Early [18F]FET-PET in Gliomas after Surgical Resection: Comparison with MRI and Histopathology

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Abstract

Background

The precise definition of the post-operative resection status in high-grade gliomas (HGG) is crucial for further management. We aimed to assess the feasibility of assessment of the resection status with early post-operative positron emission tomography (PET) using [ ¹⁸F]O-(2-[ ¹⁸F]-fluoroethyl)-L-tyrosine ([ ¹⁸F]FET).

Methods

25 patients with the suspicion of primary HGG were enrolled. All patients underwent pre-operative [ ¹⁸F]FET-PET and magnetic resonance imaging (MRI). Intra-operatively, resection status was assessed using 5-aminolevulinic acid (5-ALA). Imaging was repeated within 72h after neurosurgery. Post-operative [ ¹⁸F]FET-PET was compared with MRI, intra-operative assessment and clinical follow-up.

Results

[ ¹⁸F]FET-PET, MRI and intra-operative assessment consistently revealed complete resection in 12/25 (48%) patients and incomplete resection in 6/25 cases (24%). In 7 patients, PET revealed discordant findings. One patient was re-resected. 3/7 experienced tumor recurrence, 3/7 died shortly after brain surgery.

Conclusion

Early assessment of the resection status in HGG with [ ¹⁸F]FET-PET seems to be feasible.

Related collections

Most cited references 18

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Clinical applications of PET in brain tumors.

Daphne Chen (2007)

Malignant gliomas and metastatic tumors are the most common brain tumors. Neuroimaging plays a significant role clinically. In low-grade tumors, neuroimaging is needed to evaluate recurrent disease and to monitor anaplastic transformation into high-grade tumors. In high-grade and metastatic tumors, the imaging challenge is to distinguish between recurrent tumor and treatment-induced changes such as radiation necrosis. The current clinical gold standard, MRI, provides superior structural detail but poor specificity in identifying viable tumors in brain treated with surgery, radiation, or chemotherapy. (18)F-FDG PET identifies anaplastic transformation and has prognostic value. The sensitivity and specificity of (18)F-FDG in evaluating recurrent tumor and treatment-induced changes can be improved significantly by co-registration with MRI and potentially by delayed imaging 3-8 h after injection. Amino acid PET tracers are more sensitive than (18)F-FDG in imaging recurrent tumors and in particular recurrent low-grade tumors. They are also promising in differentiating between recurrent tumors and treatment-induced changes.

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Delineation of brain tumor extent with [11C]L-methionine positron emission tomography: local comparison with stereotactic histopathology.

L. Kracht, M Hoevels, Richard Jacobs … (2004)

Methyl-[11C]L-methionine ([11C]MET) positron emission tomography (PET) in brain tumors reflects amino acid transport and has been shown to be more sensitive than magnetic resonance imaging in stereotactic biopsy planning. It remains unclear whether the increased [11C]MET uptake is limited to solid tumor tissue or even detects infiltrating tumor parts. In 30 patients, a primary or recurrent brain tumor was suspected on magnetic resonance imaging. Patients were investigated with [11C]MET-PET before stereotactic biopsy. The biopsy trajectories were plotted into the [11C]MET-PET images with a newly designed C-based software program. The exact local [11C]MET uptake was determined within rectangular regions of interest of 4 mm in width and length aligned with the biopsy specimen. Individual histologic specimens were rated for the presence of solid tumor tissue, infiltration area, and nontumorous tissue changes. Receiver operating characteristics analysis demonstrated a sensitivity of 87% and specificity of 89% for the detection of tumor tissue at a threshold of 1.3-fold [11C]MET uptake relative to normal brain tissue. At this threshold, only 13 of 100 tumor positive specimen were false negative mainly in grade 2 astrocytoma. In grade 2 astrocytoma, mean [11C]MET uptake in the infiltration area was significantly higher than in solid tumor tissue (P < 0.003). [11C]MET-PET detects solid parts of brain tumors, as well as the infiltration area at high sensitivity and specificity. High [11C]MET uptake in infiltrating tumor of astrocytoma WHO grade 2 reflects high activity in this tumor compartment. Molecular imaging, with [11C]MET, will guide improved management of patients with brain tumors.

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11C-methionine PET for differential diagnosis of low-grade gliomas.

K Herholz, T Hölzer, B Bauer … (1998)

Management of low-grade gliomas continues to be a challenging task, because CT and MRI do not always differentiate from nontumoral lesions. Furthermore, tumor extent and aggressiveness often remain unclear because of a lack of contrast enhancement. Previous studies indicated that large neutral amino acid tracers accumulate in most brain tumors, including low-grade gliomas, probably because of changes of endothelial and blood-brain barrier function. We describe 11C-methionine uptake measured with PET in a series of 196 consecutive patients, most of whom were studied because of suspected low-grade gliomas. Uptake in the most active lesion area, relative to contralateral side, was significantly different among high-grade gliomas, low-grade gliomas, and chronic or subacute nontumoral lesions, and this difference was independent from contrast enhancement in CT or MRI. Corticosteroids had no significant effect on methionine uptake in low-grade gliomas but reduced uptake moderately in high-grade gliomas. Differentiation between gliomas and nontumoral lesions by a simple threshold was correct in 79%. Recurrent or residual tumors had a higher uptake than primary gliomas. In conclusion, the high sensitivity of 11C-methionine uptake for functional endothelial or blood-brain barrier changes suggests that this tracer is particularly useful for evaluation and follow-up of low-grade gliomas.

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Author and article information

Contributors

Jonathan A Coles: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 26 October 2015

Publication date Collection: 2015

Volume: 10

Issue: 10

Electronic Location Identifier: e0141153

Affiliations

[1 ]Department of Nuclear Medicine, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Germany

[2 ]Department of Neurosurgery, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Germany

[3 ]Department of Nuclear Medicine, Klinikum Konstanz, Luisenstr. 7a, 78464, Konstanz, Germany

[4 ]Department of Nuclear Medicine, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany

[5 ]Department of Nuclear Medicine, Universitätsmedizin Rostock, Gertrudenplatz 1, 18057, Rostock, Germany

Glasgow University, UNITED KINGDOM

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: BK NB JG CL. Performed the experiments: BK NB JG CL. Analyzed the data: BK NB JG FR CL BJK. Contributed reagents/materials/analysis tools: FR CL. Wrote the paper: BK NB JG FR CL BJK. Supervised the study: BJK.

* E-mail: benjamin.klaesner@ 123456klinikum-konstanz.de

Article

Publisher ID: PONE-D-15-22131

DOI: 10.1371/journal.pone.0141153

PMC ID: 4621037

PubMed ID: 26502297

SO-VID: 7a664d07-ad3c-4596-8d97-ec36f6dfa78d

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 21 May 2015

Date accepted : 3 October 2015

Page count

Figures: 3, Tables: 2, Pages: 9

Funding

The authors have no support or funding to report.

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Data Availability All relevant data are within the paper.

ScienceOpen disciplines: Uncategorized

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