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Wiggins RH, Hoffman JM, Fine GC, Covington MF, Salem AE, Koppula BR, Morton KA. PET-CT in Clinical Adult Oncology-V. Head and Neck and Neuro Oncology. Cancers (Basel) 2022; 14:cancers14112726. [PMID: 35681709 PMCID: PMC9179458 DOI: 10.3390/cancers14112726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Positron emission tomography (PET), typically combined with computed tomography (CT) has become a critical advanced imaging technique in oncology. With PET-CT, a radioactive molecule (radiotracer) is injected in the bloodstream and localizes to sites of tumor because of specific cellular features of the tumor that accumulate the targeting radiotracer. The CT scan, performed at the same time, provides information to facilitate attenuation correction, so that radioactivity from deep or dense structures can be better visualized, but with head and neck malignancies it is critical to provide correlating detailed anatomic imaging. PET-CT has a variety of applications in oncology, including staging, therapeutic response assessment, restaging, and surveillance. This series of six review articles provides an overview of the value, applications, and imaging and interpretive strategies of PET-CT in the more common adult malignancies. The fifth report in this series provides a review of PET-CT imaging in head and neck and neuro oncology. Abstract PET-CT is an advanced imaging modality with many oncologic applications, including staging, assessment of response to therapy, restaging, and longitudinal surveillance for recurrence. The goal of this series of six review articles is to provide practical information to providers and imaging professionals regarding the best use of PET-CT for specific oncologic indications, and the potential pitfalls and nuances that characterize these applications. In addition, key tumor-specific clinical information and representative PET-CT images are provided to outline the role that PET-CT plays in the management of oncology patients. Hundreds of different types of tumors exist, both pediatric and adult. A discussion of the role of FDG PET for all of these is beyond the scope of this review. Rather, this series of articles focuses on the most common adult malignancies that may be encountered in clinical practice. It also focuses on FDA-approved and clinically available radiopharmaceuticals, rather than research tracers or those requiring a local cyclotron. The fifth review article in this series focuses on PET-CT imaging in head and neck tumors, as well as brain tumors. Common normal variants, key anatomic features, and benign mimics of these tumors are reviewed. The goal of this review article is to provide the imaging professional with guidance in the interpretation of PET-CT for the more common head and neck malignancies and neuro oncology, and to inform the referring providers so that they can have realistic expectations of the value and limitations of PET-CT for the specific type of tumor being addressed.
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Affiliation(s)
- Richard H. Wiggins
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
| | - John M. Hoffman
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
| | - Gabriel C. Fine
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
| | - Matthew F. Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
| | - Ahmed Ebada Salem
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
- Department of Radiodiagnosis and Intervention, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
| | - Bhasker R. Koppula
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
| | - Kathryn A. Morton
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
- Intermountain Healthcare Hospitals, Summit Physician Specialists, Murray, UT 84123, USA
- Correspondence: ; Tel.: +1-801-581-7553
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PET Imaging in Neuro-Oncology: An Update and Overview of a Rapidly Growing Area. Cancers (Basel) 2022; 14:cancers14051103. [PMID: 35267411 PMCID: PMC8909369 DOI: 10.3390/cancers14051103] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/08/2022] [Accepted: 02/19/2022] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Positron emission tomography (PET) is a functional imaging technique which plays an increasingly important role in the management of brain tumors. Owing different radiotracers, PET allows to image different metabolic aspects of the brain tumors. This review outlines currently available PET radiotracers and their respective indications in neuro-oncology. It specifically focuses on the investigation of gliomas, meningiomas, primary central nervous system lymphomas as well as brain metastases. Recent advances in the production of PET radiotracers, image analyses and translational applications to peptide radionuclide receptor therapy, which allow to treat brain tumors with radiotracers, are also discussed. The objective of this review is to provide a comprehensive overview of PET imaging’s potential in neuro-oncology as an adjunct to brain magnetic resonance imaging (MRI). Abstract PET plays an increasingly important role in the management of brain tumors. This review outlines currently available PET radiotracers and their respective indications. It specifically focuses on 18F-FDG, amino acid and somatostatin receptor radiotracers, for imaging gliomas, meningiomas, primary central nervous system lymphomas as well as brain metastases. Recent advances in radiopharmaceuticals, image analyses and translational applications to therapy are also discussed. The objective of this review is to provide a comprehensive overview of PET imaging’s potential in neuro-oncology as an adjunct to brain MRI for all medical professionals implicated in brain tumor diagnosis and care.
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Voss M, Wenger KJ, von Mettenheim N, Bojunga J, Vetter M, Diehl B, Franz K, Gerlach R, Ronellenfitsch MW, Harter PN, Hattingen E, Steinbach JP, Rödel C, Rieger J. Short-term fasting in glioma patients: analysis of diet diaries and metabolic parameters of the ERGO2 trial. Eur J Nutr 2021; 61:477-487. [PMID: 34487222 PMCID: PMC8783850 DOI: 10.1007/s00394-021-02666-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/19/2021] [Indexed: 12/21/2022]
Abstract
Purpose The prospective, randomized ERGO2 trial investigated the effect of calorie-restricted ketogenic diet and intermittent fasting (KD-IF) on re-irradiation for recurrent brain tumors. The study did not meet its primary endpoint of improved progression-free survival in comparison to standard diet (SD). We here report the results of the quality of life/neurocognition and a detailed analysis of the diet diaries. Methods 50 patients were randomized 1:1 to re-irradiation combined with either SD or KD-IF. The KD-IF schedule included 3 days of ketogenic diet (KD: 21–23 kcal/kg/d, carbohydrate intake limited to 50 g/d), followed by 3 days of fasting and again 3 days of KD. Follow-up included examination of cognition, quality of life and serum samples. Results The 20 patients who completed KD-IF met the prespecified goals for calorie and carbohydrate restriction. Substantial decreases in leptin and insulin and an increase in uric acid were observed. The SD group, of note, had a lower calorie intake than expected (21 kcal/kg/d instead of 30 kcal/kg/d). Neither quality of life nor cognition were affected by the diet. Low glucose emerged as a significant prognostic parameter in a best responder analysis. Conclusion The strict caloric goals of the ERGO2 trial were tolerated well by patients with recurrent brain cancer. The short diet schedule led to significant metabolic changes with low glucose emerging as a candidate marker of better prognosis. The unexpected lower calorie intake of the control group complicates the interpretation of the results. Clinicaltrials.gov number: NCT01754350; Registration: 21.12.2012. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-021-02666-1.
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Affiliation(s)
- Martin Voss
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany. .,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany. .,Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Stiftung Des Öffentlichen Rechts, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. .,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Paul-Ehrlich-Straße 42-44, 60596, Frankfurt/Main, Germany.
| | - Katharina J Wenger
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.,Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Stiftung Des Öffentlichen Rechts, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Paul-Ehrlich-Straße 42-44, 60596, Frankfurt/Main, Germany.,Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany
| | - Nina von Mettenheim
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.,Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Stiftung Des Öffentlichen Rechts, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Paul-Ehrlich-Straße 42-44, 60596, Frankfurt/Main, Germany
| | - Jörg Bojunga
- Department of Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Manuela Vetter
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.,Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Stiftung Des Öffentlichen Rechts, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Paul-Ehrlich-Straße 42-44, 60596, Frankfurt/Main, Germany
| | - Bianca Diehl
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.,Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Stiftung Des Öffentlichen Rechts, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Paul-Ehrlich-Straße 42-44, 60596, Frankfurt/Main, Germany
| | - Kea Franz
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.,Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Stiftung Des Öffentlichen Rechts, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Paul-Ehrlich-Straße 42-44, 60596, Frankfurt/Main, Germany.,Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany
| | - Ruediger Gerlach
- Department of Neurosurgery, HELIOS Hospital Erfurt, Nordhäuser Straße 74, 99089, Erfurt, Germany
| | - Michael W Ronellenfitsch
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.,Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Stiftung Des Öffentlichen Rechts, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Paul-Ehrlich-Straße 42-44, 60596, Frankfurt/Main, Germany
| | - Patrick N Harter
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.,Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Stiftung Des Öffentlichen Rechts, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Paul-Ehrlich-Straße 42-44, 60596, Frankfurt/Main, Germany.,Institute of Neurology (Edinger-Institute), University Hospital Frankfurt, Goethe University, Heinrich-Hoffmann Strasse 7, 60528, Frankfurt/Main, Germany
| | - Elke Hattingen
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.,Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Stiftung Des Öffentlichen Rechts, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Paul-Ehrlich-Straße 42-44, 60596, Frankfurt/Main, Germany.,Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany
| | - Joachim P Steinbach
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.,Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Stiftung Des Öffentlichen Rechts, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Paul-Ehrlich-Straße 42-44, 60596, Frankfurt/Main, Germany
| | - Claus Rödel
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.,Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Stiftung Des Öffentlichen Rechts, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Paul-Ehrlich-Straße 42-44, 60596, Frankfurt/Main, Germany.,Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Johannes Rieger
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany.,Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
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Solnes LB, Jacobs AH, Coughlin JM, Du Y, Goel R, Hammoud DA, Pomper MG. Central Nervous System Molecular Imaging. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Stefano A, Comelli A, Bravatà V, Barone S, Daskalovski I, Savoca G, Sabini MG, Ippolito M, Russo G. A preliminary PET radiomics study of brain metastases using a fully automatic segmentation method. BMC Bioinformatics 2020; 21:325. [PMID: 32938360 PMCID: PMC7493376 DOI: 10.1186/s12859-020-03647-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022] Open
Abstract
Background Positron Emission Tomography (PET) is increasingly utilized in radiomics studies for treatment evaluation purposes. Nevertheless, lesion volume identification in PET images is a critical and still challenging step in the process of radiomics, due to the low spatial resolution and high noise level of PET images. Currently, the biological target volume (BTV) is manually contoured by nuclear physicians, with a time expensive and operator-dependent procedure. This study aims to obtain BTVs from cerebral metastases in patients who underwent L-[11C]methionine (11C-MET) PET, using a fully automatic procedure and to use these BTVs to extract radiomics features to stratify between patients who respond to treatment or not. For these purposes, 31 brain metastases, for predictive evaluation, and 25 ones, for follow-up evaluation after treatment, were delineated using the proposed method. Successively, 11C-MET PET studies and related volumetric segmentations were used to extract 108 features to investigate the potential application of radiomics analysis in patients with brain metastases. A novel statistical system has been implemented for feature reduction and selection, while discriminant analysis was used as a method for feature classification. Results For predictive evaluation, 3 features (asphericity, low-intensity run emphasis, and complexity) were able to discriminate between responder and non-responder patients, after feature reduction and selection. Best performance in patient discrimination was obtained using the combination of the three selected features (sensitivity 81.23%, specificity 73.97%, and accuracy 78.27%) compared to the use of all features. Secondly, for follow-up evaluation, 8 features (SUVmean, SULpeak, SUVmin, SULpeak prod-surface-area, SUVmean prod-sphericity, surface mean SUV 3, SULpeak prod-sphericity, and second angular moment) were selected with optimal performance in discriminant analysis classification (sensitivity 86.28%, specificity 87.75%, and accuracy 86.57%) outperforming the use of all features. Conclusions The proposed system is able i) to extract 108 features for each automatically segmented lesion and ii) to select a sub-panel of 11C-MET PET features (3 and 8 in the case of predictive and follow-up evaluation), with valuable association with patient outcome. We believe that our model can be useful to improve treatment response and prognosis evaluation, potentially allowing the personalization of cancer treatment plans.
