Use of PET Imaging in Neuro-Oncological Surgery

Abstract

This review provides an overview of current applications and perspectives of PET imaging in neuro-oncological surgery. The past and future of PET imaging in the management of patients with glioma and brain metastases are elucidated with an emphasis on amino acid tracers, such as O-(2-[18F]fluoroethyl)-L-tyrosine (18F-FET). The thematic scope includes surgical resection planning, prognostication, non-invasive prediction of molecular tumor characteristics, depiction of intratumoral heterogeneity, response assessment, differentiation between tumor progression and treatment-related changes, and emerging new tracers. Furthermore, the role of PET using specific somatostatin receptor ligands for the management of patients with meningioma is discussed. Further advances in neuro-oncological imaging can be expected from promising new techniques, such as hybrid PET/MR scanners and the implementation of artificial intelligence methods, such as radiomics.

Dynamic 11C-Methionine PET-CT: Prognostic Factors for Disease Progression and Survival in Patients with Suspected Glioma Recurrence

“…Positron emission tomography (PET) is a functional molecular technique able to early detect pathophysiological changes in gliomas that usually occur before the morpho-structural changes detected by structural imaging [ 7 , 8 ]. PET-CT with amino-acid radiotracers, including carbon-11 methionine ( 11 C-MET), fluorine-18 fluoroethyltyrosine ( 18 F-FET) and fluorine-18 fluorodihydroxyphenylalanine ( 18 F-DOPA), is a well-established tool in the evaluation of glioma patients in different phases of disease, including prognostic evaluation [ 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The prognostic value of semiquantitative PET parameters, such as tumour maximum uptake/reference background mean uptake (T/B) and metabolic tumour volume, has been proven for different PET amino-acid tracers [ 16 , 17 ].…”

Bombesin Receptor Family Activation and CNS/Neural Tumors: Review of Evidence Supporting Possible Role for Novel Targeted Therapy

“…While magnetic resonance imaging (MRI) remains the mainstay for initial and follow-up imaging of CNS/neural tumors and provides important information on tumor location, size, number of lesions, perifocal edema, and contrast enhancement, other aspects of tumor behavior are either not defined or incompletely defined, such as tumor heterogeneity, extent of metabolically active tissue, differentiating treatmentrelated changes from recurrent disease in previously treated patients, and extent of tumor invasion, in some cases (132,(239)(240)(241)(242). Because of these latter limitations, there is increased interest in the development of other imaging approaches, particularly the use of positron emission tomographic (PET) techniques including [ 18 F]Fluorodeoxyglucose (FDG) (132,235,239,243), as well as other nuclear medicine approaches (132,235,243,244).…”

“…There are also numerous studies of PRRT with radiolabeled BnR analogues in patients with breast cancer (17,23,25,73,269), and other non-endocrine cancer cells (73), which show promise. Third, because of the success of tumor localization and PRRT-mediated cytotoxicity with radiolabeled somatostatin analogues in NETs, as well as limited studies showing promise with PRRT with radiolabeled somatostatin analogues in some patients with symptomatic/malignant CNS/neural tumors (meningiomas) (270)(271)(272)(273), malignant neuroblastomas (274,275), there is increased interest in applying nuclear medicine approaches to other CNS/ neural tumors (125,235,240,276,277).…”

Glioblastoma: Emerging Treatments and Novel Trial Designs

“…The type of treatment provided and the molecular background of the disease are mandatory elements to estimate response to treatment. Integration of molecular and clinical data with imaging improves ORR estimation; nonetheless, functional imaging provided by magnetic resonance imaging (MRI) and positron emission tomography (PET) is increasing as to allow a more reliable distinction of progression/response to treatment [107][108][109][110][111][112][113]. Criteria of response assessment have been modified and reflects the type of treatment provided [107,108].…”