Ischemic Complications After High-Grade Glioma Resection Could Interfere With Residual Tumor Detection With 18F-Fluorocholine PET/CT

Abstract

Ischemic complications after resection of high-grade glioma are frequent and may constitute potential cause of false-positive results in postsurgical evaluation using 18F-fluorocholine PET/CT. On the other hand, hypoxia caused by ischemia promotes invasive glioma growth. We present 3 cases of patients with different grades of ischemic injury after resection of high-grade glioma. The combined interpretation of diffusion-weighted imaging and apparent diffusion coefficient map on MRI, in this clinical setting, is mandatory to avoid PET/CT misinterpretations.

Prognostic Potential of Postoperative 18F-Fluorocholine PET/CT in Patients With High-Grade Glioma. Clinical Validation of FuMeGA Postoperative PET Criteria

“…Even a possible flare phenomenon, of unknown origin and significance, has been described as a potential cause of radiotracer uptake 22 . 18 F-fluorocholine uptake, in this context, is probably explained by inflammatory and repair processes, brain-blood barrier disruption, and luxury perfusion 26,29 . Thus, in our experience, a positive postoperative 18 F-fluorocholine PET/CT should be interpreted with diffusion-weighted imaging to discard the presence of ischemia as a potential cause of false-positive result.…”

“…Inflammation or contusion around the resection cavity, after HGG resection, is a constant. Reactive and ischemic postoperative changes may affect the accuracy of PET with amino acid and choline analog radiotracers in the detection of RV 22,26 . In addition, ischemic complications during/after resection may account for up to two-thirds of cases 27 …”

“…In addition, the awareness of ischemia existence and extension is important based on its prognostic implications. Several studies support that ischemia promotes hypoxia-mediated aggressive tumor growth, resulting in multifocal and diffuse recurrence patterns and impaired survival 26,30,31 …”

“…Reactive and ischemic postoperative changes may affect the accuracy of PET with amino acid and choline analog radiotracers in the detection of RV. 22,26 In addition, ischemic complications during/after resection may account for up to two-thirds of cases. 27 A preclinical study recommends 18 F-fluoroethyl-thyrosine PET later than 2 weeks after resection because the detection of radiotracer uptake at the rim of the resection cavity decreases in the second week after surgery.…”

Psychological resilience is related to postoperative adverse events and quality of life in patients with glioma: a retrospective cohort study

“…At present, radical surgical resection combined with adjuvant radiotherapy or chemotherapy is considered to be the best treatment for glioma. However, the incidence of postoperative adverse events is as high as 18% to 71% ( 8 ), which significantly affects the postoperative recovery, prolongs the hospital stay, worsens the quality of life (QoL), and even increases the mortality of patients ( 9 , 10 ). Some risk factors were identified to increase the incidence of postoperative adverse events and worsen the QoL in glioma patients, such as grade of glioma, duration of surgical procedures and the existence of chronic diseases ( 5 , 8 , 9 ).…”