Utility of FET-PET in detecting high-grade gliomas presenting with equivocal MR imaging features

Ameya D. Puranik; Mathew Boon; Nilendu Purandare; Venkatesh Rangarajan; Tejpal Gupta; Aliasgar Moiyadi; Prakash Shetty; Epari Sridhar; Archi Agrawal; Indraja Dev; Sneha Shah

doi:10.4103/wjnm.WJNM_89_18

World Journal of Nuclear Medicine, Table of Contents

CC BY-NC-ND 4.0 · World J Nucl Med 2019; 18(03): 266-272
DOI: 10.4103/wjnm.WJNM_89_18

Original Article

Utility of FET-PET in detecting high-grade gliomas presenting with equivocal MR imaging features

Authors

Ameya D. Puranik

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
Mathew Boon

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
Nilendu Purandare

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
Venkatesh Rangarajan

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
Tejpal Gupta

¹Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
Aliasgar Moiyadi

²Department of Neurosurgery, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
Prakash Shetty

²Department of Neurosurgery, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
Epari Sridhar

³Department of Pathology, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
Archi Agrawal

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
Indraja Dev

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
Sneha Shah

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India

Abstract

High-grade gliomas, metastases, and primary central nervous system lymphoma (PCNSL) are common high-grade brain lesions, which may have overlapping features on magnetic resonance (MR) imaging. Our objective was to assess the utility of 18-fluoride-fluoro-ethyl-tyrosine positron emission tomography (FET-PET) in reliably differentiating between these lesions, by studying their metabolic characteristics. Patients with high-grade brain lesions suspicious for glioma, with overlapping features for metastases and PCNSL were referred for FET-PET by Neuroradiologists from Multidisciplinary Neuro-Oncology Joint Clinic. Tumor-to-contralateral white mater ratio (T/Wm) at 5 and 20 min was derived and compared to histopathology. Receiver operating characteristic curve analysis was used to find the optimal T/Wm cutoff to differentiate between the tumor types. T/Wm was higher for glial tumors compared to nonglial tumors (metastases, PCNSL, tuberculoma, and anaplastic meningioma). A cutoff of 1.9 was derived to reliably diagnose a tumor of glial origin with a sensitivity and specificity of 93.8% and 91%, respectively. FET-PET can be used to diagnose glial tumors presenting as high-grade brain lesions when MR findings show overlapping features for other common high-grade lesions.

Keywords

Brain lesions - fluoroethyl-tyrosine-positron-emission tomography - high-grage glioma - magnetic resonance imaging

