Potential for differentiation of glioma recurrence from radionecrosis using integrated ¹⁸F-fluoroethyl-L-tyrosine (FET) positron emission tomography/magnetic resonance imaging: A prospective evaluation

Abstract

Synergetic effect of multiple MR parameters evaluated together in addition to FET PET uptake highlights the fact that integrated 18F-FET PET/MRI might have the potential to impact management of patients with glioma by timely and conclusive recognition of true recurrence from radiation necrosis.

Diagnostic and Prognostic Potential of 18F-FET PET in the Differential Diagnosis of Glioma Recurrence and Treatment-Induced Changes After Chemoradiation Therapy

“…In their retrospective study on 32 treated glioma patients undergoing simultaneous 18 F-FET PET/MRI and MRI spectroscopy to identify suspect GR, Sogani et al. found that the addition of 18 F-FET parameters slightly improved sensitivity of advanced MRI and magnetic resonance spectroscopy (MRS), with sensitivity, specificity, and diagnostic accuracy of 100, 85.7, and 96.87% for 18 F-FET PET/MRI and 96, 85.7, and 93.75% for advanced MRI and MRS ( 43 ).…”

Diagnostic Performance of PET and Perfusion-Weighted Imaging in Differentiating Tumor Recurrence or Progression from Radiation Necrosis in Posttreatment Gliomas: A Review of Literature

“…Subsequently, several studies have reported better diagnostic accuracy by simultaneous use of PET and PWI (On-line Table 4). 36,38,51,54,55,[67][68][69][70][71][72][73][74][75] In a pilot study of 30 HGGs, ASL provided better results than DSC and FDG in detecting TR. However, DSC provided better spatial resolution with improved sensitivity when predominant TR with superimposed regions of predominant mixed RN were excluded while ASL sensitivity remained unchanged.…”

“…70 Integrated PET/MR imaging simultaneously acquires functional and structural parameters, which might have the potential to impact patient management by timely and accurate recognition of TR. 55,71,72 AATs show superior contrast to that of FDG because of low uptake in the normal brain tissue. [ 18 F] FET provides valuable information for re-radiation treatment planning of HGGs by differentiating metabolically active tumor from normal brain tissue.…”

“…The diagnostic accuracy, sensitivity, and specificity for recurrence detection by using all MR imaging parameters were 93.75%, 96%, and 85.7%, respectively, which further improved to 96.87%, 100%, and 85.7%, respectively, on addition of FET TBR. 71 Recently, a few studies tested the feasibility of dynamic FET-PET and have shown further improvement in the already remarkable diagnostic accuracy of static PET. 48,64,72 In a large heterogeneous cohort (n ¼ 124) of gliomas with different grades and histologies, Galldiks et al 48 found a sensitivity of 93% and specificity of 100% in differentiating TR from benign treatmentrelated changes by combining static and dynamic FET-PET.…”

[11C]Methionine and [11C]PBR28 as PET Imaging Tracers to Differentiate Metastatic Tumor Recurrence or Radiation Necrosis

“…Primary brain tumors are noted to overexpress amino acid transporters and increase amino acid uptake compared to normal brain. 3 The most promising amino acid imaging tracers include 18 Fluoro-O-(2) fluoroethyl-l-tyrosine ([ 18 F]FET), 4 - 6 [ 11 C] Methionine (MET), and 18 F-dihydroxyphenylalanine ( 18 F-DOPA) are similarly sensitive and specific for tumor regrowth. 7 Studies primarily in gliomas have reported [ 11 C]MET has 70-100% sensitivity and 60-100% specificity for TR.…”