Use of [¹⁸F]fluorodeoxyglucose positron emission tomography in patients with primary malignant brain tumors

Abstract

In patients with malignant gliomas, [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) may discriminate tumor progression from radionecrosis. We evaluated data from 50 patients undergoing FDG-PET for suspicion of tumor progression. Forty-nine were treated with surgery, 48 with radiotherapy, and 37 with chemotherapy. Twenty-one had intensive radiotherapy with either three daily treatments in two 5-day periods and intravenous carboplatin (17) or interstitial brachytherapy or stereotactic radiotherapy. Twenty underwent surgery after magnetic resonance imaging/FDG-PET; 9 demonstrated increased uptake of FDG and evidence of tumor, whereas 6 had decreased uptake and no evidence of tumor. In 5 patients, there was no correlation (all had intensive radiotherapy). In 17 patients who received bromodeoxyuridine intravenously just before surgery, the bromodeoxyuridine labeling index corresponded to the histological appearance in all but 2 patients (both had received intensive radiotherapy). In 30 patients without surgery, decreased uptake of FDG suggested prolonged survival; increased uptake of FDG did not predict survival. Eight of 10 with intensive radiotherapy had decreased label uptake. We conclude FDG-PET for evaluation of patients with possible recurrent tumors requires more study. In patients with intensive radiotherapy, FDG-PET results cannot be correlated accurately with tumor progression.

Serial evaluation of patients with brain tumors using volume MRI and 3D1H MRSI

“…[110][111][112][113] Brain tumors usually accumulate more than normal brain whereas necrotic tissue is Figure 5. MRI data and rCBV maps obtained from a patient with a glioblastoma multiforme, showing echo planar images obtained before and during the bolus of contrast agent, pre-and post gadolinium T 1 -weighted spin echo images, a T 2 -weighted spin echo image and a calculated rCBV image, together with concentration time curves from regions of interest corresponding to normal gray and white matter, necrosis and tumor.…”

Diagnostic Accuracy of PET for Recurrent Glioma Diagnosis: A Meta-Analysis

“…When considering both low-and high-grade gliomas, [16][17][18][19][21][22][23]27,32,33,40,41 sensitivity ranged between 0.23 and 0.95 and specificity ranged between 0.17 and 1.0. For high-grade gliomas, [16][17][18][19]27,34,35,39,41 sensitivity ranged between 0.18 and 1.00 and specificity ranged 0.25 and 1.0. Studies including both low-and high-grade gliomas had a summary sensitivity of 0.77 (95% CI, 0.66 -0.85) and a summary specificity of 0.78 (95% CI, 0.54 -0.91), corresponding to a positive likelihood ratio of 3.4 (95% CI, 1.6 -7.5) and a negative likelihood ratio of 0.30 (95% CI, 0.21-0.43) (Fig 2).…”

Oncological applications of positron emission tomography with fluorine-18 fluorodeoxyglucose

“…Some false-negative FDG cases have been demonstrated, however, especially in recurrences of low-grade gliomas but also in histologically proven recurrences of high-grade gliomas. Some false-positive cases have also been demonstrated [361,[368][369][370][371]. Falsenegative cases may especially correspond to small lesions included in the cortex, or to partially cystic or necrotic lesions.…”