Full Text

References

References
1 Chen W, Silverman DH. Advances in evaluation of primary brain tumors. Semin Nucl Med 2008;38:240-50.
2 Ostrom QT, Gittleman H, Liao P, Vecchione-Koval T, Wolinsky Y, Kruchko C, et al. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2010–2014. Neuro Oncol 2017;19:iv1-iv88.
3 Price SJ. The role of advanced MR imaging in understanding brain tumour pathology. Br J Neurosurg 2007;21:562-75.
4 Ding Y, Xing Z, Liu B, Lin X, Cao D. Differentiation of primary central nervous system lymphoma from high-grade glioma and brain metastases using susceptibility-weighted imaging. Brain Behav 2014;4:841-9.
5 Langen KJ, Stoffels G, Filss C, Heinzel A, Stegmayr C, Lohmann P, et al. Imaging of amino acid transport in brain tumours: Positron emission tomography with O-(2-[18F]fluoroethyl)-L-tyrosine (FET). Methods 2017;130:124-34.
6 la Fougère C, Suchorska B, Bartenstein P, Kreth FW, Tonn JC. Molecular imaging of gliomas with PET: Opportunities and limitations. Neuro Oncol 2011;13:806-19.
7 Floeth FW, Pauleit D, Sabel M, Reifenberger G, Stoffels G, Stummer W, et al. 18F-FET PET differentiation of ring-enhancing brain lesions. J Nucl Med 2006;47:776-82.
8 Omuro A, DeAngelis LM. Glioblastoma and other malignant gliomas: A clinical review. JAMA 2013;310:1842-50.
9 Sperduto PW, Chao ST, Sneed PK, Luo X, Suh J, Roberge D, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: A multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys 2010;77:655-61.
10 Pasricha S, Gupta A, Gawande J, Trivedi P, Patel D. Primary central nervous system lymphoma: A study of clinicopathological features and trend in Western India. Indian J Cancer 2011;48:199-203.
11 Dunet V, Rossier C, Buck A, Stupp R, Prior JO. Performance of 18F-fluoro-ethyl-tyrosine (18F-FET) PET for the differential diagnosis of primary brain tumor: A systematic review and metaanalysis. J Nucl Med 2012;53:207-14.
12 Gempt J, Bette S, Ryang YM, Buchmann N, Peschke P, Pyka T, et al. 18F-fluoro-ethyl-tyrosine positron emission tomography for grading and estimation of prognosis in patients with intracranial gliomas. Eur J Radiol 2015;84:955-62.
13 Verger A, Filss CP, Lohmann P, Stoffels G, Sabel M, Wittsack HJ, et al. Comparison of 18F-FET PET and perfusion-weighted MRI for glioma grading: A hybrid PET/MR study. Eur J Nucl Med Mol Imaging 2017;44:2257-65.
14 Rizzo L, Crasto SG, Moruno PG, Cassoni P, Rudà R, Boccaletti R, et al. Role of diffusion- and perfusion-weighted MR imaging for brain tumour characterisation. Radiol Med 2009;114:645-59.
15 Kono K, Inoue Y, Nakayama K, Shakudo M, Morino M, Ohata K, et al. The role of diffusion-weighted imaging in patients with brain tumors. AJNR Am J Neuroradiol 2001;22:1081-8.
16 Hartmann M, Heiland S, Harting I, Tronnier VM, Sommer C, Ludwig R, et al. Distinguishing of primary cerebral lymphoma from high-grade glioma with perfusion-weighted magnetic resonance imaging. Neurosci Lett 2003;338:119-22.
17 Blasel S, Jurcoane A, Franz K, Morawe G, Pellikan S, Hattingen E, et al. Elevated peritumoural rCBV values as a mean to differentiate metastases from high-grade gliomas. Acta Neurochir (Wien) 2010;152:1893-9.
18 Purandare NC, Puranik A, Shah S, Agrawal A, Gupta T, Moiyadi A, et al. Common malignant brain tumors: Can 18F-FDG PET/CT aid in differentiation? Nucl Med Commun 2017;38:1109-16.
19 Das K, Mittal BR, Vasistha RK, Singh P, Mathuriya SN. Role of (18) F-fluorodeoxyglucose positron emission tomography scan in differentiating enhancing brain tumors. Indian J Nucl Med 2011;26:171-6.
20 Kosaka N, Tsuchida T, Uematsu H, Kimura H, Okazawa H, Itoh H, et al. 18F-FDG PET of common enhancing malignant brain tumors. AJR Am J Roentgenol 2008;190:W365-9.
21 Stegmayr C, Schöneck M, Oliveira D, Willuweit A, Filss C, Galldiks N, et al. Reproducibility of O-(2-(18)F-fluoroethyl)-L-tyrosine uptake kinetics in brain tumors and influence of corticoid therapy: An experimental study in rat gliomas. Eur J Nucl Med Mol Imaging 2016;43:1115-23.
22 Yamaguchi S, Hirata K, Kobayashi H, Shiga T, Manabe O, Kobayashi K, et al. The diagnostic role of (18) F-FDG PET for primary central nervous system lymphoma. Ann Nucl Med 2014;28:603-9.
23 Pöpperl G, Kreth FW, Mehrkens JH, Herms J, Seelos K, Koch W, et al. FET PET for the evaluation of untreated gliomas: Correlation of FET uptake and uptake kinetics with tumour grading. Eur J Nucl Med Mol Imaging 2007;34:1933-42.
24 Langen KJ, Hamacher K, Weckesser M, Floeth F, Stoffels G, Bauer D, et al. O-(2-[18F]fluoroethyl)-L-tyrosine: Uptake mechanisms and clinical applications. Nucl Med Biol 2006;33:287-94.
25 Albert NL, Winkelmann I, Suchorska B, Wenter V, Schmid-Tannwald C, Mille E, et al. Early static (18)F-FET-PET scans have a higher accuracy for glioma grading than the standard 20-40 min scans. Eur J Nucl Med Mol Imaging 2016;43:1105-14.
26 Heiss P, Mayer S, Herz M, Wester HJ, Schwaiger M, Senekowitsch-Schmidtke R, et al. Investigation of transport mechanism and uptake kinetics of O-(2-[18F]fluoroethyl)-L-tyrosine in vitro and in vivo. J Nucl Med 1999;40:1367-73.
27 Rapp M, Heinzel A, Galldiks N, Stoffels G, Felsberg J, Ewelt C, et al. Diagnostic performance of 18F-FET PET in newly diagnosed cerebral lesions suggestive of glioma. J Nucl Med 2013;54:229-35.