PET with amino acid tracers provides additional insight beyond MR imaging into the biology of gliomas that can be used for initial diagnosis, delineation of tumor margins, planning of surgical and radiation therapy, assessment of residual tumor, and evaluation of posttreatment response. Hybrid PET MR imaging allows the simultaneous acquisition of various PET and MR imaging parameters in a single investigation with reduced scanning time and improved anatomic localization. This review aimed to provide neuroradiologists with a concise overview of the various amino acid tracers and a practical understanding of the clinical applications of amino acid PET MR imaging in glioma management. Future perspectives in newer advances, novel radiotracers, radiomics, and cost-effectiveness are also outlined.ABBREVIATIONS: AAT ¼ amino acid tracer; AA ¼ amino acid; ASCT ¼ alanine-serine-cysteine transporter; BTV ¼ biologic tumor volume; GBM ¼ glioblas-G liomas represent approximately 80% of malignant brain tumors, with an annual incidence rate of 5.6 cases per 100,000 individuals worldwide. Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor, representing approximately 50% of all gliomas and 16% of all brain tumors. 1 Depending on the size and extent of these tumors, the standard of care for newly diagnosed GBMs usually includes maximal surgical resection followed by radiation and chemotherapy. Despite substantial development in managing high-grade gliomas (HGGs), the median survival is ,15 months, with 1-and 5-year survival rates of 40% and 5.5%, respectively. 2 Imaging is crucial for diagnosing, guiding biopsy, surgical planning, and distinguishing treatment-related changes (TRC) from recurrence in glioma management. MR imaging is the primary imaging technique; however, it lacks specificity to distinguish between viable neoplastic tissue and tumor-free areas.Advanced MR imaging techniques such as PWI, DWI, DTI, MRS, and molecular imaging (PET) facilitate visualization and quantification of different metabolic processes and improve overall diagnostic performance in brain tumors. Hybrid PET MR imaging with novel radiotracers provides a noninvasive, simultaneous assessment of brain tumor morphologic, functional, metabolic, and molecular parameters. 3,4 This review aimed to provide neuroradiologists with a concise overview of the various amino acid tracers (AATs) and a practical understanding of the clinical applications of amino acid (AA) PET MR imaging in glioma management. We will review the current literature regarding AA-PET MR imaging in glioma treatment and discuss its role in the initial diagnosis, delineation of tumor margin, planning of radiation therapy, assessment of residual tumor, and evaluation of treatment response. We will sum up with future perspectives on newer advances, novel radiotracers, radiomics, and cost-effectiveness. RadiopharmaceuticalsThe Joint European Association of Nuclear Medicine (EANM)/ European Association of Neuro-Oncology (EANO)/Response Assessment in Neuro-Oncology (RA...
Background Diffusion Tensor Imaging (DTI) has shown measurable changes in the brains of patients with persistent post-concussive syndrome (PCS). Because of inconsistent results in univariate DTI metrics among patients with mild traumatic brain injury (mTBI), currently, there is no single objective and reliable MRI index for the clinical decision-making for patients with PCS.Objectives The aim of this study was to evaluate the performance of a newly developed post-concussive syndrome index (PCSI) derived from machine learning of multiparametric MRI data, to classify and differentiate subjects with mTBI and PCS history from those without history of mTBI.Methods Data were retrospectively extracted from 139 patients aged between 18 and 60 years with PCS who had MRI examinations obtained 2 weeks to 1-year post-mTBI, as well as MRI data from 333 subjects without a history of head trauma. The performance of the PCSI was assessed by comparing patients with a clinical diagnosis of PCS to control subjects. The PCSI values for patients with PCS were compared based on mechanism of injury, time interval from injury to MRI examination, gender, prior concussion history, loss of consciousness, and reported symptoms.Results Patients with mTBI had a mean PCSI value of 0.57, compared to the control group, which had a mean PCSI value of 0.12 (p = 8.42e− 23) with accuracy of 88%, sensitivity of 64%, and specificity of 95% respectively. No statistically significant differences were found in PCSI values when comparing by mechanism of injury, gender, or loss of consciousness.Conclusion The PCSI for individuals aged between 18 and 60 years was able to accurately identify patients with post-concussive injuries from 2 weeks to 1-year post-mTBI and differentiate them from controls. The study's results suggest that the multiparametric MRI-based PCSI has great potential as an objective clinical tool to support the diagnosis, treatment, and follow-up care of those with post-concussive syndrome. Future research is required to investigate the replicability of this method using other types of clinical MRI scanners.
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