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Affiliation(s)
- Alessandro Stefano
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy
| | - Albert Comelli
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy.,Ri.MED Foundation, Palermo, Italy
| | - Valentina Bravatà
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy.
| | | | - Igor Daskalovski
- Department of Physics and Astronomy, University of Catania, Catania, Italy
| | - Gaetano Savoca
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy
| | | | - Massimo Ippolito
- Nuclear Medicine Department, Cannizzaro Hospital, Catania, Italy
| | - Giorgio Russo
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy.,Medical Physics Unit, Cannizzaro Hospital, Catania, Italy
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Moreau A, Febvey O, Mognetti T, Frappaz D, Kryza D. Contribution of Different Positron Emission Tomography Tracers in Glioma Management: Focus on Glioblastoma. Front Oncol 2019; 9:1134. [PMID: 31737567 PMCID: PMC6839136 DOI: 10.3389/fonc.2019.01134] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/10/2019] [Indexed: 12/19/2022] Open
Abstract
Although rare, glioblastomas account for the majority of primary brain lesions, with a dreadful prognosis. Magnetic resonance imaging (MRI) is currently the imaging method providing the higher resolution. However, it does not always succeed in distinguishing recurrences from non-specific temozolomide, have been shown to improve -related changes caused by the combination of radiotherapy, chemotherapy, and targeted therapy, also called pseudoprogression. Strenuous attempts to overcome this issue is highly required for these patients with a short life expectancy for both ethical and economic reasons. Additional reliable information may be obtained from positron emission tomography (PET) imaging. The development of this technique, along with the emerging of new classes of tracers, can help in the diagnosis, prognosis, and assessment of therapies. We reviewed the current data about the commonly used tracers, such as 18F-fluorodeoxyglucose (18F-FDG) and radiolabeled amino acids, as well as different PET tracers recently investigated, to report their strengths, limitations, and relevance in glioblastoma management.
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Affiliation(s)
| | | | | | | | - David Kryza
- UNIV Lyon - Université Claude Bernard Lyon 1, LAGEPP UMR 5007 CNRS Villeurbanne, Villeurbanne, France
- Hospices Civils de Lyon, Lyon, France
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Abstract
PURPOSE OF REVIEW The current treatment of gliomas dovetails results of decades-old clinical trials with modern trends in chemotherapy. Molecular characterization now plays a pivotal role, and IDH mutations are key characteristics and the subject of active debate. IDH-mutant tumors produce the 'onco-metabolite', 2-hydroxyglutarate. Metabolic changes have become central to the understanding of tumor biology, and tumors display a fundamental metabolic change called the Warburg Effect. The Warburg Effect represents a preference for glycolysis, as opposed to oxidative phosphorylation. The present review details the clinical context and discusses clinical and preclinical metabolic imaging tools to characterize the Warburg Effect. RECENT FINDINGS A clinical Warburg Index is proposed, defined as the lactate concentration measured by H-MRSI over the SUV measured by FDG-PET, to measure the Warburg Effect. A preclinical technique called deuterium metabolic imaging has successfully imaged the Warburg Effect in vivo in glioblastoma. SUMMARY Metabolic imaging provides an opportunity to measure the Warburg Effect and other metabolic changes in brain tumors. An increased understanding of metabolic shifts integral to brain cancer has the potential to address multiple contemporary debates on glioma pathophysiology and treatment. Metabolic imaging tools thus have the potential to advance research findings, clinical trial development, and clinical care.
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Abstract
PURPOSE As well as in many others cancers, FDG uptake is correlated with the degree of malignancy in gliomas, that is, commonly high FDG uptake in high-grade gliomas. However, in clinical practice, it is not uncommon to observe high-grade gliomas with low FDG uptake. Our aim was to explore the tumor metabolism in 2 populations of high-grade gliomas presenting high or low FDG uptake. METHODS High-resolution magic-angle spinning nuclear magnetic resonance spectroscopy was realized on tissue samples from 7 high-grade glioma patients with high FDG uptake and 5 high-grade glioma patients with low FDG uptake. Tumor metabolomics was evaluated from 42 quantified metabolites and compared by network analysis. RESULTS Whether originating from astrocytes or oligodendrocytes, the high-grade gliomas with low FDG avidity represent a subgroup of high-grade gliomas presenting common characteristics: low aspartate, glutamate, and creatine levels, which are probably related to the impaired electron transport chain in mitochondria; high serine/glycine metabolism and so one-carbon metabolism; low glycerophosphocholine-phosphocholine ratio in membrane metabolism, which is associated with tumor aggressiveness; and finally negative MGMT methylation status. CONCLUSIONS It seems imperative to identify this subgroup of high-grade gliomas with low FDG avidity, which is especially aggressive. Their identification could be important for early detection for a possible personalized treatment, such as antifolate treatment.
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Law I, Albert NL, Arbizu J, Boellaard R, Drzezga A, Galldiks N, la Fougère C, Langen KJ, Lopci E, Lowe V, McConathy J, Quick HH, Sattler B, Schuster DM, Tonn JC, Weller M. Joint EANM/EANO/RANO practice guidelines/SNMMI procedure standards for imaging of gliomas using PET with radiolabelled amino acids and [ 18F]FDG: version 1.0. Eur J Nucl Med Mol Imaging 2018; 46:540-557. [PMID: 30519867 PMCID: PMC6351513 DOI: 10.1007/s00259-018-4207-9] [Citation(s) in RCA: 322] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 10/29/2018] [Indexed: 01/12/2023]
Abstract
These joint practice guidelines, or procedure standards, were developed collaboratively by the European Association of Nuclear Medicine (EANM), the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the European Association of Neurooncology (EANO), and the working group for Response Assessment in Neurooncology with PET (PET-RANO). Brain PET imaging is being increasingly used to supplement MRI in the clinical management of glioma. The aim of these standards/guidelines is to assist nuclear medicine practitioners in recommending, performing, interpreting and reporting the results of brain PET imaging in patients with glioma to achieve a high-quality imaging standard for PET using FDG and the radiolabelled amino acids MET, FET and FDOPA. This will help promote the appropriate use of PET imaging and contribute to evidence-based medicine that may improve the diagnostic impact of this technique in neurooncological practice. The present document replaces a former version of the guidelines published in 2006 (Vander Borght et al. Eur J Nucl Med Mol Imaging. 33:1374–80, 2006), and supplements a recent evidence-based recommendation by the PET-RANO working group and EANO on the clinical use of PET imaging in patients with glioma (Albert et al. Neuro Oncol. 18:1199–208, 2016). The information provided should be taken in the context of local conditions and regulations.
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Affiliation(s)
- Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, 9, Blegdamsvej, 2100-DK, Copenhagen Ø, Denmark.
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Javier Arbizu
- Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarre, Pamplona, Spain
| | - Ronald Boellaard
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.,Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexander Drzezga
- Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Norbert Galldiks
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Forschungszentrum Julich, Julich, Germany
| | - Christian la Fougère
- Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, -4), Forschungszentrum Julich, Julich, Germany.,Department of Nuclear Medicine, RWTH University Aachen, Aachen, Germany
| | - Egesta Lopci
- Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Val Lowe
- Department of Radiology, Nuclear Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jonathan McConathy
- Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harald H Quick
- High-Field and Hybrid MR Imaging, University Hospital Essen, Essen, Germany
| | - Bernhard Sattler
- Department for Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - David M Schuster
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
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Chen F, Li Z, Weng C, Li P, Tu L, Chen L, Xie W, Li L. Progressive multifocal exophytic pontine glioblastoma: a case report with literature review. CHINESE JOURNAL OF CANCER 2017; 36:34. [PMID: 28347331 PMCID: PMC5369214 DOI: 10.1186/s40880-017-0201-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 01/03/2017] [Indexed: 11/10/2022]
Abstract
Multifocal pontine glioblastoma exhibiting an exophytic growth pattern in the cerebello-pontine angle (CPA) is rare. We present a case of a 5-year-old girl with consecutive neurological imaging and other clinical findings indicating progressive multifocal exophytic pontine glioblastoma. Three lesions were reported, of which two were initially presented, and one was developed 2 months later. One lesion demonstrated a progressing exophytic extension in the cistern of the left side of the CPA. The other two lesions were located and confined within the pons. Initial magnetic resonance imaging and positron emission tomography–computed tomography indicated low-grade glioma or inflammatory disease. However, 2 and 3 months later, subsequent magnetic resonance spectroscopy (MRS) displayed elevated choline and depressed N-acetyl aspartate peaks compared with the peaks on the initial MRS, indicating a high-grade glioma. Subtotal resection was performed for the CPA lesion. Histopathologic examination showed discrepant features of different parts of the CPA lesion. The patient received no further chemotherapy or radiotherapy and died 2 months after surgery. The multifocal and exophytic features of this case and the heterogeneous manifestations on neurological images were rare and confusing for both diagnosis and surgical decision-making. Our case report may contribute knowledge and helpful guidance for other medical doctors.
