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¹⁸F-FET PET Differentiation of Ring-Enhancing Brain Lesions

¹ Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany; ² Institute of Medicine and Brain Imaging Center West, Research Center Jülich, Jülich, Germany; ³ Department of Neuropathology, Heinrich-Heine-University, Düsseldorf, Germany; and ⁴ Institute of Nuclear Chemistry and Brain Imaging Center West, Research Center Jülich, Jülich, Germany

Correspondence: For correspondence or reprints contact: Karl-Josef Langen, Institute of Medicine, Research Center Jülich, P.O. Box 1913, D-52425 Jülich, Germany. E-mail: k.j.langen{at}fz-juelich.de

The aim of this study was to explore the differential diagnostic value of PET using the amino acid O-(2-¹⁸F-fluoroethyl)-L-tyrosine (¹⁸F-FET) in patients with newly diagnosed solitary intracerebral lesions showing ring enhancement on contrast-enhanced MRI. Methods: ¹⁸F-FET PET analyses were performed on 14 consecutive patients with intracerebral ring-enhancing lesions. Eleven of the patients were additionally studied with ¹⁸F-FDG PET. In all patients, the main differential diagnosis after MRI was a malignant lesion, in particular glioblastoma multiforme, versus a benign lesion, in particular brain abscess. A malignant tumor was suspected for lesions showing increased ¹⁸F-FET uptake on PET images with a mean lesion-to-brain ratio of at least 1.6 (¹⁸F-FET PET positive). A nonneoplastic lesion was suspected in cases of minimal or absent ¹⁸F-FET uptake, with a mean lesion-to-brain ratio of less than 1.6 (¹⁸F-FET PET negative). Histologic diagnosis was obtained by serial biopsies in 13 of the 14 patients. One patient refused the biopsy, but follow-up indicated an abscess because his lesion regressed under antibiotic therapy. Results: Histology and clinical follow-up showed high-grade malignant gliomas in 5 patients and nonneoplastic lesions in 9 patients. The findings of ¹⁸F-FET PET were positive in all 5 glioma patients and in 3 of 9 patients with nonneoplastic lesions, including 2 patients with brain abscesses and 1 patient with a demyelinating lesion. The findings of ¹⁸F-FDG PET were positive (mean lesion-to-gray matter ratio 0.7) in 4 of 4 glioma patients and 3 of 7 patients with nonneoplastic lesions. Conclusion: Although ¹⁸F-FET PET has been shown to be valuable for the diagnostic evaluation of brain tumors, our data indicate that, like ¹⁸F-FDG PET, ¹⁸F-FET PET has limited specificity in distinguishing between neoplastic and nonneoplastic ring-enhancing intracerebral lesions. Thus, histologic investigation of biopsy specimens remains mandatory to make this important differential diagnosis.

Key Words: ring enhancement • ¹⁸F-FET PET • abscess • glioblastoma

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