Biopsy validation of 18F-DOPA PET and biodistribution in gliomas for neurosurgical planning and radiotherapy target delineation: results of a prospective pilot study

Pafundi, Deanna H.; Laack, Nadia N.; Youland, Ryan S.; Parney, Ian F.; Lowe, Val J.; Giannini, Caterina; Kemp, Brad; Grams, Michael P.; Morris, Jonathan M.; Hoover, Jason M.; Hu, Leland; Sarkaria, Jann N.; Brinkmann, Debra H.

doi:10.1093/neuonc/not002

Cited by 174 publications

(159 citation statements)

References 14 publications

(42 reference statements)

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“…Similar results have been obtained with 18 F-FDOPA PET in progressive or recurrent glioblastomas where a larger tumor extent was identified when compared with MRI-derived regional cerebral blood volume maps (55). Accordingly, 18 F-FDOPA PET-based tumor volumes have been shown to extend beyond the contrast-enhancing volume on conventional MRI (56). In addition, initial nonenhancing glioblastoma areas were also identified with this radiotracer since they were subsequently followed by abnormal MRI contrast enhancement (57).…”

Section: Delineation Of Glioma Extentsupporting

confidence: 76%

“…The identification of malignant foci, commonly defined as "hot spots" in heterogeneous gliomas and a specific characteristic of glioblastomas (58), is essential for biopsy planning. The objective is to ensure that the most biologically aggressive portion of the tumor, which ultimately determines the patient' s prognosis as well as treatment, is not under-sampled (56,59). Similar to the delineation of tumor extent, amino acid tracers are more suitable than 18 F-FDG in identifying malignant foci in gliomas.…”

Section: Biopsy and Resectionmentioning

confidence: 99%

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PET Imaging in Glioblastoma: Use in Clinical Practice

Verger¹,

Langen²

2017

Glioblastoma

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Positron emission tomography (PET) is a nuclear medicine imaging method with increasing relevance for the diagnosis, prognostication, and monitoring of glioblastomas. PET provides additional insight beyond magnetic resonance imaging (MRI) into the biology of gliomas, which can be used for noninvasive grading, differential diagnosis, delineation of tumor extent, planning of surgery, and radiotherapy and post-treatment monitoring. In clinical practice, two classes of radiotracers have been used predominantly for imaging purposes, namely glucose metabolism tracers and amino acid transport tracers. Both classes of tracers can provide information on grading and prognosis of gliomas, but amino acid tracers, which exhibit lower uptake in normal brain tissue, are better suited for delineation of tumor extent, treatment planning, or follow-up than 18 F-2-fluoro-2-deoxy-D-glucose ( 18 F-FDG). Owing to the progress in PET imaging using radiolabeled amino acids in recent years, the Response Assessment in Neuro-Oncology (RANO) working group, an international effort to develop new standardized response criteria for clinical trials in brain tumors, has recently recommended amino acid PET as an additional tool in the diagnostic assessment of brain tumors. PET Imaging in Glioblastomas 156These developments as well as multimodality imaging should improve the diagnostic assessment of these tumors.

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Section: Delineation Of Glioma Extentsupporting

confidence: 76%

Section: Biopsy and Resectionmentioning

confidence: 99%

PET Imaging in Glioblastoma: Use in Clinical Practice

Verger¹,

Langen²

2017

Glioblastoma

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“…Especially in newly diagnosed tumors, uptake has been shown to be related to proliferation, whereas this correlation has not been observed in recurrent gliomas (20). In astrocytomas, 18 F-FDOPA PET has detected areas with more actively proliferating cell populations (as proven by biopsy) and permitted targeted radiation (21). 18 F-fluoro-L-thymidine (FLT) PET in some instances has been superior to amino acid PET for imaging proliferation in different gliomas and may add significant information about invasiveness, but 18 F-FDOPA PET has been found to be superior to 18 F-FDG and 18 F-FLT in the evaluation of low-grade gliomas (22).…”

mentioning

confidence: 99%

Clinical Impact of Amino Acid PET in Gliomas

Heiss

2014

J Nucl Med

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“…For comparison, tissue contrast values in the literature were adopted for 18 F-FMISO and 18 F-FDOPA (37,101). SUV values from these studies were converted to activity in units of counts:…”

Section: -8mentioning

confidence: 99%

“…The adopted 18 F-FDOPA SUV for tumour and normal tissue were 2.7 and 1.1 respectively from Pafundi et al (37). Here, a patient weight of 80kg is assumed.…”

Section: -8mentioning

confidence: 99%

Dual-tracer simultaneous acquisition of positron emission tomography

Bell¹

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Positron emission tomography (PET) imaging is a versatile modality with the ability to examine metabolic factors in individual tissues in vivo. It is an indispensable tool for research and treatment planning of diseases such as cancer. However, versatility could be increased if it were possible to image multiple tracers simultaneously. Such an ability could be important in developing a treatment strategy for diseases that remain intractable in the majority of cases, such as advanced glioma.Metabolic imaging with PET using target specific radiotracers has been shown to improve the delineation of tumour margins and provide increased information about tumour microbiology. However, the physical properties of radiotracers limits their combined use, such that imaging of more than one molecular target using PET is not generally considered feasible.Multiplexing PET imaging (dual-tracer PET) offers a solution that allows for individual PET imaging of two or more individual radiotracers, within the same scanning session. Although the technique was first proposed in the 1980s, this approach is not utilised despite offering significant advantages such as multiple target imaging and validation of new PET radiopharmaceuticals. Reasons for this lack of implementation may include assumptions about the potential loss in image quality and the logistics in synthesizing multiple PET tracers simultaneously.In this PhD, Dual-Tracer PET imaging techniques were developed, with a focus on the ability to validate chosen dual-tracer protocols prior to scanning. A set of techniques was devised to handle cases of increasing complexity: (initially) where the first tracer can be assumed to be static after a certain amount of time; secondly where the first tracer has a constant slow uptake that can be assumed to be linear; and the general case where the first tracer retains residual dynamics, with the use of a basis pursuit to separate the signals.These approaches were tested by applying them to specific, clinically relevant use cases.Development of these techniques has provided a framework for study designers to effectively implement dual-tracer PET imaging with confidence for the validation of new tracers, the investigation of cases where multiple biological factors are important and the further development of diagnosis and treatment in future applications. Finally, by utilising iii basis pursuit approaches, it is possible to consider any combination of tracers regardless of tracer and without devising specific model of uptake within tissue.iv

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Biopsy validation of 18F-DOPA PET and biodistribution in gliomas for neurosurgical planning and radiotherapy target delineation: results of a prospective pilot study

Cited by 174 publications

References 14 publications

PET Imaging in Glioblastoma: Use in Clinical Practice

PET Imaging in Glioblastoma: Use in Clinical Practice

Clinical Impact of Amino Acid PET in Gliomas

Dual-tracer simultaneous acquisition of positron emission tomography

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