machrophages and other inflammatory cells. Aim of this study was to evaluate 18F-FCH and 18F-FET uptake by human glioblastoma T98G cells. Material and methods Human glioblastoma T98G or human dermal fibroblasts cells, seeded at a density to obtain 2 × 105 cells per flask when radioactive tracers were administered, grew adherent to the plastic surface at 37°C in 5% CO2 in complete medium. Equimolar amounts of radiopharmaceuticals were added to cells for different incubation times (20 to 120 minutes) for 18F-FCH and 18F-FET respectively. The cellular radiotracer uptake was determined with a gamma counter. All experiments were carried out in duplicate and repeated three times. The uptake measurements are expressed as the percentage of the administered dose of tracer per 2 × 105 cells. Data (expressed as mean values of % uptake of radiopharmaceuticals) were compared using parametric or non-parametric tests as appropriate. Differences were regarded as statistically significant when p<0.05. Results A significant uptake of 18F-FCH was seen in T98G cells at 60, 90 and 120 minutes. The percentage uptake of 18F-FET in comparison to 18F-FCH was lower by a factor of more than 3, with different kinetic curves.18F-FET showed a more rapid initial uptake up to 40 minutes and 18F-FCH showed a progressive rise reaching a maximum after 90 minutes. Conclusions 18F-FCH and 18F-FET are candidates for neuro-oncological PET imaging. 18F-FET could be the most useful oncological PET marker in the presence of reparative changes after therapy, where the higher affinity of 18F-FCH to inflammatory cells makes it more difficult to discriminate between tumour persistence and non-neoplastic changes. Additional studies on the influence of inflammatory tissue and radionecrotic cellular components on radiopharmaceutical uptake are necessary.
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Affiliation(s)
- Marco Giovanni Persico
- Department of Oncohaematology, Nuclear Medicine Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Federica Eleonora Buroni
- Department of Oncohaematology, Nuclear Medicine Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Francesca Pasi
- Department of Oncohaematology, Radiotherapy Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Lorenzo Lodola
- Department of Oncohaematology, Nuclear Medicine Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Carlo Aprile
- Department of Oncohaematology, Nuclear Medicine Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Rosanna Nano
- Department of Biology and Biotecnology "Lazzaro Spallanzani", University of Pavia, Pavia, Italy
| | - Marina Hodolic
- Nuclear medicine research department, Iason, Graz, Austria
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Stegmayr C, Schöneck M, Oliveira D, Willuweit A, Filss C, Galldiks N, Shah NJ, Coenen HH, Langen KJ. Reproducibility of O-(2-18F-fluoroethyl)-L-tyrosine uptake kinetics in brain tumors and influence of corticoid therapy: an experimental study in rat gliomas. Eur J Nucl Med Mol Imaging 2015; 43:1115-23. [DOI: 10.1007/s00259-015-3274-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
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Gempt J, Bette S, Buchmann N, Ryang YM, Förschler A, Pyka T, Wester HJ, Förster S, Meyer B, Ringel F. Volumetric Analysis of F-18-FET-PET Imaging for Brain Metastases. World Neurosurg 2015; 84:1790-7. [PMID: 26255241 DOI: 10.1016/j.wneu.2015.07.067] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The knowledge of exact tumor margins is of importance for the treating neurosurgeon, radiotherapist, and oncologist alike. The aim of this study was to investigate whether tumor volume and tumor margins acquired by magnetic resonance imaging (MRI) are congruent with the findings acquired by O-(2-(18F)-fluoroethyl)-L-tyrosine-positron emission tomography (FET-PET). METHODS Patients received FET-PET and MRI before surgery for brain metastases. Metastases were quantified by calculating tumor-to-background uptake ratios using FET uptake. PET and MRI-based tumor volumes, as well as areas of intersection, were assessed. RESULTS Forty-one patients were enrolled in the study. The maximum tumor-to-background uptake ratio measured in all of our patients harboring histologically proven viable tumor tissue was >1.6. Absolute tumor volumes acquired by FET-PET and MRI were not congruent in our patient cohort, and tumors identified in FET-PET and MRI only partially overlapped. The ratio of intersection (intersection of tumor defined by MRI and tumor defined by FET-PET at the ratio of tumor defined by FET-PET) was within a range of 0.27-0.68 when applying the different thresholds. CONCLUSIONS Our study therefore indicates that treatment planning based on MRI or PET only might have a substantial risk of undertreatment at the tumor margins. These findings could have important implications for the planning of surgery as well as radiotherapy, although they have to be validated in further studies.
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Affiliation(s)
- Jens Gempt
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany.
| | - Stefanie Bette
- Abteilung für Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Niels Buchmann
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Yu-Mi Ryang
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Annette Förschler
- Abteilung für Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Thomas Pyka
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Hans-Jürgen Wester
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Stefan Förster
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Bernhard Meyer
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Florian Ringel
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Pretze M, Wängler C, Wängler B. 6-[18F]fluoro-L-DOPA: a well-established neurotracer with expanding application spectrum and strongly improved radiosyntheses. BIOMED RESEARCH INTERNATIONAL 2014; 2014:674063. [PMID: 24987698 PMCID: PMC4058520 DOI: 10.1155/2014/674063] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/17/2014] [Accepted: 04/18/2014] [Indexed: 11/18/2022]
Abstract
For many years, the main application of [(18)F]F-DOPA has been the PET imaging of neuropsychiatric diseases, movement disorders, and brain malignancies. Recent findings however point to very favorable results of this tracer for the imaging of other malignant diseases such as neuroendocrine tumors, pheochromocytoma, and pancreatic adenocarcinoma expanding its application spectrum. With the application of this tracer in neuroendocrine tumor imaging, improved radiosyntheses have been developed. Among these, the no-carrier-added nucleophilic introduction of fluorine-18, especially, has gained increasing attention as it gives [(18)F]F-DOPA in higher specific activities and shorter reaction times by less intricate synthesis protocols. The nucleophilic syntheses which were developed recently are able to provide [(18)F]F-DOPA by automated syntheses in very high specific activities, radiochemical yields, and enantiomeric purities. This review summarizes the developments in the field of [(18)F]F-DOPA syntheses using electrophilic synthesis pathways as well as recent developments of nucleophilic syntheses of [(18)F]F-DOPA and compares the different synthesis strategies regarding the accessibility and applicability of the products for human in vivo PET tumor imaging.
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Affiliation(s)
- M. Pretze
- Molecular Imaging and Radiochemistry, Department of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - C. Wängler
- Biomedical Chemistry, Department of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim of Heidelberg University, 68167 Mannheim, Germany
| | - B. Wängler
- Molecular Imaging and Radiochemistry, Department of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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