Diagnostic Accuracy of Amino Acid and FDG-PET in Differentiating Brain Metastasis Recurrence from Radionecrosis after Radiotherapy: A Systematic Review and Meta-Analysis

Li, H.; Deng, Lei; Bai, Hao; Sun, Jia; Cao, Yuan; Tao, Yongguang; States, Lisa J.; Farwell, Michael D.; Zhang, P.; Xiao, Bing; Yang, Li

doi:10.3174/ajnr.a5472

Cited by 46 publications

(26 citation statements)

References 61 publications

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“…Twenty-four meta-analyses on the use of PET or PET/CT with different tracers in brain tumors, published from 2012, were selected through the comprehensive computer literature search (Figure 1) [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31]. The characteristics of the selected meta-analyses on the diagnostic performance are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Performance and Prognostic Value of PET/CT with Different Tracers for Brain Tumors: A Systematic Review of Published Meta-Analyses

Treglia

Muoio

Trevisi

et al. 2019

IJMS

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Background: Several meta-analyses reporting data on the diagnostic performance or prognostic value of positron emission tomography (PET) with different tracers in detecting brain tumors have been published so far. This review article was written to summarize the evidence-based data in these settings. Methods: We have performed a comprehensive literature search of meta-analyses published in the Cochrane library and PubMed/Medline databases (from inception through July 2019) about the diagnostic performance or prognostic value of PET with different tracers in patients with brain tumors. Results: We have summarized the results of 24 retrieved meta-analyses on the use of PET or PET/computed tomography (CT) with different tracers in brain tumors. The tracers included were: fluorine-18 fluorodeoxyglucose (18F-FDG), carbon-11 methionine (11C-methionine), fluorine-18 fluoroethyltyrosine (18F-FET), fluorine-18 dihydroxyphenylalanine (18F-FDOPA), fluorine-18 fluorothymidine (18F-FLT), and carbon-11 choline (11C-choline). Evidence-based data demonstrated good diagnostic performance of PET with different tracers in detecting brain tumors, in particular, radiolabelled amino acid tracers showed the highest diagnostic performance values. All the PET tracers evaluated had significant prognostic value in patients with glioma. Conclusions: Evidence-based data showed a good diagnostic performance for some PET tracers in specific indications and significant prognostic value in brain tumors.

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Section: Resultsmentioning

confidence: 99%

Diagnostic Performance and Prognostic Value of PET/CT with Different Tracers for Brain Tumors: A Systematic Review of Published Meta-Analyses

Treglia

Muoio

Trevisi

et al. 2019

IJMS

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“…FDG, while widely used, has discordant results in its ability to differentiate recurrent brain metastasis from radiation necrosis, possible due to different thresholds used in each study and elevated background brain parenchymal uptake [27]. Amino acid PET agents such as [F-18]-uroethyltyrosine ([F-18]-FET) and [C-11]-MET [28,29] have been used with some success as a means to differentiate progressive metastatic disease from radiation necrosis.…”

Section: Discussionmentioning

confidence: 99%

[18F]-Fluciclovine PET discrimination of recurrent intracranial metastatic disease from radiation necrosis

Parent

Patel

Nye

et al. 2020

Preprint

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Background Stereotactic radiosurgery (SRS) is often the primary treatment modality for patients with intracranial metastatic disease. Despite advances in magnetic resonance imaging, including use of perfusion and diffusion sequences and molecular imaging, distinguishing radiation necrosis from progressive tumor remains a diagnostic and clinical challenge. We investigated the sensitivity and specificity of 18F-fluciclovine PET to accurately distinguish radiation necrosis from recurrent intracranial metastatic disease in patients who had previously undergone SRS. Methods Fluciclovine PET imaging was performed in 8 patients with a total of 15 lesions that had previously undergone SRS and had subsequent MRI and clinical features suspicious for recurrent disease. The SUVmax of each lesion and the contralateral normal brain parenchyma were summated and evaluated at 4 different time points (5 minutes, 10 minutes, 30 minutes, and 55 minutes). Lesions were characterized as either recurrent disease (11 of 15 lesions) or radiation necrosis (4 of 15 lesions) and confirmed with histopathological correlation (7 lesions) or through serial MRI studies (8 lesions). Results Time activity curve analysis found statistically greater radiotracer accumulation for all lesions, including radiation necrosis, when compared to contralateral normal brain. While the mean and median SUVmax for recurrent disease was statistically greater than that of radiation necrosis at all time points, the difference was more significant at the earlier time points (p = 0.004 at 5 min – 0.025 at 55 min). Using a SUVmax threshold of ≥ 1.3, fluciclovine PET demonstrated a 100% accuracy in distinguishing recurrent disease from radiation necrosis up to 30 minutes after injection and an accuracy of 87% (sensitivity = 0.91, specificity = 0.75) at the last time point of 55 minutes. However, tumor to brain ratios (TBRmax) were not significantly different between recurrent disease and radiation necrosis at any time point due to variable levels of fluciclovine uptake in the background brain parenchyma. Conclusions Fluciclovine PET may play an important role in distinguishing active intracranial metastatic lesions from radiation necrosis in patients previously treated with SRS but needs to be validated in larger studies.

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“…However, confounding influences of FDG-PET false positive (from inflammation and stroke) or negative results with reported specificity and sensitivity (86% and 80%, respectively) in irradiated BMs must be considered when incorporating FDG-PET into treatment planning. 18 For instance, MR perfusion 19 [18-F]fluoromisonidazole-PET (hypoxia imaging) 20 and fluorothymidine F-18 PET (proliferation imaging) 21 and alternative amino acid PET tracers, such as [ 11 C]-methionine (MET-PET) or [F] fluoroethyl-L-tyrosine, which reduce cortical background 22 or translocator protein-18 kDa-PET, which is specific for inflammation, 23 may prove to have advantages over FDG-PET in SRS treatment planning to delineate tumor from RN. Finally, as opposed to PET-CT or PET alone, the use of PET-MRI may enhance coregistration and streamline the incorporation of PET into SRS treatment planning.…”

Section: Discussionmentioning

confidence: 99%

Coregistration of Magnetic Resonance and [18F] Fludeoxyglucose–Positron Emission Tomography Imaging for Stereotactic Radiation Therapy Planning: Case Report in a Previously Irradiated Brain Metastasis With Recurrent Tumor and Radiation Necrosis

Scranton

Sadrameli

Butler

et al. 2020

Practical Radiation Oncology

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Diagnostic Accuracy of Amino Acid and FDG-PET in Differentiating Brain Metastasis Recurrence from Radionecrosis after Radiotherapy: A Systematic Review and Meta-Analysis

Abstract: Amino acid and FDG-PET had good diagnostic accuracy in differentiating brain metastasis recurrence from radionecrosis after radiation therapy.

Cited by 46 publications

References 61 publications

Diagnostic Performance and Prognostic Value of PET/CT with Different Tracers for Brain Tumors: A Systematic Review of Published Meta-Analyses

Diagnostic Performance and Prognostic Value of PET/CT with Different Tracers for Brain Tumors: A Systematic Review of Published Meta-Analyses

[18F]-Fluciclovine PET discrimination of recurrent intracranial metastatic disease from radiation necrosis

Coregistration of Magnetic Resonance and [18F] Fludeoxyglucose–Positron Emission Tomography Imaging for Stereotactic Radiation Therapy Planning: Case Report in a Previously Irradiated Brain Metastasis With Recurrent Tumor and Radiation Necrosis

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