The positive predictive value of O-(2-[18F]fluoroethyl)-l-tyrosine (FET) PET in the diagnosis of a glioma recurrence after multimodal treatment

Mehrkens, Jan H.; Pöpperl, Gabriele; Rachinger, Walter; Herms, Jochen; Seelos, Klaus; Tatsch, Klaus; Tonn, Jörg‐Christian; Kreth, Friedrich W.

doi:10.1007/s11060-008-9526-4

Cited by 109 publications

(57 citation statements)

References 30 publications

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“…Our study supports further larger scale prospective studies that include histopathologic confirmation to confirm the high diagnostic accuracy of 18 F-FET-PET for differentiating recurrent glioma and non-specific post-therapeutic changes as reported in previous studies (23), but the high diagnostic accuracy of TBR of 18 F-FET uptake of more than 90% could not be confirmed here.…”

Section: Discussionsupporting

confidence: 75%

Late Pseudoprogression in Glioblastoma: Diagnostic Value of Dynamic O-(2-[18F]fluoroethyl)-L-Tyrosine PET

Kebir

Fimmers

Galldiks

et al. 2016

Clinical Cancer Research

107

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Purpose: Pseudoprogression (PsP) is characterized by therapyassociated but not tumor growth-associated increases of contrastenhancing glioblastoma lesions on MRI. Although typically occurring during the first 3 months after radiochemotherapy, PsP may occur later in the course of the disease and may then be particularly difficult to distinguish from true tumor progression. We explored PET using O-(2-Experimental Design: Twenty-six patients with glioblastoma that presented with increasing contrast-enhancing lesions later than 3 months after completion of radiochemotherapy underwent 18 F-FET-PET. Maximum and mean tumor/brain ratios (TBR max and TBR mean ) of 18 F-FET uptake as well as time-to-peak (TTP) and patterns of the time-activity curves were determined. The final diagnosis of true progression versus late PsP was based on follow-up MRI using RANO criteria.Results: Late PsP occurred in 7 patients with a median time from radiochemotherapy completion of 24 weeks while the remaining patients showed true tumor progression. TBR max and TBR mean were significantly higher in patients with true progression than in patients with late PsP (TBR max 2.4 AE 0.1 vs. 1.5 AE 0.2, P ¼ 0.003; TBR mean 2.1 AE 0.1 vs. 1.5 AE 0.2, P ¼ 0.012) whereas TTP was significantly shorter (mean TTP 25 AE 2 vs. 40 AE 2 min, P < 0.001). ROC analysis yielded an optimal cutoff value of 1.9 for TBR max to differentiate between true progression and late PsP (sensitivity 84%, specificity 86%, accuracy 85%, P ¼ 0.015).Conclusions: O-(2-[ 18 F]fluoroethyl)-L-tyrosine PET provides valuable information in assessing the elusive phenomenon of late PsP. Clin Cancer Res; 22(9); 2190-6. Ó2015 AACR.

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Section: Discussionsupporting

confidence: 75%

Late Pseudoprogression in Glioblastoma: Diagnostic Value of Dynamic O-(2-[18F]fluoroethyl)-L-Tyrosine PET

Kebir

Fimmers

Galldiks

et al. 2016

Clinical Cancer Research

107

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“…18 F-FET PET coregistered to MRI detected the effects of a multimodal treatment more sensitively than did conventional MRI alone (139) and reached a sensitivity of more than 80% and a specificity of close to 100% (140). With 18 F-FLT PET, a distinction between responders and nonresponders to a combination therapy was possible: 18 F-FLT PET at 2 and 6 wk predicted survival better than did MRI (141).…”

