Accuracy of F-DOPA PET and perfusion-MRI for differentiating radionecrotic from progressive brain metastases after radiosurgery

Magnetic resonance imaging (MRI) is the cornerstone for evaluating patients with brain masses such as primary and metastatic tumors. Important challenges in effectively detecting and diagnosing brain metastases and in accurately characterizing their subsequent response to treatment remain. These difficulties include discriminating metastases from potential mimics such as primary brain tumors and infection, detecting small metastases, and differentiating treatment response from tumor recurrence and progression. Optimal patient management could be benefited by improved and well-validated prognostic and predictive imaging markers, as well as early response markers to identify successful treatment prior to changes in tumor size. To address these fundamental needs, newer MRI techniques including diffusion and perfusion imaging, MR spectroscopy, and positron emission tomography (PET) tracers beyond traditionally used 18-fluorodeoxyglucose are the subject of extensive ongoing investigations, with several promising avenues of added value already identified. These newer techniques provide a wealth of physiologic and metabolic information that may supplement standard MR evaluation, by providing the ability to monitor and characterize cellularity, angiogenesis, perfusion, pH, hypoxia, metabolite concentrations, and other critical features of malignancy. This chapter reviews standard and advanced imaging of brain metastases provided by computed tomography, MRI, and amino acid PET, focusing on potential biomarkers that can serve as problem-solving tools in the clinical management of patients with brain metastases.

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“…FDOPA PET also appears to be accurate in identifying pseudoprogression (Cicone et al, 2014) and may be superior to perfusion MRI (Fig. 7.9).…”

Section: Caveats To Interpreting Posttreatment Imaging Changesmentioning

confidence: 99%

Brain metastases: neuroimaging

Pope

2018

Handbook of Clinical Neurology

140

128

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“…[10][11][12][13][14][15] In these studies, data evaluation was based predominantly on static PET parameters (eg, tumor-to-brain ratios).…”

Section: C-methyl-l-methionine ( 11 C-met) O-(2-[ 18 F]fluoroethyl)-mentioning

confidence: 99%

DynamicO-(2-¹⁸F-fluoroethyl)-L-tyrosine positron emission tomography differentiates brain metastasis recurrence from radiation injury after radiotherapy

et al. 2016

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Background. The aim of this study was to investigate the potential of dynamic O-(2-[ 18 F]fluoroethyl)-L-tyrosine ( 18 F-FET) PET for differentiating local recurrent brain metastasis from radiation injury after radiotherapy since contrastenhanced MRI often remains inconclusive. Methods. Sixty-two patients (mean age, 55 ± 11 y) with single or multiple contrast-enhancing brain lesions (n = 76) on MRI after radiotherapy of brain metastases (predominantly stereotactic radiosurgery) were investigated with dynamic 18 F-FET PET. Maximum and mean tumor-to-brain ratios (TBR max , TBR mean ) of 18 F-FET uptake were determined (20-40 min postinjection) as well as tracer uptake kinetics (ie, time-to-peak and slope of time-activity curves). Diagnoses were confirmed histologically (34%; 26 lesions in 25 patients) or by clinical follow-up (66%; 50 lesions in 37 patients). Diagnostic accuracies of PET parameters for the correct identification of recurrent brain metastasis were evaluated by receiver-operating-characteristic analyses or the chi-square test. Results. TBRs were significantly higher in recurrent metastases (n = 36) than in radiation injuries (n = 40) (TBR max 3.3 ± 1.0 vs 2.2 ± 0.4, P < .001; TBR mean 2.2 ± 0.4 vs 1.7 ± 0.3, P < .001). The highest accuracy (88%) for diagnosing local recurrent metastasis could be obtained with TBRs in combination with the slope of time-activity curves (P < .001). Conclusions. The results of this study confirm previous preliminary observations that the combined evaluation of the TBRs of 18 F-FET uptake and the slope of time-activity curves can differentiate local brain metastasis recurrence from radiation-induced changes with high accuracy. 18 F-FET PET may thus contribute significantly to the management of patients with brain metastases.

