Dual-time-point O-(2-[18F]fluoroethyl)-L-tyrosine PET for grading of cerebral gliomas

Lohmann, Philipp; Herzog, Hans; Kops, Elena Rota; Stoffels, Gabriele; Judov, Natalie; Filß, Christian; Galldiks, Norbert; Tellmann, Lutz; Weiss, Carolin; Sabel, Michael; Coenen, Heinz H.; Shah, N. Jon; Langen, Karl‐Josef

doi:10.1007/s00330-015-3691-6

Cited by 81 publications

(48 citation statements)

References 23 publications

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“…Spherical VOI: A spherical VOI with a diameter of 30 mm in the contralateral hemisphere including white and gray matter, as published previously [18, 19]. …”

Section: Methodsmentioning

confidence: 99%

“…Therefore, several different and inconsistent approaches for background assessment are used in the current literature and in the clinical routine: one approach uses a region of interest (ROI) in the contralateral hemisphere including white and gray matter [15, 16], which is in line with the German guideline for amino acid imaging, which stated that a ROI should be placed in unaffected contralateral brain tissue, “e.g., with a diameter of 50 mm” [17]. Other approaches apply volumes-of-interest (VOI) including gray and white matter, i.e., a spherical VOI with a diameter of 30 mm [18, 19] or a VOI consisting of crescent-shaped ROIs [13, 20]. Although first suggestions were made regarding a software-based assessment using [ 11 C]-methionine PET previously [21], there is still no standardized and consistent procedure used in the clinical routine.…”

Section: Introductionmentioning

confidence: 99%

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Towards standardization of 18F-FET PET imaging: do we need a consistent method of background activity assessment?

et al. 2017

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BackgroundPET with O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) has reached increasing clinical significance for patients with brain neoplasms. For quantification of standard PET-derived parameters such as the tumor-to-background ratio, the background activity is assessed using a region of interest (ROI) or volume of interest (VOI) in unaffected brain tissue. However, there is no standardized approach regarding the assessment of the background reference. Therefore, we evaluated the intra- and inter-reader variability of commonly applied approaches for clinical 18F-FET PET reading.The background activity of 20 18F-FET PET scans was independently evaluated by 6 readers using a (i) simple 2D-ROI, (ii) spherical VOI with 3.0 cm diameter, and (iii) VOI consisting of crescent-shaped ROIs; each in the contralateral, non-affected hemisphere including white and gray matter in line with the European Association of Nuclear Medicine (EANM) and German guidelines. To assess intra-reader variability, each scan was evaluated 10 times by each reader. The coefficient of variation (CoV) was assessed for determination of intra- and inter-reader variability. In a second step, the best method was refined by instructions for a guided background activity assessment and validated by 10 further scans.ResultsCompared to the other approaches, the crescent-shaped VOIs revealed most stable results with the lowest intra-reader variabilities (median CoV 1.52%, spherical VOI 4.20%, 2D-ROI 3.69%; p < 0.001) and inter-reader variabilities (median CoV 2.14%, spherical VOI 4.02%, 2D-ROI 3.83%; p = 0.001). Using the guided background assessment, both intra-reader variabilities (median CoV 1.10%) and inter-reader variabilities (median CoV 1.19%) could be reduced even more.ConclusionsThe commonly applied methods for background activity assessment show different variability which might hamper 18F-FET PET quantification and comparability in multicenter settings. The proposed background activity assessment using a (guided) crescent-shaped VOI allows minimization of both intra- and inter-reader variability and might facilitate comprehensive methodological standardization of amino acid PET which is of interest in the light of the anticipated EANM technical guidelines.

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“…Spherical VOI: A spherical VOI with a diameter of 30 mm in the contralateral hemisphere including white and gray matter, as published previously [18, 19]. …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Towards standardization of 18F-FET PET imaging: do we need a consistent method of background activity assessment?

et al. 2017

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“…During recent years, 18 F-FET PET has been increasingly used to optimize and individualize the specific therapy: 18 F-FET PET has shown its value for biopsy guidance and planning of surgery and radiotherapy (4)(5)(6). Furthermore, dynamic 18 F-FET PET has shown utility for the estimation of tumor grade (7)(8)(9) and a remarkably high prognostic value in newly diagnosed glioma using the analysis of the timeactivity curves including the parameter minimal time to peak (TTP min ), for which short TTP min was associated with worse outcome (10,11). Besides these clinically relevant features at primary diagnosis, 18 F-FET PET imaging was shown to improve disease monitoring by early identification of tumor recurrence and progression and discrimination from posttherapeutic changes (12)(13)(14)(15)(16)(17).…”

mentioning

confidence: 99%

Serial ¹⁸F-FET PET Imaging of Primarily ¹⁸F-FET–Negative Glioma: Does It Make Sense?

