Positron Emission Tomography with O-(2-[18F]fluoroethyl)-l-tyrosine versus Magnetic Resonance Imaging in the Diagnosis of Recurrent Gliomas

Rachinger, Walter; Goetz, Claudia; Pöpperl, Gabriele; Gildehaus, Franz Josef; Kreth, Friedrich W.; Holtmannspötter, Markus; Herms, Jochen; Koch, Walter; Tatsch, Klaus; Tonn, Jörg‐Christian

doi:10.1227/01.neu.0000171642.49553.b0

Cited by 270 publications

(152 citation statements)

References 31 publications

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“…The presence of a FET-PET uptake higher than background tissue represents a diagnostic challenge. This has also been described in recent reports 19,20 while previous studies indicate that FET-PET can be a valuable tool to detect recurrent tumors 21,22,13 . A recent paper evaluated the performance of FET-PET in differentiating recurrent brain metastases from radiation necrosis, providing a cut-off value for uptake, relative to background (TBRmean and TBRmax) and describing patterns of uptake change over time more suggestive of tumor recurrence or radiation necrosis 13 .…”

Section: Discussionsupporting

confidence: 69%

Radiologic Patterns of Necrosis After Proton Therapy of Skull Base Tumors

Korchi

Garibotto

Lövblad

et al. 2013

Can. J. Neurol. Sci.

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Proton beam therapy (PBT) is used for the treatment of skull base tumors to precisely deliver high-doses of radiation to the tumor volume while sparing normal brain tissue and other organs at risk such as the optic apparatus, the brainstem and the pituitary gland. It offers superior dose distribution as compared to photon radiation therapy. The clinical advantage of PBT over photon techniques is the marked reduction in the integral dose to the patient due to the absence of an exit dose beyond the proton Bragg peak. Proton beam therapy has shown benefits in the treatment of skull base tumors, uveal melanoma, optic pathway gliomas, pituitary adenomas, acoustic neuromas, nasopharynx and paranasal sinus tumors and spinal cord tumors. [1][2][3][4] . A rare yet important complication following brain radiation therapy is radiation necrosis 5-7 , i.e. the appearance of a new ABSTRACT: Background: Discrimination between radiation necrosis and tumor progression after radiation therapy represents a radiologic challenge. The aim of our investigation is to identify patterns of radiation necrosis on brain magnetic resonance imaging (MRI) and positron emission tomography (PET) with Fluoroethyltyrosin (FET) after proton beam therapy (PBT) for skull base tumors. Material and Methods:Five consecutive patients with extra-axial neoplasms were included, presenting a total of eight radiation necrosis lesions (three clival chordomas; two petroclival chondrosarcomas; two women; mean age: 49 ± 18.2 years). Radiation necrosis was defined as the appearance of abnormal enhancement on MRI after PBT decreasing over time, and additional histopathologic confirmation in one patient. MRI and PET imaging were retrospectively analyzed by two experienced radiologists in consensus. Results: All lesions were localized close to the primary tumor in the field of irradiation. Three patients showed bilateral symmetrical lesions. All lesions showed T2 hyperintensity and T1 hypointensity. Cerebral blood volume (CBV) was reduced in all available studies. None of the lesions showed a restricted diffusion. FET-PET (three patients) showed a higher uptake in four out of five lesions; three of which had a mean tumor-to-background (TBRmean) uptake lower than 1.95 and FET uptake increasing over time and were correctly classified into radiation necrosis. Conclusions: Most radiation necroses were in direct continuity with the primary tumor mimicking tumor progression. The most consistent imaging findings for PBT radiation necrosis are low CBV without restricted diffusion and FET-PET TBRmean lower than 1.95 or increasing uptake over time. Bilateral symmetric involvement may be another indicator of radiation necrosis.RÉSUMÉ: Critères radiologiques de la nécrose après protonthérapie des tumeurs de la base du crâne. Contexte : La distinction entre la nécrose due à l'irradiation et la progression de la tumeur après l'irradiation est un défi au point de vue radiologique. Le but de notre étude était d'identifier le profil radiologique de la nécrose radio-induite à l'IRM et...

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Section: Discussionsupporting

confidence: 69%

Radiologic Patterns of Necrosis After Proton Therapy of Skull Base Tumors

Korchi

Garibotto

Lövblad

et al. 2013

Can. J. Neurol. Sci.

