18F-Fluciclovine PET/CT in Suspected Residual or Recurrent High-Grade Glioma

Bogsrud, Trond Velde; Løndalen, Ayca; Brandal, Petter; Leske, Henning; Panagopoulos, Ioannis; Borghammer, Per; Bach‐Gansmo, Tore

doi:10.1097/rlu.0000000000002641

Cited by 35 publications

(45 citation statements)

References 33 publications

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“…F-Fluciclovine images showed high contrast, confirmed by the high tumor-to-brain ratios (tumor SUVmax-to-SUVmean of a reference normal-brain region), concordant with the first clinical studies [10][11][12][13][14]. Our results showed that the two ratios calculated with two different reference regions (either the contralateral normal brain tissue or the cerebellum) are highly correlated, as was previously described by Kondo et al [10].…”

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confidence: 91%

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18F-Fluciclovine (18F-FACBC) PET imaging of recurrent brain tumors

Michaud

Beattie

Akhurst

et al. 2019

Eur J Nucl Med Mol Imaging

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The aim of our study was to investigate the efficacy of 18 F-Fluciclovine brain PET imaging in recurrent gliomas, and to compare the utility of these images to that of contrast enhanced magnetic resonance imaging (MRI) and to [ 11 C-methyl]-L-methionine (11 C-Methionine) PET imaging. We also sought to gain insight into the factors affecting the uptake of 18 F-FACBC in both tumors and normal brain, and specifically to evaluate how the uptake in these tissues varied over an extended period of time post injection. Methods Twenty-seven patients with recurrent or progressive primary brain tumor (based on clinical and MRI/CT data) were studied using dynamic 18 F-Fluciclovine brain imaging for up to 4 h. Of these, 16 patients also had 11 C-Methionine brain scans. Visual findings, semi-quantitative analyses and pharmacokinetic modeling of a subset of the 18 F-Fluciclovine images was conducted. The information derived from these analyses were compared to data from 11 C-Methionine and to contrast-enhanced MRI. Results 18 F-Fluciclovine was positive for all 27 patients, whereas contrast MRI was indeterminate for three patients. Tumor 18 F-Fluciclovine SUVmax ranged from 1.5 to 10.5 (average: 4.5 ± 2.3), while 11 C-Methionine's tumor SUVmax ranged from 2.2 to 10.2 (average: 5.0 ± 2.2). Image contrast was higher with 18 F-Fluciclovine compared to 11 C-Methionine (p < 0.0001). This was due to 18 F-Fluciclovine's lower background in normal brain tissue (0.5 ± 0.2 compared to 1.3 ± 0.4 for 11 C-Methionine). 18 F-Fluciclovine uptake in both normal brain and tumors was well described by a simple one-compartment (three-parameter: V b ,k 1 ,k 2) model. Normal brain was found to approach transient equilibrium with a half-time that varied greatly, ranging from 1.5 to 8.3 h (mean 2.7 ± 2.3 h), and achieving a consistent final distribution volume averaging 1.4 ± 0.2 ml/cc. Tumors equilibrated more rapidly (t 1/2 ranging from 4 to 148 min, average 57 ± 51 min), with an average distribution volume of 3.2 ± 1.1 ml/cc. A qualitative comparison showed that the rate of normal brain uptake of 11 C-Methionine was much faster than that of 18 F-Fluciclovine. Conclusion Tumor uptake of 18 F-Fluciclovine correlated well with the established brain tumor imaging agent 11 C-Methionine but provided significantly higher image contrast. 18 F-Fluciclovine may be particularly useful when the contrast MRI is non-diagnostic. Based on the data gathered, we were unable to determine whether Fluciclovine uptake was due solely to recurrent tumor or if inflammation or other processes also contributed.

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confidence: 91%

“…Recently, Tsuyuguchi et al showed in a preliminary study of six patients that 18 F-Fluciclovine may provide better assessment than 11 C-Methionine for the initial detection of glioma [13]. Furthermore, 18 F-Fluciclovine may be a promising tracer to detect high grade recurrent gliomas [14].…”

Section: Introductionmentioning

confidence: 99%

18F-Fluciclovine (18F-FACBC) PET imaging of recurrent brain tumors

Michaud

Beattie

Akhurst

et al. 2019

Eur J Nucl Med Mol Imaging

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“…Bashir et al [ 27 ] found that a 20-min 18 F-FET PET scan is a powerful tool with TBRmax (sensitivity 99%, specificity 94%) to distinguish posttreatment changes from recurrent glioblastoma 6 months postradiotherapy. Bogsrud et al [ 28 ] reported the performance of a new type of amino acid 18 F-fluciclovine in PET/CT of suspected residual or recurrent glioma, but the ability of 18 F-fluciclovine PET/CT to discriminate between recurrent glioma and treatment-related changes could not be determined because no patients had confirmed treatment-related changes. More recently, 18 F-labelled DOPA is a more widely used amino acid tracer than 11 C-MET because it has a longer half-life of up to 110 min, whereas that of 11 C-MET is only 20 min.…”