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Affiliation(s)
- Fanfan Chen
- Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, P. R. China
| | - Zongyang Li
- Neurosurgery Department, Shenzhen Second People's Hospital, Shenzhen University, Shenzhen, 518000, Guangdong, P. R. China
| | - Chengyin Weng
- Oncology Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, P. R. China
| | - Peng Li
- Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, P. R. China
| | - Lanbo Tu
- Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, P. R. China
| | - Lei Chen
- Neurosurgery Department, Shenzhen Second People's Hospital, Shenzhen University, Shenzhen, 518000, Guangdong, P. R. China
| | - Wei Xie
- Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, P. R. China
| | - Ling Li
- Record Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, P. R. China.
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11
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Albert NL, Weller M, Suchorska B, Galldiks N, Soffietti R, Kim MM, la Fougère C, Pope W, Law I, Arbizu J, Chamberlain MC, Vogelbaum M, Ellingson BM, Tonn JC. Response Assessment in Neuro-Oncology working group and European Association for Neuro-Oncology recommendations for the clinical use of PET imaging in gliomas. Neuro Oncol 2016; 18:1199-208. [PMID: 27106405 DOI: 10.1093/neuonc/now058] [Citation(s) in RCA: 482] [Impact Index Per Article: 60.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/14/2016] [Indexed: 12/30/2022] Open
Abstract
This guideline provides recommendations for the use of PET imaging in gliomas. The review examines established clinical benefit in glioma patients of PET using glucose ((18)F-FDG) and amino acid tracers ((11)C-MET, (18)F-FET, and (18)F-FDOPA). An increasing number of studies have been published on PET imaging in the setting of diagnosis, biopsy, and resection as well radiotherapy planning, treatment monitoring, and response assessment. Recommendations are based on evidence generated from studies which validated PET findings by histology or clinical course. This guideline emphasizes the clinical value of PET imaging with superiority of amino acid PET over glucose PET and provides a framework for the use of PET to assist in the management of patients with gliomas.
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Affiliation(s)
- Nathalie L Albert
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Michael Weller
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Bogdana Suchorska
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Norbert Galldiks
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Riccardo Soffietti
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Michelle M Kim
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Christian la Fougère
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Whitney Pope
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Ian Law
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Javier Arbizu
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Marc C Chamberlain
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Michael Vogelbaum
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Ben M Ellingson
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Joerg C Tonn
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
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Ghany AFA, Hamed MAG. The diagnostic value of dual phase FDG PET CT in grading of gliomas. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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13
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Chiang S. Follow-Up Imaging: Molecular Imaging is Likely Best as a Single Modality, but Multimodality Imaging is the Future. Front Neurol 2015; 6:74. [PMID: 25964775 PMCID: PMC4408856 DOI: 10.3389/fneur.2015.00074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 03/18/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephen Chiang
- Radiology-Nuclear Medicine, Houston Methodist Hospital , Houston, TX , USA
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14
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Huang RY, Neagu MR, Reardon DA, Wen PY. Pitfalls in the neuroimaging of glioblastoma in the era of antiangiogenic and immuno/targeted therapy - detecting illusive disease, defining response. Front Neurol 2015; 6:33. [PMID: 25755649 PMCID: PMC4337341 DOI: 10.3389/fneur.2015.00033] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/09/2015] [Indexed: 02/04/2023] Open
Abstract
Glioblastoma, the most common malignant primary brain tumor in adults is a devastating diagnosis with an average survival of 14–16 months using the current standard of care treatment. The determination of treatment response and clinical decision making is based on the accuracy of radiographic assessment. Notwithstanding, challenges exist in the neuroimaging evaluation of patients undergoing treatment for malignant glioma. Differentiating treatment response from tumor progression is problematic and currently combines long-term follow-up using standard magnetic resonance imaging (MRI), with clinical status and corticosteroid-dependency assessments. In the clinical trial setting, treatment with gene therapy, vaccines, immunotherapy, and targeted biologicals similarly produces MRI changes mimicking disease progression. A neuroimaging method to clearly distinguish between pseudoprogression and tumor progression has unfortunately not been found to date. With the incorporation of antiangiogenic therapies, a further pitfall in imaging interpretation is pseudoresponse. The Macdonald criteria that correlate tumor burden with contrast-enhanced imaging proved insufficient and misleading in the context of rapid blood–brain barrier normalization following antiangiogenic treatment that is not accompanied by expected survival benefit. Even improved criteria, such as the RANO criteria, which incorporate non-enhancing disease, clinical status, and need for corticosteroid use, fall short of definitively distinguishing tumor progression, pseudoresponse, and pseudoprogression. This review focuses on advanced imaging techniques including perfusion MRI, diffusion MRI, MR spectroscopy, and new positron emission tomography imaging tracers. The relevant image analysis algorithms and interpretation methods of these promising techniques are discussed in the context of determining response and progression during treatment of glioblastoma both in the standard of care and in clinical trial context.
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Affiliation(s)
- Raymond Y Huang
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
| | - Martha R Neagu
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
| | - David A Reardon
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
| | - Patrick Y Wen
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
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15
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Rosenkrantz AB, Mendiratta-Lala M, Bartholmai BJ, Ganeshan D, Abramson RG, Burton KR, Yu JPJ, Scalzetti EM, Yankeelov TE, Subramaniam RM, Lenchik L. Clinical utility of quantitative imaging. Acad Radiol 2015; 22:33-49. [PMID: 25442800 PMCID: PMC4259826 DOI: 10.1016/j.acra.2014.08.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 12/24/2022]
Abstract
Quantitative imaging (QI) is increasingly applied in modern radiology practice, assisting in the clinical assessment of many patients and providing a source of biomarkers for a spectrum of diseases. QI is commonly used to inform patient diagnosis or prognosis, determine the choice of therapy, or monitor therapy response. Because most radiologists will likely implement some QI tools to meet the patient care needs of their referring clinicians, it is important for all radiologists to become familiar with the strengths and limitations of QI. The Association of University Radiologists Radiology Research Alliance Quantitative Imaging Task Force has explored the clinical application of QI and summarizes its work in this review. We provide an overview of the clinical use of QI by discussing QI tools that are currently used in clinical practice, clinical applications of these tools, approaches to reporting of QI, and challenges to implementing QI. It is hoped that these insights will help radiologists recognize the tangible benefits of QI to their patients, their referring clinicians, and their own radiology practice.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016.
| | - Mishal Mendiratta-Lala
- Henry Ford Hospital, Abdominal and Cross-sectional Interventional Radiology, Detroit, Michigan
| | - Brian J Bartholmai
- Division of Radiology Informatics, Mayo Clinic in Rochester, Rochester, Minnesota
| | | | - Richard G Abramson
- Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Kirsteen R Burton
- Department of Medical Imaging and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - John-Paul J Yu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Ernest M Scalzetti
- Department of Radiology, SUNY Upstate Medical University, Syracuse New York
| | - Thomas E Yankeelov
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee
| | - Rathan M Subramaniam
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
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Mathieu D, Lecomte R, Tsanaclis AM, Larouche A, Fortin D. Standardization and Detailed Characterization of the Syngeneic Fischer/F98 Glioma Model. Can J Neurol Sci 2014; 34:296-306. [PMID: 17803026 DOI: 10.1017/s0317167100006715] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction:Adequate animal glioma models are mandatory for the pursuit of preclinical research in neuro-oncology. Many implantation models have been described, but none perfectly emulate human malignant gliomas. This work reports our experience in standardizing, optimizing and characterizing the Fischer/F98 glioma model on the clinical, pathological, radiological and metabolic aspects.Materials and methods:F98 cells were implanted in 70 Fischer rats, varying the quantity of cells and volume of implantation solution, and using a micro-infusion pump to minimize implantation trauma, after adequate coordinates were established. Pathological analysis consisted in hematoxylin and eosin (H&E) staining and immunohistochemistry for GFAP, vimentin, albumin, TGF-b1, TGF-b2, CD3 and CD45. Twelve animals were used for MR imaging at 5, 10, 15 and 20 days. Corresponding MR images were compared with pathological slides. Two animals underwent 18F-FDG and 11C-acetate PET studies for metabolic characterization of the tumors.Results:Implantation with 1x104 cells produced a median survival of 26 days and a tumor take of 100%. Large infiltrative neoplasms with a necrotic core were seen on H&E. Numerous mitosis, peritumoral infiltrative behavior, and neovascular proliferation were also obvious. GFAP and vimentin staining was positive inside the tumor cells. Albumin staining was observed in the extracellular space around the tumors. CD3 staining was negligible. The MR images correlated the pathologic findings. 18F-FDG uptake was strong in the tumors.Conclusion:The standardized model described in this study behaves in a predictable and reproducible fashion, and could be considered for future pre-clinical studies. It adequately mimics the behavior of human malignant astrocytomas.