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“…Studies using radiolabeled fluorodeoxyglucose ( 18 F-FDG), a surrogate of glucose metabolism, have demonstrated significantly higher uptake in recurrent disease compared with pseudoprogression with high sensitivity and specificity [42,43]. PET imaging of neutral amino acid transport or metabolism, including 11 C-methionine ( 11 C-MET) [44], 18 F-fluorodopa ( 18 F-FDOPA) [45], and 18 F-fluoro-ethyltyrosine ( 18 F-FET) [46,47], have also shown value in differentiating pseudoprogression from tumor with higher lesion conspicuity due to lower background activity in normal brain. A recent systematic review finds amino acid tracers (MET, FET, and FDOPA) to have higher diagnostic accuracy than conventional and advanced MRI in the differentiation of glioma recurrence from treatment-induced changes, and superior to MRI in the assessment of treatment response [48].…”

Section: Metabolic Imagingmentioning

confidence: 99%

Pseudoprogression, radionecrosis, inflammation or true tumor progression? challenges associated with glioblastoma response assessment in an evolving therapeutic landscape

et al. 2017

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“…A higher diagnostic accuracy was shown by Grosu et al, with 11 C-MET able to differentiate tumor tissue from treatment-related changes with a sensitivity of 91% and a specificity of 100% (63). Using 18 F-FET PET, the detection of tumor recurrence/progression was even more accurate, with a sensitivity and specificity of 100% and 93%, respectively, compared with 93-and 50% for MRI alone (73,78). Pöpperl et al were able to distinguish recurrent tumor and RN with 100% accuracy, applying a threshold of 2.0 for LNR max , and Galldiks et al suggested that the combined evaluation of the LNR mean of 18 F-FET uptake and the pattern of the time-activity curve can differentiate brain metastasis recurrence from RN with high accuracy (70,73).…”

Section: Amino-acid Petmentioning

confidence: 91%

“…Also, reliable monitoring of TMZ and nitrosourea-based chemotherapy effects has been demonstrated in patients with recurrent HGG (9,31,64,66,70,71). In a study by Rachinger et al, 18 F-FET PET was able to distinguish tumor progression from stable disease with 93% specificity and 100% sensitivity, while the specificity of conventional MRI alone was 50% (78). 18 F-FET PET responders, based on a decrease of more than 10% of LNR after completion of therapy, also showed a significant longer overall survival than nonresponders (60).…”

Section: Amino-acid Petmentioning

confidence: 99%

PET for Therapy Response Assessment in Glioblastoma

et al. 2017

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Glioblastoma (GB) is the most malignant and the most common type of glioma in adults, accounting for 60-70% of all malignant gliomas. Despite the current therapy, the clinical course of GB is usually rapid, with a mean survival time of approximately 1 year. For therapy response assessment in GB, magnetic resonance imaging (MRI) is the method of choice. In 2010, the Response Assessment in Neuro-Oncology (RANO) was introduced, including the tumor size (in 2D) as measured on T2-weighted and Fluid Attenuated Inversion Recovery (FLAIR)-weighted images, in addition to the contrast-enhancing tumor part. Although the RANO criteria addressed some of the limitations of the previous MacDonald criteria for therapy evaluation in high-grade glioma, treatment-related side effects hamper correct response assessment. To address the above-mentioned drawbacks in the follow-up of GB, incorporating changes in tumor biology measured by advanced MRI and positron emission tomography (PET) imaging, which may precede anatomical changes of the tumor volume, is promising. Imaging biomarkers capable of predicting response at an early time point after treatment initiation are the premise of personalized treatment enabling change or GB Treatment Response Using PET 176 discontinuation of therapy to prevent ineffective treatment or adverse events of treatment. In this chapter, an overview of applicable PET tracers for the therapy response assessment in GB and the determination of tumor recurrence versus treatment-related effects is given.

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Positron Emission Tomography with O-(2-[18F]fluoroethyl)-l-tyrosine versus Magnetic Resonance Imaging in the Diagnosis of Recurrent Gliomas

Cited by 270 publications

References 31 publications

Radiologic Patterns of Necrosis After Proton Therapy of Skull Base Tumors

Radiologic Patterns of Necrosis After Proton Therapy of Skull Base Tumors

Pseudoprogression, radionecrosis, inflammation or true tumor progression? challenges associated with glioblastoma response assessment in an evolving therapeutic landscape

PET for Therapy Response Assessment in Glioblastoma

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