Section: Discussionmentioning

confidence: 99%

Identify glioma recurrence and treatment effects with triple-tracer PET/CT

Liu

Chen

et al. 2021

BMC Med Imaging

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Background Differential diagnosis of tumour recurrence (TuR) from treatment effects (TrE), mostly induced by radiotherapy and chemotherapy, is still difficult by using conventional computed tomography (CT) or magnetic resonance (MR) imaging. We have investigated the diagnostic performance of PET/CT with 3 tracers, 13N-NH3, 18F-FDOPA, and 18F-FDG, to identify TuR and TrE in glioma patients following treatment. Methods Forty-three patients with MR-suspected recurrent glioma were included. The maximum and mean standardized uptake values (SUVmax and SUVmean) of the lesion and the lesion-to-normal grey-matter cortex uptake (L/G) ratio were obtained from each tracer PET/CT. TuR or TrE was determined by histopathology or clinical MR follow-up for at least 6 months. Results In this cohort, 34 patients were confirmed to have TuR, and 9 patients met the diagnostic standard of TrE. The SUVmax and SUVmean of 13N-NH3 and 18F-FDOPA PET/CT at TuR lesions were significantly higher compared with normal brain tissue (13N-NH3 0.696 ± 0.558, 0.625 ± 0.507 vs 0.486 ± 0.413; 18F-FDOPA 0.455 ± 0.518, 0.415 ± 0.477 vs 0.194 ± 0.203; both P < 0.01), but there was no significant difference in 18F-FDG (6.918 ± 3.190, 6.016 ± 2.807 vs 6.356 ± 3.104, P = 0.290 and 0.493). L/G ratios of 13N-NH3 and 18F-FDOPA were significantly higher in TuR than in TrE group (13N-NH3, 1.573 ± 0.099 vs 1.025 ± 0.128, P = 0.008; 18F-FDOPA, 2.729 ± 0.131 vs 1.514 ± 0.141, P < 0.001). The sensitivity, specificity and AUC (area under the curve) by ROC (receiver operating characteristic) analysis were 57.7%, 100% and 0.803, for 13N-NH3; 84.6%, 100% and 0.938, for 18F-FDOPA; and 80.8%, 100%, and 0.952, for the combination, respectively. Conclusion Our results suggest that although multiple tracer PET/CT may improve differential diagnosis efficacy, for glioma TuR from TrE, 18F-FDOPA PET-CT is the most reliable. The combination of 18F-FDOPA and 13N-NH3 does not increase the diagnostic efficiency, while 18F-FDG is not worthy for differential diagnosis of glioma TuR and TrE.

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“…Bashir et al [27] found that a 20-minute 18 F-FET PET scan is a powerful tool with TBRmax (sensitivity 99%, speci city 94%) to distinguish posttreatment changes from recurrent glioblastoma 6 months postradiotherapy. Bogsrud et al [28] reported the performance of a new type of amino acid 18 F-uciclovine in PET/CT of suspected residual or recurrent glioma, but the ability of 18 F-uciclovine PET/CT to discriminate between recurrent glioma and treatment-related changes could not be determined because no patients had con rmed treatment-related changes. More recently, 18 F-labelled DOPA is a more widely used amino acid tracer than 11 C-MET because it has a longer half-life of up to 110 minutes, whereas that of 11 C-MET is only 20 minutes.…”

Section: Discussionmentioning

confidence: 99%

Identify glioma recurrence and treatment effects with triple-tracer PET/CT

Liu

Chen

et al. 2021

Preprint

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Purpose: Differential diagnosis of tumour recurrence (TuR) from treatment effects (TrE), mostly induced by radiotherapy and chemotherapy, is still difficult by using conventional computed tomography (CT) or magnetic resonance (MR) imaging. We have investigated the diagnostic performance of PET/CT with 3 tracers, 13N-NH3, 18F-FDOPA, and 18F-FDG, to identify TuR and TrE in glioma patients following treatment. Methods: Forty-three patients with MR-suspected recurrent glioma were included. The maximum and mean standardized uptake values (SUVmax and SUVmean) of the lesion and the lesion-to-normal grey-matter cortex uptake (L/G) ratio were obtained from each tracer PET/CT. TuR or TrE was determined by histopathology or clinical MR follow-up for at least 6 months. Results: In this cohort, 34 patients were confirmed to have TuR, and 9 patients met the diagnostic standard of TrE. The SUVmax and SUVmean of 13N-NH3 and 18F-FDOPA PET/CT at TuR lesions were significantly higher compared with normal brain tissue (13N-NH3 0.696±0.558, 0.625±0.507 vs 0.486±0.413; 18F-FDOPA 0.455±0.518, 0.415±0.477 vs 0.194±0.203; both P<0.01), but there was no significant difference in 18F-FDG (6.918±3.190, 6.016±2.807 vs 6.356±3.104, P=0.290 and 0.493). L/G ratios of 13N-NH3 and 18F-FDOPA were significantly higher in TuR than in TrE group (13N-NH3, 1.573±0.099 vs 1.025±0.128, P=0.008; 18F-FDOPA, 2.729±0.131 vs 1.514±0.141, P<0.001). The sensitivity, specificity and AUC (area under the curve) by ROC (receiver operating characteristic) analysis were 57.7%, 100% and 0.803, for 13N-NH3; 84.6%, 100% and 0.938, for 18F-FDOPA; and 80.8%, 100%, and 0.952, for the combination, respectively.Conclusion: Our results suggest that although multiple tracer PET/CT may improve differential diagnosis efficacy, for glioma TuR from TrE, 18F-FDOPA PET-CT is the most reliable. The combination of 18F-FDOPA and 13N-NH3 does not increase the diagnostic efficiency, while 18F-FDG is not worthy for differential diagnosis of glioma TuR and TrE.

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18F-Fluciclovine PET/CT in Suspected Residual or Recurrent High-Grade Glioma

Cited by 35 publications

References 33 publications

18F-Fluciclovine (18F-FACBC) PET imaging of recurrent brain tumors

18F-Fluciclovine (18F-FACBC) PET imaging of recurrent brain tumors

Identify glioma recurrence and treatment effects with triple-tracer PET/CT

Identify glioma recurrence and treatment effects with triple-tracer PET/CT

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