Section: Monitoring Treatment Effects Petmentioning

confidence: 94%

Multimodality Assessment of Brain Tumors and Tumor Recurrence

Heiss¹,

Raab²,

Lanfermann³

2011

J Nucl Med

122

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the differences in the information obtained by various MRI and PET modalities and (2) the best combination of imaging procedures to detect brain tumors, to define the biologic activity or malignancy of a tumor, to validate therapeutic effects, and to differentiate between recurrent tumor and tissue necrosis.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNM designates each JNM continuing education article for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only credit commensurate with the extent of their participation in the activity.For CE credit, participants can access this activity through the SNM Web site (http://www.snm.org/ce_online) through October 2012.Neuroimaging plays a significant role in the diagnosis of intracranial tumors, especially brain gliomas, and must consist of an assessment of location and extent of the tumor and of its biologic activity. Therefore, morphologic imaging modalities and functional, metabolic, or molecular imaging modalities should be combined for primary diagnosis and for following the course and evaluating therapeutic effects. MRI is the gold standard for providing detailed morphologic information and can supply some additional insights into metabolism (MR spectroscopy) and perfusion (perfusion-weighted imaging) but still has limitations in identifying tumor grade, invasive growth into neighboring tissue, and treatment-induced changes, as well as recurrences. These insights can be obtained by various PET modalities, including imaging of glucose metabolism, amino acid uptake, nucleoside uptake, and hypoxia. Diagnostic accuracy can benefit from coregistration of PET results and MRI, combining the high-resolution morphologic images with the biologic information. These procedures are optimized by the newly developed combination of PET and MRI modalities, permitting the simultaneous assessment of morphologic, functional, metabolic, and molecular information on the human brain. Brai n tumors are newly formed alterations of morphology, and for their diagnosis, therefore, CT or MRI is mandatory. These imaging modalities are essential for delineating the normal and pathologic anatomy and also for assessing vascular supply and impairment of the blood-brain barrier (BBB) (perfusion-weighted imaging; contrast enhancement). Additionally, MRI is capable of giving functional information on microstructural (diffusion-weighted imaging [DWI]), physiologic, and metabolic (MR spectroscopy [MRS]) changes of tumor tissues. PET and MRI provide physiologic, biochemical, and molecular information related to tumor metabolism, proliferation rate, invasiveness, and interaction with surrounding and remote areas-informati...

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“…Forty-minute dynamic 18 F-FET PET scans were acquired with an ECAT Exact HR1 scanner (Siemens) according to standard protocols (12,14).…”

Section: F-fet Pet Image Acquisition and Assessmentmentioning

confidence: 99%

Dynamic ¹⁸F-FET PET in Newly Diagnosed Astrocytic Low-Grade Glioma Identifies High-Risk Patients

Jansen¹,

Suchorska

Wenter³

et al. 2013

J Nucl Med

124

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Because the clinical course of low-grade gliomas in the individual adult patient varies considerably and is unpredictable, we investigated the prognostic value of dynamic 18 F-fluorethyltyrosine ( 18 F-FET) PET in the early diagnosis of astrocytic low-grade glioma (World Health Organization grade II). Methods: Fifty-nine patients with newly diagnosed low-grade glioma and dynamic 18 F-FET PET before histopathologic assessment were retrospectively investigated. 18 F-FET PET analysis comprised a qualitative visual classification of lesions; assessment of the semiquantitative parameters maximal, mean, and total standardized uptake value as ratio to background and biologic tumor volume; and dynamic analysis of intratumoral 18 F-FET uptake over time (increasing vs. decreasing time-activity curves). The correlation between PET parameters and progression-free survival, overall survival, and time to malignant transformation was investigated. Results: 18 F-FET uptake greater than the background level was found in 34 of 59 tumors. Dynamic 18 F-FET uptake analysis was available for 30 of these 34 patients. Increasing and decreasing timeactivity curves were found in 18 and 12 patients, respectively. Neither the qualitative factor presence or absence of 18 F-FET uptake nor any of the semiquantitative uptake parameters significantly influenced clinical outcome. In contrast, decreasing time-activity curves in the kinetic analysis were highly prognostic for shorter progression-free survival and time to malignant transformation (P , 0.001). Conclusion: Absence of 18 F-FET uptake in newly diagnosed astrocytic low-grade glioma does not generally indicate an indolent disease course. Among the 18 F-FET-positive gliomas, decreasing time-activity curves in dynamic 18 F-FET PET constitute an unfavorable prognostic factor in astrocytic low-grade glioma and, by identifying high-risk patients, may ease treatment decisions.

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The positive predictive value of O-(2-[18F]fluoroethyl)-l-tyrosine (FET) PET in the diagnosis of a glioma recurrence after multimodal treatment

Cited by 109 publications

References 30 publications

Late Pseudoprogression in Glioblastoma: Diagnostic Value of Dynamic O-(2-[18F]fluoroethyl)-L-Tyrosine PET

Late Pseudoprogression in Glioblastoma: Diagnostic Value of Dynamic O-(2-[18F]fluoroethyl)-L-Tyrosine PET

Multimodality Assessment of Brain Tumors and Tumor Recurrence

Dynamic ¹⁸F-FET PET in Newly Diagnosed Astrocytic Low-Grade Glioma Identifies High-Risk Patients

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The positive predictive value of O-(2-[18F]fluoroethyl)-l-tyrosine (FET) PET in the diagnosis of a glioma recurrence after multimodal treatment

Cited by 109 publications

References 30 publications

Late Pseudoprogression in Glioblastoma: Diagnostic Value of Dynamic O-(2-[18F]fluoroethyl)-L-Tyrosine PET

Late Pseudoprogression in Glioblastoma: Diagnostic Value of Dynamic O-(2-[18F]fluoroethyl)-L-Tyrosine PET

Multimodality Assessment of Brain Tumors and Tumor Recurrence

Dynamic 18F-FET PET in Newly Diagnosed Astrocytic Low-Grade Glioma Identifies High-Risk Patients

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Product

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Dynamic ¹⁸F-FET PET in Newly Diagnosed Astrocytic Low-Grade Glioma Identifies High-Risk Patients