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Spatial Heterogeneity of Low-Grade Gliomas at the Capillary Level: A PET Study on Tumor Blood Flow and Amino Acid Uptake

¹ PET Center, Division of Nuclear Medicine, University Hospital, Zürich, Switzerland; ² Department of Oncology, University Hospital, Zürich, Switzerland; ³ Department of Neurosurgery, Cantonal Hospital, Aarau, Switzerland; ⁴ Department of Oncology and Hematology, Cantonal Hospital, Aarau, Switzerland; and ⁵ Department of Neurology, Cantonal Hospital, Aarau, Switzerland

View larger version (73K): [in this window] [in a new window]   FIGURE 1.  Heterogeneity of 18F-FET uptake and CBF in 3 low-grade gliomas. Corresponding axial slices are presented. Color scale represents T/Cb ratio of 18F-FET and CBF. (A) Oligoastrocytoma shows markedly increased 18F-FET uptake and CBF in right frontoinsular region (patient 11 in Table 1). 18F-FET and CBF peak uptake regions coincide; however, active volume of CBF is smaller than active 18F-FET volume. (B) Reduced 18F-FET uptake and CBF in fibrillary astrocytoma (patient 1). (C) Oligoastrocytoma (patient 12). Anterior tumor part involves corpus callosum and shows substantially reduced CBF and 18F-FET uptake when compared with posterior tumor part. This heterogeneity is not evident from any MRI sequences. Yellow line through posterior part of brain and tumor illustrates positioning of trace ROI (Fig. 4).

View larger version (7K): [in this window] [in a new window]   FIGURE 2.  Distribution of global () and peak () 18F-FET uptake and CBF. Values represent T/Cb ratios.

View larger version (6K): [in this window] [in a new window]   FIGURE 3.  Correlation of global active tumor volumes of 18F-FET and CBF (Spearman rank = 0.944, P < 0.01). Significant correlation is maintained if outlier is excluded from analysis ( = 0.885, P < 0.01).

View larger version (17K): [in this window] [in a new window]   FIGURE 4.  Trace ROI analysis in a single patient (patient 12). Pixelwise profiles of 18F-FET uptake () and CBF () span from normal cortex over white matter and tumor. Vertical dashed lines represent tumor borders on MRI (patient 12; Fig. 1C). Increases of tumor CBF (T/Cb ratio > 1.0) are more confined to tumor center. T/Cb ratio increases in this patient at a ratio of approximately 2.1 of 18F-FET uptake.