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Affiliation(s)
- David Mathieu
- Department of Surgery, Division of Neurosurgery and Neuro-oncology, Centre Hospitalier Universitaire de Sherbrooke. Sherbrooke University, Sherbrooke, Quebec, Canada
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17
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Yang M, Su H, Soga T, Kranc KR, Pollard PJ. Prolyl hydroxylase domain enzymes: important regulators of cancer metabolism. HYPOXIA 2014; 2:127-142. [PMID: 27774472 PMCID: PMC5045062 DOI: 10.2147/hp.s47968] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The hypoxia-inducible factor (HIF) prolyl hydroxylase domain enzymes (PHDs) regulate the stability of HIF protein by post-translational hydroxylation of two conserved prolyl residues in its α subunit in an oxygen-dependent manner. Trans-4-prolyl hydroxylation of HIFα under normal oxygen (O2) availability enables its association with the von Hippel-Lindau (VHL) tumor suppressor pVHL E3 ligase complex, leading to the degradation of HIFα via the ubiquitin-proteasome pathway. Due to the obligatory requirement of molecular O2 as a co-substrate, the activity of PHDs is inhibited under hypoxic conditions, resulting in stabilized HIFα, which dimerizes with HIFβ and, together with transcriptional co-activators CBP/p300, activates the transcription of its target genes. As a key molecular regulator of adaptive response to hypoxia, HIF plays important roles in multiple cellular processes and its overexpression has been detected in various cancers. The HIF1α isoform in particular has a strong impact on cellular metabolism, most notably by promoting anaerobic, whilst inhibiting O2-dependent, metabolism of glucose. The PHD enzymes also seem to have HIF-independent functions and are subject to regulation by factors other than O2, such as by metabolic status, oxidative stress, and abnormal levels of endogenous metabolites (oncometabolites) that have been observed in some types of cancers. In this review, we aim to summarize current understandings of the function and regulation of PHDs in cancer with an emphasis on their roles in metabolism.
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Affiliation(s)
- Ming Yang
- Cancer Biology and Metabolism Group, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Huizhong Su
- Cancer Biology and Metabolism Group, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Tomoyoshi Soga
- Institute for Advanced Biosciences, Keio University, Mizukami, Tsuruoka, Yamagata, Japan
| | - Kamil R Kranc
- MRC Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, UK
| | - Patrick J Pollard
- Cancer Biology and Metabolism Group, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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18
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Yang M, Soga T, Pollard PJ. Oncometabolites: linking altered metabolism with cancer. J Clin Invest 2013; 123:3652-8. [PMID: 23999438 DOI: 10.1172/jci67228] [Citation(s) in RCA: 308] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The discovery of cancer-associated mutations in genes encoding key metabolic enzymes has provided a direct link between altered metabolism and cancer. Advances in mass spectrometry and nuclear magnetic resonance technologies have facilitated high-resolution metabolite profiling of cells and tumors and identified the accumulation of metabolites associated with specific gene defects. Here we review the potential roles of such "oncometabolites" in tumor evolution and as clinical biomarkers for the detection of cancers characterized by metabolic dysregulation.
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Affiliation(s)
- Ming Yang
- Cancer Biology and Metabolism Group, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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19
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Ellingson BM, Chen W, Harris RJ, Pope WB, Lai A, Nghiemphu PL, Czernin J, Phelps ME, Cloughesy TF. PET Parametric Response Mapping for Clinical Monitoring and Treatment Response Evaluation in Brain Tumors. PET Clin 2012; 8:201-17. [PMID: 27157948 DOI: 10.1016/j.cpet.2012.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PET parametric response maps (PRMs) are a provocative new molecular imaging technique for quantifying brain tumor response to therapy in individual patients. By aligning sequential PET scans over time using anatomic MR imaging information, the voxel-wise change in radiotracer uptake can be quantified and visualized. PET PRMs can be performed before and after a particular therapy to test whether the tumor is responding favorably, or performed relative to a distant time point to monitor changes through the course of a treatment. This article focuses on many of the technical details involved in generating, visualizing, and quantifying PET PRMs, and practical applications and example case studies.
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Affiliation(s)
- Benjamin M Ellingson
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Biomedical Physics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Biomedical Engineering, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Wei Chen
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Robert J Harris
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Biomedical Physics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Albert Lai
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Phioanh L Nghiemphu
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Johannes Czernin
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael E Phelps
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Timothy F Cloughesy
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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20
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Sandu N, Schaller B. Molecular imaging of stem cell therapy in brain tumors: a step towards personalized medicine. Arch Med Sci 2012; 8:601-5. [PMID: 23056068 PMCID: PMC3460495 DOI: 10.5114/aoms.2012.30282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 11/24/2010] [Accepted: 12/14/2010] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nora Sandu
- Department of Neurosurgery, University of Lausanne, Switzerland
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21
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Abstract
2-Hydroxyglutarate (2-HG) is a potential oncometabolite involved in gliomagenesis that has been identified as an aberrant product of isocitrate dehydrogenase (IDH)-mutated glial tumors. Recent genomics studies have shown that heterozygous mutation of IDH genes 1 and 2, present in up to 86% of grade II gliomas, is associated with a favorable outcome. Two reports in this issue describe both ex vivo and in vivo methods that could noninvasively detect the presence of 2-HG in glioma patients. This approach could have valuable implications for diagnosis, prognosis, and stratification of brain tumors, as well as for monitoring of treatment in glioma patients.
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Affiliation(s)
- Philippe Metellus
- Department of Neurosurgery, Hôpital de la Timone, APHM, 13005 Marseille, France.
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22
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Colavolpe C, Chinot O, Metellus P, Mancini J, Barrie M, Bequet-Boucard C, Tabouret E, Mundler O, Figarella-Branger D, Guedj E. FDG-PET predicts survival in recurrent high-grade gliomas treated with bevacizumab and irinotecan. Neuro Oncol 2012; 14:649-57. [PMID: 22379188 DOI: 10.1093/neuonc/nos012] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prognosis of recurrent high-grade glioma (HGG) is poor, although bevacizumab has been documented in that context. This study aimed to determine the independent prognostic value of fluorodeoxyglucose (FDG)-PET on progression-free survival (PFS) and overall survival (OS) of recurrent HGG after combined treatment with bevacizumab and irinotecan, compared with other documented prognostic variables. Twenty-five adult patients with histologically proven HGG were included at recurrence. Brain FDG-PET imaging was performed within 6 weeks of starting chemotherapy with bevacizumab and irinotecan. Response based on MRI was assessed every 2 months according to revised assessment in Neuro-Oncology (RANO) criteria. Median PFS and OS were 4 months (range, 0.9-10.4 months) and 7.2 months (range, 1.2-41.7 months), respectively. At 6 months, PFS and OS rate were 16.0% and 72.0%. FDG uptake was the most powerful predictor of both PFS and OS, using either univariate or multivariate analysis, among all variables tested: histological grade, Karnofsky performance status, steroid intake, and number of previous treatments. Moreover, FDG uptake was also prognostic of response to bevacizumab-based therapy. This study provides the first evidence that pretreatment FDG-PET can serve as an imaging biomarker in recurrent HGG for predicting survival following anti-angiogenic therapy with bevacizumab.
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Affiliation(s)
- Cécile Colavolpe
- Service Central de Biophysique et Médecine Nucléaire, Assistance Publique des Hôpitaux de Marseille, CHU Timone,Aix-Marseille University, Marseille, France
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23
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Colavolpe C, Metellus P, Mancini J, Barrie M, Béquet-Boucard C, Figarella-Branger D, Mundler O, Chinot O, Guedj E. Independent prognostic value of pre-treatment 18-FDG-PET in high-grade gliomas. J Neurooncol 2011; 107:527-35. [PMID: 22169956 DOI: 10.1007/s11060-011-0771-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 11/16/2011] [Indexed: 11/29/2022]
Abstract
The prognostic value of PET with (18F)-fluoro-2-deoxy-D: -glucose (FDG) has been shown in high-grade gliomas (HGG), but not compared with consensual prognostic factors. We sought to evaluate the independent predictive value of pre-treatment FDG-PET on overall (OS) and event-free survival (EFS). We retrospectively analyzed 41 patients with histologically-confirmed HGG (31 glioblastomas and 10 anaplastic gliomas). The pre-treatment uptake of FDG was assessed qualitatively by five-step visual metabolic grading, and quantitatively by the ratio between the tumor and contralateral maximal standardized uptake value (T/CL). EFS and OS following PET were compared with FDG uptake by univariate analysis, and by two multivariate analyses: one including main consensual prognostic factors (age, KPS, extent of surgery and histological grade), and the other including the classification system of the Radiation Therapy Oncology Group (Recursive Partitioning Analysis, RPA). Median OS and EFS were 13.8 and 7.4 months, respectively, for glioblastomas, and over 25.8 and 12 months, respectively, for anaplastic gliomas (P = 0.040 and P = 0.027). The T/CL ratio predicted OS in the entire group [P = 0.003; Hazard Ratio (HR) = 2.3] and in the glioblastoma subgroup (P = 0.018; HR = 2), independently of age, Karnofsky performance status, histological grade, and surgery, and independently of RPA classification. T/CL ratio tended to predict EFS in the whole group (P = 0.052). The prognostic value of visual metabolic grade on OS was less significant than T/CL ratio, both in the entire group and in the glioblastoma subgroup (P = 0.077 and P = 0.059). Quantitative evaluation of the ratio between the maximal tumor and contralateral uptake in pre-treatment FDG-PET provides significant additional prognostic information in newly-diagnosed HGG, independently of consensual prognostic factors.
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Affiliation(s)
- Cécile Colavolpe
- APHM, Hôpital de la Timone, Service Central de Biophysique et Médecine Nucléaire, 13005 Marseille, France
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24
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Use of positron emission tomography in the evaluation of diffuse intrinsic brainstem gliomas in children. J Pediatr Hematol Oncol 2011; 33:369-73. [PMID: 21602725 DOI: 10.1097/mph.0b013e31820ad915] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diffuse intrinsic brainstem gliomas (DIBSGs) in children remain difficult tumors to treat and have a very poor prognosis. Intensifying both chemotherapy and radiation programs have been attempted without success. Positron emission tomography (PET) has been used to differentiate benign from malignant tumors and may predict outcome. OBJECTIVES To determine whether PET can characterize a specific metabolic pattern of DIBSGs and correlate this with patient survival. METHODS We conducted a retrospective review of patients with DIBSGs and PET scans at diagnosis. Data for ¹⁸[F] fluorodeoxyglucose (FDG) and ¹¹C-methionine (CMET) PET scans were collected. Treatment and survival were reviewed. RESULTS We identified 30 patients with DIBSGs, 25 of whom had FDG and/or CMET PET scans. Scans showed both focal and generalized metabolic activity, and the patterns showed no correlation with survival. Patients with both FDG and CMET positive scans had a mean survival of 380 days, whereas those negative for both isotopes had a mean survival of 446 days. CONCLUSIONS There was no specific PET pattern identified in this DIBSG cohort but a trend toward improved survival was noted with absence of FDG and CMET metabolism. Metabolically active areas may suggest potential sites for biopsy. We believe that biopsy is essential for improving therapy for this patient population.