et al. 2016

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PET with O-(2-18 F-fluoroethyl)-L-tyrosine ( 18 F-FET) has gained increasing importance for glioma management. With regard to the occurrence of 18 F-FET-negative glioma, we investigated the value of 18 F-FET PET monitoring of primarily 18 F-FET-negative gliomas concerning the detection of progression and malignant transformation. Methods: We included 31 patients (26 World Health Organization [WHO] grade II, 5 WHO grade III) with primarily 18 F-FET-negative glioma and available 18 F-FET PET follow-up. 18 F-FET PET analysis comprised maximal tumor-to-background ratio (TBR max ) and dynamic analysis of tumoral 18 F-FET uptake over time (increasing vs. decreasing) including minimal time to peak (TTP min ). PET findings were correlated with MRI and clinical findings of progression as well as histology of recurrent tumors. Results: Twenty-three of 31 patients experienced tumor progression (median progression-free survival, 41.7 mo). Fourteen of 23 patients showed tumoral 18 F-FET uptake concurrent to and 4 of 23 before MRI-derived or clinical signs of tumor progression; 2 of 23 patients presented signs of progression in MRI when no concomitant 18 F-FET PET was available, but subsequent follow-up PET was positive. In 3 of 23 patients, no 18 F-FET uptake was detected at tumor progression. Overall, 20 of 31 primarily 18 F-FET-negative glioma turned 18 F-FET-positive during the followup. At first occurrence of tumoral 18 F-FET uptake, TBR max was significantly higher in patients with malignant transformation (11/20) than in those without malignant progression (3.2 ± 0.9 vs. 1.9 ± 0.5; P 5 0.001), resulting in a high detection rate for malignant transformation (for TBR max . 2.46: sensitivity, 82%; specificity, 89%; negative predictive value, 80%; positive predictive value, 90%; and accuracy, 85%). Although static evaluation was superior to dynamic analysis for the detection of malignant transformation (for TTP min # 17.5 min: sensitivity, 73%; specificity, 67%; negative predictive value, 67%; positive predictive value, 73%; and accuracy, 70%), short TTP min was associated with an early malignant transformation in the further disease course. Overall, 18 of 31 patients experienced malignant transformation; of these, 16 of 17 (94%) evaluable patients showed 18 F-FET uptake at the time of malignant transformation. Conclusion: 18 F-FET PET monitoring with static and dynamic evaluation is useful even in primarily 18 F-FET-negative glioma, providing a high detection rate of both tumor progression and malignant transformation, partly before further signs of progression in MRI. Hence, 18 F-FET uptake indicating malignant transformation might influence the patient management.

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“…High FET uptake indicative of tumour cell infiltration was associated with markers of neuronal cell loss in MRS . The early phase of FET uptake appears to be most informative for grading and prognosis , and tracer accumulation is slow in low‐grade gliomas, for which late scans provide the best contrast . Kinetic analysis of FET uptake significantly improved sensitivity for the detection of high‐grade gliomas even for lesions with low or diffuse tracer uptake ; the uptake kinetic of FET was an independent predictor of overall and to a lesser extent also progression‐free survival .…”

Section: Diagnosis Grading and Prognosismentioning

confidence: 96%

Positron emission tomography imaging in gliomas: applications in clinical diagnosis, for assessment of prognosis and of treatment effects, and for detection of recurrences

Heiss

2017

Euro J of Neurology

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Neuroimaging plays a significant role in the diagnosis of intracranial tumours, especially brain gliomas, and must consist of an assessment of location and extent of the tumour and of its biological activity. Therefore, morphological imaging modalities and functional, metabolic or molecular imaging modalities should be combined for primary diagnosis and for following the course and evaluating therapeutic effects. Magnetic resonance imaging (MRI) is the gold standard for providing detailed morphological information and can supply some additional insights into metabolism (MR spectroscopy) and perfusion (perfusion-weighted imaging) but still has limitations in identifying tumour grade, invasive growth into neighbouring tissue and treatment-induced changes, as well as recurrences. These insights can be obtained by various positron emission tomography (PET) modalities, including imaging of glucose metabolism, amino acid uptake and nucleoside uptake. Diagnostic accuracy can benefit from coregistration of PET results and MRI, combining high-resolution morphological images with biological information. These procedures are optimized by the newly developed combination of PET and MRI modalities, permitting the simultaneous assessment of morphological, functional, metabolic and molecular information on the human brain.

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Dual-time-point O-(2-[18F]fluoroethyl)-L-tyrosine PET for grading of cerebral gliomas

Cited by 81 publications

References 23 publications

Towards standardization of 18F-FET PET imaging: do we need a consistent method of background activity assessment?

Towards standardization of 18F-FET PET imaging: do we need a consistent method of background activity assessment?

Serial ¹⁸F-FET PET Imaging of Primarily ¹⁸F-FET–Negative Glioma: Does It Make Sense?

Positron emission tomography imaging in gliomas: applications in clinical diagnosis, for assessment of prognosis and of treatment effects, and for detection of recurrences

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Dual-time-point O-(2-[18F]fluoroethyl)-L-tyrosine PET for grading of cerebral gliomas

Cited by 81 publications

References 23 publications

Towards standardization of 18F-FET PET imaging: do we need a consistent method of background activity assessment?

Towards standardization of 18F-FET PET imaging: do we need a consistent method of background activity assessment?

Serial 18F-FET PET Imaging of Primarily 18F-FET–Negative Glioma: Does It Make Sense?

Positron emission tomography imaging in gliomas: applications in clinical diagnosis, for assessment of prognosis and of treatment effects, and for detection of recurrences

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Serial ¹⁸F-FET PET Imaging of Primarily ¹⁸F-FET–Negative Glioma: Does It Make Sense?