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“…However, recurrent brain metastases cannot easily be differentiated from radiation injury using conventional MRI (Stockham et al, 2012). More recently, the differentiation between radiation injury and recurrence of brain metastasis has been markedly improved by imaging parameters derived from static and dynamic amino acid PET scans, suggesting that a diagnostic accuracy in the range between 80 and 90% can be obtained (Ceccon et al, 2017; Cicone et al, 2015; Galldiks et al, 2012; Kickingereder et al, 2013; Lizarraga et al, 2014; Terakawa et al, 2008; Tsuyuguchi et al, 2003). However, dynamic FET PET scans require a more costly and time-consuming acquisition, data reconstruction and analysis and, thus, are not yet implemented in clinical routine.…”

Section: Introductionmentioning

confidence: 99%

Combined FET PET/MRI radiomics differentiates radiation injury from recurrent brain metastasis

Lohmann

Köcher

Ceccon

et al. 2018

NeuroImage: Clinical

121

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BackgroundThe aim of this study was to investigate the potential of combined textural feature analysis of contrast-enhanced MRI (CE-MRI) and static O-(2-[18F]fluoroethyl)-L-tyrosine (FET) PET for the differentiation between local recurrent brain metastasis and radiation injury since CE-MRI often remains inconclusive.MethodsFifty-two patients with new or progressive contrast-enhancing brain lesions on MRI after radiotherapy (predominantly stereotactic radiosurgery) of brain metastases were additionally investigated using FET PET. Based on histology (n = 19) or clinicoradiological follow-up (n = 33), local recurrent brain metastases were diagnosed in 21 patients (40%) and radiation injury in 31 patients (60%). Forty-two textural features were calculated on both unfiltered and filtered CE-MRI and summed FET PET images (20–40 min p.i.), using the software LIFEx. After feature selection, logistic regression models using a maximum of five features to avoid overfitting were calculated for each imaging modality separately and for the combined FET PET/MRI features. The resulting models were validated using cross-validation. Diagnostic accuracies were calculated for each imaging modality separately as well as for the combined model.ResultsFor the differentiation between radiation injury and recurrence of brain metastasis, textural features extracted from CE-MRI had a diagnostic accuracy of 81% (sensitivity, 67%; specificity, 90%). FET PET textural features revealed a slightly higher diagnostic accuracy of 83% (sensitivity, 88%; specificity, 75%). However, the highest diagnostic accuracy was obtained when combining CE-MRI and FET PET features (accuracy, 89%; sensitivity, 85%; specificity, 96%).ConclusionsOur findings suggest that combined FET PET/CE-MRI radiomics using textural feature analysis offers a great potential to contribute significantly to the management of patients with brain metastases.

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Accuracy of F-DOPA PET and perfusion-MRI for differentiating radionecrotic from progressive brain metastases after radiosurgery

Abstract: F-DOPA PET is a highly accurate tool for differentiating RN from PD brain metastases after stereotactic radiosurgery. In this specific setting, F-DOPA PET seems to perform better than perfusion-MR.

Cited by 129 publications

References 33 publications

Brain metastases: neuroimaging

Brain metastases: neuroimaging

DynamicO-(2-¹⁸F-fluoroethyl)-L-tyrosine positron emission tomography differentiates brain metastasis recurrence from radiation injury after radiotherapy

Combined FET PET/MRI radiomics differentiates radiation injury from recurrent brain metastasis

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Accuracy of F-DOPA PET and perfusion-MRI for differentiating radionecrotic from progressive brain metastases after radiosurgery

Abstract: F-DOPA PET is a highly accurate tool for differentiating RN from PD brain metastases after stereotactic radiosurgery. In this specific setting, F-DOPA PET seems to perform better than perfusion-MR.

Cited by 129 publications

References 33 publications

Brain metastases: neuroimaging

Brain metastases: neuroimaging

DynamicO-(2-18F-fluoroethyl)-L-tyrosine positron emission tomography differentiates brain metastasis recurrence from radiation injury after radiotherapy

Combined FET PET/MRI radiomics differentiates radiation injury from recurrent brain metastasis

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DynamicO-(2-¹⁸F-fluoroethyl)-L-tyrosine positron emission tomography differentiates brain metastasis recurrence from radiation injury after radiotherapy