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25
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Metellus P, Colin C, Taieb D, Guedj E, Nanni-Metellus I, de Paula AM, Colavolpe C, Fuentes S, Dufour H, Barrie M, Chinot O, Ouafik L, Figarella-Branger D. IDH mutation status impact on in vivo hypoxia biomarkers expression: new insights from a clinical, nuclear imaging and immunohistochemical study in 33 glioma patients. J Neurooncol 2011; 105:591-600. [PMID: 21643985 DOI: 10.1007/s11060-011-0625-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 05/25/2011] [Indexed: 12/15/2022]
Abstract
Mutations in the gene encoding isocitrate dehydrogenase enzyme isoforms 1 (IDH1) and 2 (IDH2) have recently been identified in a large proportion of glial tumors of the CNS, but their mechanistic role in tumor development remains unclear. Here, we assessed the actual impact of IDH1 and IDH2 mutations in patients harboring WHO grade II and III gliomas. We sequenced IDH1 at codon 132 and IDH2 at codon 172 in 33 patients with WHO grade II and III gliomas who benefited from a preoperative (18)F-FDG positron emission tomography (PET). Immunohistochemical expression of Hypoxia Inducible Factor-1alpha (HIF-1α), Carbonic Anhydrase IX (CAIX), Glucose Transporter 1 (GLUT1) and Caspase 3 active form (CASP3) along with the R132HIDH1 mutation was assessed in all cases as well as 1p/19q deletion status and p53 expression. HIF-1α expression was found in 15% of IDH-mutated compared to 7.7% of IDH-nonmutated tumors (P = 0.954). Also, GLUT-1 positive staining was found in 5% of IDH-mutated and in 7.1% of IDH-nonmutated tumors (P = 0.794). Finally, CA-IX expression was found in 15% of IDH-mutated and in 7.7% of IDH-nonmutated tumors (P = 0.484). The combined expression of these three hypoxic markers was found in two WHO grade III tumors, one of which was IDH-mutated whereas the other was IDH-nonmutated (P = 0.794). In IDH-mutated tumors, the median SUVmax ratio was 2.24 versus 2.15 in IDH-nonmutated tumors (P = 0.775). Together, these data question the actual relationship between IDH mutation status and in vivo hypoxic biomarkers expression in WHO grade II and III gliomas.
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Affiliation(s)
- Philippe Metellus
- Hôpital de la Timone, Service de Neurochirurgie, Assistance Publique-Hôpitaux de Marseille, 13000 Marseille, France.
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26
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Abstract
For most cancers, PET is essentially a diagnostic tool. For brain tumors, PET has got its main contribution at the level of the therapeutic management. Indeed, specific reasons render the therapeutic management of brain tumors, especially gliomas, a real challenge. Although some gliomas may appear well-delineated on conventional neuroimaging such as CT and MRI, they are by nature infiltrating neoplasms and the interface between tumor and normal brain tissue may not be accurately defined. Moreover, gliomas may present as ill-defined lesions for which various MRI sequences combination does not provide a unique contour for tumor delineation. Also, gliomas are often histologically heterogeneous with anaplastic areas evolving within a low-grade tumor, and contrast-enhancement on CT or MRI does not represent a good marker for anaplastic tissue detection. Finally, assessment of tumor residue, recurrence, or progression, may be altered by different signals related to inflammation or adjuvant therapies, and contrast enhancement on CT and MRI is not an appropriate marker at the postoperative or posttherapeutic stage. These limitations of conventional neuroimaging in detecting tumor tissue, delineating tumor extent and evidencing anaplastic changes, lead to potential inaccuracy in lesion targeting at different steps of the management (diagnostic, surgical, postoperative, and posttherapeutic stages). Molecular information provided by PET has proved helpful to supplement morphological imaging data in this context. F-18 FDG and amino-acid tracers such as C-11 methionine (C-11 MET) provide complementary metabolic data that are independent from the anatomical MR information. These tracers help in the definition of glioma extension, detection of anaplastic areas, and postoperative follow-up. Additionally, PET data have a prognostic value independently of histology. To take advantage of PET data in glioma treatment, PET might be integrated in the planning of image-guided biopsy, resection, and radiosurgery.
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Affiliation(s)
- Serge Goldman
- PET-Biomedical Cyclotron Unit, ERASME Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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27
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Zukotynski KA, Fahey FH, Kocak M, Alavi A, Wong TZ, Treves ST, Shulkin BL, Haas-Kogan DA, Geyer JR, Vajapeyam S, Boyett JM, Kun LE, Poussaint TY. Evaluation of 18F-FDG PET and MRI associations in pediatric diffuse intrinsic brain stem glioma: a report from the Pediatric Brain Tumor Consortium. J Nucl Med 2011; 52:188-95. [PMID: 21233173 DOI: 10.2967/jnumed.110.081463] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The purpose of this study was to assess (18)F-FDG uptake in children with a newly diagnosed diffuse intrinsic brain stem glioma (BSG) and to investigate associations with progression-free survival (PFS), overall survival (OS), and MRI indices. METHODS Two Pediatric Brain Tumor Consortium (PBTC) therapeutic trials in children with newly diagnosed BSG were designed to test radiation therapy combined with molecularly targeted agents (PBTC-007: phase I/II study of gefitinib; PBTC-014: phase I/II study of tipifarnib). Baseline brain (18)F-FDG PET scans were obtained in 40 children in these trials. Images were evaluated by consensus between 2 PET experts for intensity and uniformity of tracer uptake. Associations of (18)F-FDG uptake intensity and uniformity with both PFS and OS, as well as associations with tumor MRI indices at baseline (tumor volume on fluid-attenuated inversion recovery, baseline intratumoral enhancement, diffusion and perfusion values), were evaluated. RESULTS In most of the children, BSG (18)F-FDG uptake was less than gray-matter uptake. Survival was poor, irrespective of intensity of (18)F-FDG uptake, with no association between intensity of (18)F-FDG uptake and PFS or OS. However, hyperintense (18)F-FDG uptake in the tumor, compared with gray matter, suggested poorer survival rates. Patients with (18)F-FDG uptake in 50% or more of the tumor had shorter PFS and OS than did patients with (18)F-FDG uptake in less than 50% of the tumor. There was some evidence that tumors with higher (18)F-FDG uptake were more likely to show enhancement, and when the diffusion ratio was lower, the uniformity of (18)F-FDG uptake appeared higher. CONCLUSION Children with BSG for which (18)F-FDG uptake involves at least half the tumor appear to have poorer survival than children with uptake in less than 50% of the tumor. A larger independent study is needed to verify this hypothesis. Intense tracer uptake in the tumors, compared with gray matter, suggests decreased survival. Higher (18)F-FDG uptake within the tumor was associated with enhancement on MR images. Increased tumor cellularity as reflected by restricted MRI diffusion may be associated with increased (18)F-FDG uniformity throughout the tumor.
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28
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Portwine C, Marriott C, Barr RD. PET imaging for pediatric oncology: an assessment of the evidence. Pediatr Blood Cancer 2010; 55:1048-61. [PMID: 20979168 DOI: 10.1002/pbc.22747] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Positron emission tomography (PET) has shown potential benefits when used in therapeutic clinical trials for children with cancer. However, existing trials are limited in scope with small numbers of patients and varied observations, making accurate conclusions about the usefulness of PET scanning impossible. This review examines PET and its applications in pediatric oncology. While evidence is limited, there appears to be a basis for rigorous evaluation of this imaging modality before widespread application without validation from clinical trials.
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Affiliation(s)
- Carol Portwine
- Division of Pediatric Hematology/Oncology, McMaster University, Hamilton, Ontario, Canada.
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29
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Sandu N, Schaller B. Stem cell transplantation in brain tumors: a new field for molecular imaging? Mol Med 2010; 16:433-7. [PMID: 20593112 DOI: 10.2119/molmed.2010.00035] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 06/28/2010] [Indexed: 01/23/2023] Open
Abstract
Neural stem cells have been proposed as a new and promising treatment modality in various pathologies of the central nervous system, including malignant brain tumors. However, the underlying mechanism by which neural stem cells target tumor areas remains elusive. Monitoring of these cells is currently done by use of various modes of molecular imaging, such as optical imaging, magnetic resonance imaging and positron emission tomography, which is a novel technology for visualizing metabolism and signal transduction to gene expression. In this new context, the microenvironment of (malignant) brain tumors and the blood-brain barrier gains increased interest. The authors of this review give a unique overview of the current molecular-imaging techniques used in different therapeutic experimental brain tumor models in relation to neural stem cells. Such methods for molecular imaging of gene-engineered neural stem/progenitor cells are currently used to trace the location and temporal level of expression of therapeutic and endogenous genes in malignant brain tumors, closing the gap between in vitro and in vivo integrative biology of disease in neural stem cell transplantation.
