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Locally Increased Uptake of Fluorine-18-Fluorodeoxyglucose After Intracavitary Administration of Iodine-131-Labeled Antibody for Primary Brain Tumors

Department of Nuclear Medicine, London Health Sciences Centre, London, England; Departments of Radiology and pathology and Division of Neurology, Duke University Medical Center, Durham, North Carolina

Correspondence: For correspondence or reprints contact: R. Edward Coleman, MD, Box 3949, Duke University Medical Center, Durham, NC 27710.

ABSTRACT

After the intracavitary administration of ¹³¹I-labeled monoclonal antibody for treatment of primary brain tumors after surgical resection, a persistent rim of ¹⁸F-fluorodeoxyglucose (FDG) accumulation surrounding the cavity can be observed on PET. This rim, although it accumulates more FDG than adjacent normal brain tissue, is not necessarily associated with tumor. In our study, we examine the characteristics of the rim that indicate persistent tumor and tumor progression. Methods: Sequential PET studies obtained after treatment in 10 patients were reviewed and the results correlated with dosimetry and post-treatment histologie diagnoses. Results: The rim of FDG accumulation was seen on the first post-treatment scan obtained 1–3 mo after therapy and persisted unchanged over the 2–26 mo follow-up period. Pathologically, the nonmalignant rim was associated with marked increase of macrophage infiltrates. Modularity of the rim was associated with tumor. Conclusion: Our study demonstrates that a rim of FDG accumulation is seen after intracav itary administration of ¹³¹I-labeled monoclonal antibody therapy independent of the presence of malignant disease. Malignant recurrence is suggested by the development of new nodularity in the rim of FDG accumulation.

Key Words: PET • primary brain tumors • iodine-131-monoclonal antibody • fluorine-18-fluorodeoxyglucose

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