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Affiliation(s)
- Nora Sandu
- Department of Neurosurgery, University of Lausanne, Lausanne, Switzerland
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30
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Pirotte BJM, Lubansu A, Massager N, Wikler D, Van Bogaert P, Levivier M, Brotchi J, Goldman S. Clinical impact of integrating positron emission tomography during surgery in 85 children with brain tumors. J Neurosurg Pediatr 2010; 5:486-99. [PMID: 20433263 DOI: 10.3171/2010.1.peds09481] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECT In this paper, the authors' goal was to evaluate the impact of PET information on brain tumor surgery in children. METHODS Between 1995 and 2007, 442 children were referred to the authors' institution for a newly diagnosed brain lesion. Of these, 85 were studied with FDG-PET and/or L-(methyl-(11)C)-methionine -PET in cases in which MR images were unable to assist in selecting accurate biopsy targets (35 patients) or to delineate tumors for maximal resection (50 patients). In surgical cases, PET and MR images were combined in image fusion planning for stereotactic biopsies or navigation-based resections. The preoperative planning images were compared postoperatively with MR imaging and PET findings and histological data for evaluating the clinical impact on the diagnostic yield and tumor resection. RESULTS The PET data influenced surgical decisions or procedures in all cases. The use of PET helped to better differentiate indolent from active components in complex lesions (in 12 patients); improved target selection and diagnostic yield of stereotactic biopsies without increasing the sampling; provided additional prognostic information; reduced the amount of tissue needed for biopsy sampling in brainstem lesions (in 20 cases); better delineated lesions that were poorly delineated on MR imaging and that infiltrated functional cortex (in 50 cases); significantly increased the amount of tumor tissue removed in cases in which total resection influenced survival (in 20 cases); guided resection in hypermetabolic areas (in 15 cases); improved early postoperative detection of residual tumor (in 20 cases); avoided unnecessary reoperation (in 5 cases); and supported the decision to undertake early second-look resection (in 8 cases). CONCLUSIONS The authors found that PET has a significant impact on the surgical decisions and procedures for managing pediatric brain tumors. Further studies may demonstrate whether PET improves outcomes in children.
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Affiliation(s)
- Benoit J M Pirotte
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, 808, route de Lennik, B-1070 Brussels, Belgium.
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31
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Pirotte BJM, Lubansu A, Massager N, Wikler D, Van Bogaert P, Levivier M, Brotchi J, Goldman S. Clinical interest of integrating positron emission tomography imaging in the workup of 55 children with incidentally diagnosed brain lesions. J Neurosurg Pediatr 2010; 5:479-85. [PMID: 20433262 DOI: 10.3171/2010.1.peds08336] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In this paper, the authors' goal was to evaluate the impact of PET data on the clinical management of incidental brain lesions in children. METHODS Between 1995 and 2007, 442 children with a newly diagnosed brain lesion were referred to the authors' department. Of these, 55 presented with an incidental brain lesion and were selected for study because MR imaging sequences revealed limitations in assessing the tumor, its evolving nature, and/or the malignant potential of the lesion diagnosed. Thirteen children were studied using FDG-PET and 42 with L-(methyl-(11)C)-methionine (MET)-PET; 3 children underwent both FDG-PET and MET-PET but only the MET-PET results were used in the analysis. The PET and MR images were combined in image fusion navigation planning. Drawing on their experience with PET in adults, the authors proposed the following treatment plans: 1) surgery in children with imaging evidence of increased PET tracer uptake, which is highly specific of tumor and/or malignant tumor tissue; or 2) conservative treatment in children in whom there was little or no tracer uptake on PET. The authors compared the PET data with the MR imaging-based diagnosis and either 1) the results of histological examination in surgically treated cases, or 2) the long-term outcome in untreated cases. They studied PET and MR imaging sensitivity and specificity in detecting tumor and malignant tissues, and evaluated whether PET data altered their clinical management. RESULTS Seventeen children had increased PET tracer uptake and underwent surgery. Tumor diagnosis was confirmed in all cases (that is, there were no false-positive findings). Cases in which there was little or no PET tracer uptake supported conservative treatment in 38 children. However, because PET was under evaluation, 16 of 38 lesions that were judged accessible for resection were surgically treated. Histological examination results demonstrated neither malignant nor evolving tumor tissue but yielded 9 indolent tumors (6 dysembryoplastic neuroectodermal tumors, 2 low-grade astrocytomas, and 1 low-grade astrocytoma and dysplasia) and 7 nontumoral lesions (3 cases of vasculitis, 3 of gliosis, and 1 of sarcoidosis). In 22 of the untreated 38 children, stable disease was noted during follow-up (range 18-136 months). Although an absence of PET tracer uptake might not exclude tumor tissue, PET did not reveal any false-negative findings in malignant or evolving tumor tissue detection in cases in which MR imaging showed false-positive and -negative cases in > 35 and 25% of the cases, respectively. CONCLUSIONS These data confirmed the high sensitivity and specificity of PET to detect tumor as well as malignant tissue. Regarding the treatment of the incidental brain lesions, the PET findings enabled the authors to make more appropriate decisions regarding treatment than those made on MR imaging findings alone. Therefore, the risk of surgically treating a nontumoral lesion was reduced as well as that for conservatively managing a malignant tumor. Nowadays, it is estimated that these data justify conservative management in incidental lesions with low or absent PET tracer uptake.
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Affiliation(s)
- Benoit J M Pirotte
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, 808, route de Lennik, B-1070 Brussels, Belgium.
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Asano K, Takeda T, Nakano T, Ohkuma H. Correlation of MIB-1 staining index and 201Tl-SPECT retention index in preoperative evaluation of malignancy of brain tumors. Brain Tumor Pathol 2010; 27:1-6. [DOI: 10.1007/s10014-009-0257-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 07/10/2009] [Indexed: 11/28/2022]
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Frazier JL, Lee J, Thomale UW, Noggle JC, Cohen KJ, Jallo GI. Treatment of diffuse intrinsic brainstem gliomas: failed approaches and future strategies. J Neurosurg Pediatr 2009; 3:259-69. [PMID: 19338403 DOI: 10.3171/2008.11.peds08281] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Diffuse intrinsic pontine gliomas constitute ~ 60-75% of tumors found within the pediatric brainstem. These malignant lesions present with rapidly progressive symptoms such as cranial nerve, long tract, or cerebellar dysfunctions. Magnetic resonance imaging is usually sufficient to establish the diagnosis and obviates the need for surgical biopsy in most cases. The prognosis of the disease is dismal, and the median survival is < 12 months. Resection is not a viable option. Standard therapy involves radiotherapy, which produces transient neurological improvement with a progression-free survival benefit, but provides no improvement in overall survival. Clinical trials have been conducted to assess the efficacy of chemotherapeutic and biological agents in the treatment of diffuse pontine gliomas. In this review, the authors discuss recent studies in which systemic therapy was administered prior to, concomitantly with, or after radiotherapy. For future perspective, the discussion includes a rationale for stereotactic biopsies as well as possible therapeutic options of local chemotherapy in these lesions.
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Affiliation(s)
- James L Frazier
- Departments of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Pirotte BJM, Lubansu A, Massager N, Wikler D, Goldman S, Levivier M. Results of positron emission tomography guidance and reassessment of the utility of and indications for stereotactic biopsy in children with infiltrative brainstem tumors. J Neurosurg 2009; 107:392-9. [PMID: 18459902 DOI: 10.3171/ped-07/11/392] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Most intrinsic infiltrative brainstem lesions diagnosed in children are gliomas, and these carry a very bad prognosis. Although the utility and risk of stereotactically guided biopsy procedures in intrinsic infiltrative brainstem lesions have been widely questioned, the neuroimaging diagnosis may be inaccurate in approximately 25% of cases, and the consequences of empirical therapy should not be underestimated. Stereotactic biopsy sampling is still performed in many centers, but the reported diagnostic yield ranges from 83 to 96%. The authors integrated positron emission tomography (PET) images into the planning for stereotactic biopsy procedures to direct the biopsy needle's trajectory to hypermetabolic foci of intrinsic infiltrative brainstem lesions. Their aim was to assess the benefit of the technique in terms of target selection and diagnostic yield. METHODS Twenty children with newly diagnosed intrinsic infiltrative brainstem lesions underwent a PET-guided stereotactic biopsy procedure. The PET tracer was(18)F-2-fluoro-2-deoxy-D-glucose (FDG) in six cases, (11)C-methionine in eight, and both agents were used in six. A single biopsy target was selected in the area of highest PET tracer uptake in all cases. The PET data were compared with diagnoses and outcome. RESULTS Use of PET guidance improved target selection and provided tumor diagnosis in all trajectories and in all children (high-grade glioma was diagnosed in 10, low-grade glioma in five, and nonglial tumor in five). The PET-guided trajectories provided a higher diagnostic yield than those guided by magnetic resonance imaging alone, which allowed the sampling to be reduced to a single trajectory. The PET data might also carry a prognostic value that could be useful for oncological management. CONCLUSIONS These data support the suggestion that PET guidance improves the diagnostic yield of stereotactic biopsy sampling, allows the practitioner to reduce the number of sampling procedures, and might lead to a reassessment of the utility of and indications for stereotactic biopsy in children with intrinsic infiltrative brainstem lesions.
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Affiliation(s)
- Benoit J M Pirotte
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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NISHI N, KAWAI S, YONEZAWA T, FUJIMOTO K, MASUI K. Early Appearance of High Grade Glioma on Magnetic Resonance Imaging. Neurol Med Chir (Tokyo) 2009; 49:8-12. [DOI: 10.2176/nmc.49.8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Noriyuki NISHI
- Department of Neurosurgery, Nara Prefectural Mimuro Hospital
| | - Shozo KAWAI
- Department of Neurosurgery, Osaka General Medical Center
| | - Taiji YONEZAWA
- Department of Neurosurgery, Nara Prefectural Mimuro Hospital
| | - Kenta FUJIMOTO
- Department of Neurosurgery, Osaka General Medical Center
| | - Katsuya MASUI
- Department of Neurosurgery, Osaka General Medical Center
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Colavolpe C, Guedj E, Metellus P, Barrie M, Figarella-Branger D, Mundler O, Chinot O. FDG-PET to predict different patterns of progression in multicentric glioblastoma: a case report. J Neurooncol 2008; 90:47-51. [DOI: 10.1007/s11060-008-9629-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Accepted: 06/04/2008] [Indexed: 11/25/2022]
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Exploratory evaluation of two-dimensional and three-dimensional methods of FDG PET quantification in pediatric anaplastic astrocytoma: a report from the Pediatric Brain Tumor Consortium (PBTC). Eur J Nucl Med Mol Imaging 2008; 35:1651-8. [DOI: 10.1007/s00259-008-0780-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 03/07/2008] [Indexed: 10/22/2022]
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Affiliation(s)
- G Pöpperl
- Klinikum der Ludwig-Maximilians-Universität, München-Grosshadern Klinik und Polliklinik fur Nuklearmedizin, Müchen, Germany
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Hargrave D, Chuang N, Bouffet E. Conventional MRI cannot predict survival in childhood diffuse intrinsic pontine glioma. J Neurooncol 2007; 86:313-9. [PMID: 17909941 DOI: 10.1007/s11060-007-9473-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 09/18/2007] [Indexed: 10/22/2022]
Abstract
Diffuse intrinsic pontine glioma (DIPG) of childhood has a dismal prognosis. Clinical trials of new agents are vital and it is essential that the correct endpoints and disease assessments are chosen. A retrospective review of magnetic resonance imaging (MRI) scanning in a pure population of DIPG was undertaken. Baseline diagnostic MRI findings included; local tumour extension in upper medulla (74%) or midbrain (62%), metastatic disease (3%), basilar artery encasement (82%), necrosis (33%), intratumoural haemorrhage (26%), hydrocephalus (23%) and dorsal exophytic component (18%). Post-treatment MRI scans demonstrated increases in; leptomeningeal metastatic disease (16%), cystic change/necrosis (48%), enhancement (72%) and intratumoural haemorrhage (32%). Response rates were calculated according to both RECIST (4%) and WHO (24%) criteria. No MRI parameter in either the diagnostic or response scans had prognostic significance. We recommend that currently primary endpoints for DIPG clinical trials should be overall or possibly progression free survival and that new advanced functional imaging techniques should be explored as possible surrogate markers for novel therapy activity rather than conventional MRI response criteria.
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Affiliation(s)
- Darren Hargrave
- Paediatric Oncology Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, London, SM2 5PT, UK.
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Pirotte B, Acerbi F, Lubansu A, Goldman S, Brotchi J, Levivier M. PET imaging in the surgical management of pediatric brain tumors. Childs Nerv Syst 2007; 23:739-51. [PMID: 17356889 DOI: 10.1007/s00381-007-0307-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The present article illustrates whether positron-emission tomography (PET) imaging may improve the surgical management of pediatric brain tumors (PBT) at different steps. MATERIALS AND METHODS Among 400 consecutive PBT treated between 1995 and 2005 at Erasme Hospital, Brussels, Belgium, we have studied with (18) F-2-fluoro-2-deoxy-D-glucose (FDG)-PET and/or L-(methyl-(11)C)methionine (MET)-PET and integrated PET images in the diagnostic workup of 126 selected cases. The selection criteria were mainly based on the lesion appearance on magnetic resonance (MR) sequences. Cases were selected when MR imaging showed limitations for (1) assessing the evolving nature of an incidental lesion (n = 54), (2) selecting targets for contributive and accurate biopsy (n = 32), and (3) delineating tumor tissue for maximal resection (n = 40). Whenever needed, PET images were integrated in the planning of image-guided surgical procedures (frame-based stereotactic biopsies (SB), frameless navigation-based resections, or leksell gamma knife radiosurgery). RESULTS Like in adults, PET imaging really helped the surgical management of the 126 children explored, which represented about 30% of all PBT, especially when the newly diagnosed brain lesion was (1) an incidental finding so that the choice between surgery and conservative MR follow-up was debated, and (2) so infiltrative or ill-defined on MR that the choice between biopsy and resection was hardly discussed. Integrating PET into the diagnostic workup of these two selected groups helped to (1) take a more appropriate decision in incidental lesions by detecting tumor/evolving tissue; (2) better understand complex cases by differentiating indolent and active components of the lesion; (3) improve target selection and diagnostic yield of stereotactic biopsies in gliomas; (4) illustrate the intratumoral histological heterogeneity in gliomas; (5) provide additional prognostic information; (6) reduce the number of trajectories in biopsies performed in eloquent areas such as the brainstem or the pineal region; (7) better delineate ill-defined PBT infiltrative along functional cortex than magnetic resonance imaging (MRI); (8) increase significantly, compared to using MRI alone, the number of total tumor resection and the amount of tumor tissue removed in PBT for which a total resection is a key-factor of survival; (9) target the resection on more active areas; (10) improve detection of tumor residues in the operative cavity at the early postoperative stage; (11) facilitate the decision of early second-look surgery for optimizing the radical resection; (12) improve the accuracy of the radiosurgical dosimetry planning. CONCLUSIONS PET imaging may improve the surgical management of PBT at the diagnostic, surgical, and post-operative steps. Integration of PET in the clinical workup of PBT inaugurates a new approach in which functional data can influence the therapeutic decision process. Although metabolic information from PET are valid and relevant for the clinical purposes, further studies are needed to assess whether PET-guidance may decrease surgical morbidity and increase children survival.
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Affiliation(s)
- Benoit Pirotte
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium.
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Pötzi C, Becherer A, Marosi C, Karanikas G, Szabo M, Dudczak R, Kletter K, Asenbaum S. [11C] methionine and [18F] fluorodeoxyglucose PET in the follow-up of glioblastoma multiforme. J Neurooncol 2007; 84:305-14. [PMID: 17492401 DOI: 10.1007/s11060-007-9375-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 03/12/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the value of [11C] methionine (MET) and [18F] fluorodeoxyglucose (FDG) PET in the follow-up of glioblastoma multiforme (GBM). PATIENTS AND METHODS After surgical and/or conservative treatment, 28 patients (pts) with GBM underwent FDG and MET PET on average 12.7 months after the diagnosis had been established. Scans were evaluated visually and by calculating the maximal tumor SUV as well as the ratio of tumor vs. contralateral region (RTu). The degree of tracer uptake was compared with survival time, disease duration and MRI findings. RESULTS The mean overall duration of survival was 12.7 months. The patients were divided into two groups: those that survived less than 12 months and those that survived longer than 12 months. Focally increased uptake was revealed by MET PET in 24 patients and by FDG PET in 2 patients. On MRI scans, viable tumor tissue was suspected in 18 patients. No correlations were registered between FDG/MET uptake and survival time or disease duration respectively; Kaplan-Meier calculations were negative in this regard. Similarly, negative results were obtained in subgroups of patients who had undergone microsurgical resection and whose disease was at least of 6 months' duration, and additionally in a subgroup who had undergone their last treatment longer than 6 months ago. With respect to survival groups, a positive MET PET was associated with a sensitivity of 86% and a specificity of 8%. SUV and RTu values did not differ between patients with positive or negative MRI results. CONCLUSIONS In this study FDG PET seems to be of limited value in the work-up of recurrent GBM because of its lower sensitivity than MET PET and the fact that it allows no prediction of the outcome. MET PET visualizes viable tumor tissue without adding any prognostic information and appears to be in no way superior to conventional imaging.
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Affiliation(s)
- Christian Pötzi
- Department of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Stockhammer F, Thomale UW, Plotkin M, Hartmann C, Von Deimling A. Association between fluorine-18-labeled fluorodeoxyglucose uptake and 1p and 19q loss of heterozygosity in World Health Organization Grade II gliomas. J Neurosurg 2007; 106:633-7. [PMID: 17432715 DOI: 10.3171/jns.2007.106.4.633] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Oligodendroglial tumors harboring combined 1p and 19q loss (1p/19q LOH) are characterized by a favorable prognosis and response to chemotherapy and radiotherapy, but detection of 1p/19q LOH relies on postoperative procedures. The authors investigated the potential of fluorine-18-labeled fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) to predict 1p/19q LOH preoperatively in tumors whose appearance on initial magnetic resonance images was consistent with that of low-grade glioma. METHODS The study population comprised 25 patients who had undergone preoperative FDG-PET followed by tumor resection. Neuronavigation ensured a precise match of FDG uptake with the site of biopsy. All tumor specimens were graded according to the World Health Organization (WHO) classification system. Microsatellite analysis was used to identify 1p/19q LOH. In this series, 16 of 25 gliomas corresponded to WHO Grade II. In eight of these 16, 1p/19q LOH was detected. Raised glucose utilization within the tumor was seen in the six of eight WHO Grade II gliomas with 1p/19q LOH and in none of the WHO Grade II gliomas without this genetic alteration (p = 0.003). CONCLUSIONS These findings demonstrate the potential of FDG-PET to predict 1p/19q LOH in WHO Grade II gliomas.
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Schaller BJ, Modo M, Buchfelder M. Molecular Imaging of Brain Tumors: A Bridge Between Clinical and Molecular Medicine? Mol Imaging Biol 2007; 9:60-71. [PMID: 17203238 DOI: 10.1007/s11307-006-0069-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
As the research on cellular changes has shed invaluable light on the pathophysiology and biochemistry of brain tumors, clinical and experimental use of molecular imaging methods is expanding and allows quantitative assessment. The term molecular imaging is defined as the in vivo characterization and measurement of biologic processes at the cellular and molecular level. Molecular imaging sets forth to probe the molecular abnormalities that are the basis of disease rather than to visualize the end effects of these molecular alterations and, therefore, provides different additional biochemical or molecular information about primary brain tumors compared to histological methods "classical" neuroradiological diagnostic studies. Common clinical indications for molecular imaging contain primary brain tumor diagnosis and identification of the metabolically most active brain tumor reactions (differentiation of viable tumor tissue from necrosis), prediction of treatment response by measurement of tumor perfusion, or ischemia. The interesting key question remains not only whether the magnitude of biochemical alterations demonstrated by molecular imaging reveals prognostic value with respect to survival, but also whether it identifies early disease and differentiates benign from malignant lesions. Moreover, an early identification of treatment success or failure by molecular imaging could significantly influence patient management by providing more objective decision criteria for evaluation of specific therapeutic strategies. Specially, as molecular imaging represents a novel technology for visualizing metabolism and signal transduction to gene expression, reporter gene assays are used to trace the location and temporal level of expression of therapeutic and endogenous genes. Molecular imaging probes and drugs are being developed to image the function of targets without disturbing them and in mass amounts to modify the target's function as a drug. Molecular imaging helps to close the gap between in vitro and in vivo integrative biology of disease.
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Affiliation(s)
- B J Schaller
- Neuroscience Imaging, Department of Neurological Surgery, University of Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
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Fontaine D, Duffau H, Litrico S. [New surgical techniques for brain tumors]. Rev Neurol (Paris) 2006; 162:801-11. [PMID: 17028540 DOI: 10.1016/s0035-3787(06)75082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
During the past years, the development of new technologies and techniques has been applied to brain tumor surgery, leading to decreased surgical morbidity and increased efficiency. These techniques can be used to reduce the invasiveness of the surgical approach (endoscopy, neuronavigation, robotics), to improve guidance (stereotaxy, neuronavigation), to better identify the tumor limits (neuronavigation, metabolic imaging, intra-operative MRI) or the functional areas (functional imaging, electrophysiological functional mapping) to optimize resection and to respect eloquent areas. This article reviews these techniques, focusing on their respective principles, practical utility, impact and limits.
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Affiliation(s)
- D Fontaine
- Service de Neurochirurgie, Hôpital Pasteur, CHU de Nice.
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Kwon JW, Kim IO, Cheon JE, Kim WS, Moon SG, Kim TJ, Chi JG, Wang KC, Chung JK, Yeon KM. Paediatric brain-stem gliomas: MRI, FDG-PET and histological grading correlation. Pediatr Radiol 2006; 36:959-64. [PMID: 16847598 DOI: 10.1007/s00247-006-0256-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Revised: 10/15/2005] [Accepted: 11/01/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND MRI and FDG-PET may predict the histological grading of paediatric brain-stem gliomas. OBJECTIVE To assess MRI findings and metabolic imaging using FDG-PET of brain-stem gliomas based on histological grading. MATERIALS AND METHODS Included in the study were 20 paediatric patients (age 3-14 years, mean 8.2 years) with brain-stem glioma (five glioblastomas, ten anaplastic astrocytomas and five low-grade astrocytomas). MR images were assessed for the anatomical site of tumour origin, focality, pattern of tumour growth, and enhancement. RESULTS All glioblastomas were located in the pons and showed diffuse pontine enlargement with focally exophytic features. Eight anaplastic astrocytomas were located in the pons and demonstrated diffuse pontine enlargement without exophytic features. Low-grade astrocytomas were located in the pons, midbrain or medulla and showed focally exophytic growth features and peripheral enhancement. In 12 patients in whom FDG-PET was undertaken, glioblastomas showed hypermetabolic or hypometabolic lesions, anaplastic astrocytomas showed no metabolic change or hypometabolic lesions and low-grade astrocytomas showed hypometabolism compared with the cerebellum. CONCLUSION MRI findings correlated well with histological grading of brain-stem gliomas and MRI may therefore predict the histological grading. FDG-PET may be helpful in differentiating between anaplastic astrocytoma and glioblastomas among high-grade tumours.
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Affiliation(s)
- Jong Won Kwon
- Department of Radiology, Seoul National University Hospital, 28, Yongon-Dong, Chongno-Gu, 110-744 Seoul, South Korea
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Andersen PB, Blinkenberg M, Lassen U, Kosteljanetz M, Wagner A, Poulsen HS, Sørensen PS, Paulson OB. A prospective PET study of patients with glioblastoma multiforme. Acta Neurol Scand 2006; 113:412-8. [PMID: 16674608 DOI: 10.1111/j.1600-0404.2006.00628.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the post-surgical metabolic and structural cerebral changes in patients with glioblastoma multiforme (GBM). MATERIALS AND METHODS We examined ten patients prospectively with newly diagnosed GBM. All patients were primarily treated with surgery, followed by chemotherapy (carmustine, cisplatine and etoposide) and radiotherapy. Positron emission tomography (PET) was used to measure tumor- and cerebral metabolism. CT or MRI was used to estimate tumor volume by measurements of tumor area. RESULTS Tumor metabolism was not increased during chemotherapy (P = 0.71), but increased during radiotherapy (P = 0.01). CT/MRI showed similar results with no increase in tumor area during chemotherapy (P = 0.33) but increase during radiotherapy (P = 0.002). During the entire study, tumor metabolism and area increased evenly (P = 0.01). CONCLUSIONS Our study did not show a gain of PET compared with structural imaging in the prospective evaluation of GBM. We found a difference in metabolic increase and tumor growth between the two treatment regimens, although this finding has limited relevance due to the design of the study.
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Affiliation(s)
- P B Andersen
- Department of Neurology, The Neuroscience Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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De Witte O, Oulad Ben Taib N, Branle F, Rorive S, Brotchi J, Goldman S. [Contribution of PET to the management of patients with low-grade glioma]. Neurochirurgie 2005; 50:468-73. [PMID: 15547485 DOI: 10.1016/s0028-3770(04)98327-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Management of patients with low-grade glioma is a major challenge for the neurosurgeon. When is neurosurgery indicated? Should chemotherapy or radiotherapy be used? Many questions without an answer. We reviewed our experience with 65 patients treated for low-grade glioma who had preoperative PET images (FDG or/and MET). We examined the prognostic value of PET and also determined the sensitivity and the specificity of PET images to predict outcome. METHODS Sixty-five patients with a FDG or MET PET images were analyzed. We used two visual scales and had complete follow-up data for 63 patients. The free interval was the principal criterion for statistical analysis. The sensitivity and the specificity of PET images was determined. RESULTS Strong FDG uptake was correlated with a short free interval (p=0.001). Similar results were found with the MET analysis (p=0.0076). We had a PET with MET and FDG for 36 patients. The sensitivity was 66% and the specificity 94% for FDG PET. Sensitivity was 100% and specificity 53% for MET PET. CONCLUSIONS PET imaging provides a prognostic factor independent from histology. MET PET is the best exam for the follow-up of patients with low-grade glioma and is helpful for separating aggressive from low-grade glioma.
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Affiliation(s)
- O De Witte
- Service de Neurochirurgie (Clinique Neurochirurgicale d'Oncologie),
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Gururangan S, Hwang E, Herndon JE, Fuchs H, George T, Coleman RE. [18F]fluorodeoxyglucose-positron emission tomography in patients with medulloblastoma. Neurosurgery 2005; 55:1280-8; discussion 1288-9. [PMID: 15574210 DOI: 10.1227/01.neu.0000143027.41632.2b] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2003] [Accepted: 08/02/2004] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE We evaluated the [(18)F]fluorodeoxyglucose (FDG) accumulation during positron emission tomography (PET) in patients with medulloblastoma and examined the relationship of intensity of uptake with patient outcome after the initial scan. METHODS Magnetic resonance imaging and FDG-PET scans of brain and spine were used to assess FDG uptake by visual grade (qualitative analysis) and metabolic activity ratios (T(max)/G(mean) and T(max)/W(mean)). Patients were divided into two groups based on either confirmation of tumor by biopsy and/or death resulting from progressive disease after the initial FDG-PET scan (Group A) or no intervention for the suspected lesion shown on magnetic resonance imaging after the initial FDG-PET scan but currently alive without evidence of disease (Group B). RESULTS Twenty-two patients with either recurrent (n = 21) or newly diagnosed (n = 1) medulloblastoma underwent brain (n = 18) or whole-body (n = 4) FDG-PET scans after magnetic resonance imaging evidence of suspected tumor. The median qualitative analysis was 3 (range, 0-4) in 17 Group A patients compared with 0 (range, 0-1) in 5 Group B patients (P = 0.0003). The mean T(max)/G(mean) and T(max)/W(mean) ratios for 16 Group A patients were 1.3 (range, 0.1-3.8) and 2.10 (range, 0.4-5.2), respectively, compared with 0.80 (range, 0.20-1.5) and 1.3 (range, 0.5-1.9) in 5 Group B patients (P = 0.2 for both parameters, not significant). There was a significant negative correlation between increased FDG uptake and survival. Higher qualitative analysis and T(max)/W(mean) were associated with significantly poorer 2-year overall survival after the initial scan (71% versus 15% for qualitative analysis grade of <3 versus > or =3, P = 0.001; 46% versus 0% for T(max)/W(mean) < or =2.5 versus >2.5, P = 0.004). CONCLUSION Increased FDG uptake is observed in medulloblastoma and is correlated negatively with survival.
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Affiliation(s)
- Sridharan Gururangan
- The Brain Tumor Center at Duke, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA.
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Abstract
The technological revolution in imaging during recent decades has transformed the way image-guided radiation therapy is performed. Anatomical imaging (plain radiography, computed tomography, magnetic resonance imaging) greatly improved the accuracy of delineating target structures and has formed the foundation of 3D-based radiation treatment. However, the treatment planning paradigm in radiation oncology is beginning to shift toward a more biological and molecular approach as advances in biochemistry, molecular biology, and technology have made functional imaging (positron emission tomography, nuclear magnetic resonance spectroscopy, optical imaging) of physiological processes in tumors more feasible and practical. This review provides an overview of the role of current imaging strategies in radiation oncology, with a focus on functional imaging modalities, as it relates to staging and molecular profiling (cellular proliferation, apoptosis, angiogenesis, hypoxia, receptor status) of tumors, defining radiation target volumes, and assessing therapeutic response. In addition, obstacles such as imaging-pathological validation, optimal timing of post-therapy scans, spatial and temporal evolution of tumors, and lack of clinical outcome studies are discussed that must be overcome before a new era of functional imaging-guided therapy becomes a clinical reality.
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Affiliation(s)
- Smith Apisarnthanarax
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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