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Clinical Applications of PET in Brain Tumors^*

Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California; and Department of Radiology, Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, California

View larger version (83K): [in this window] [in a new window]   FIGURE 1.  18F-FDG PET of newly diagnosed tumors: glioblastoma (A) and grade II oligodendroglioma (B).

View larger version (134K): [in this window] [in a new window]   FIGURE 2.  Image coregistration of 18F-FDG PET and MRI. (A) A 45-y-old woman with radiation necrosis. MRI showed a new contrast-enhancing lesion 4 mo after stereotactic radiosurgery for metastatic breast cancer. 18F-FDG PET showed mild uptake not higher than background level of adjacent brain tissue. Radiation necrosis was diagnosed, and MRI lesion regressed during follow-up. (B) A 54-y-old man with recurrent glioblastoma. MRI showed a new contrast-enhancing lesion. 18F-FDG PET showed moderate uptake lower than that of normal gray matter but higher than expected background level of adjacent brain tissue and corresponding to abnormal contrast-enhancing region on MRI. Surgery demonstrated recurrent glioblastoma with Ki-67 of 40%.

View larger version (70K): [in this window] [in a new window]   FIGURE 3.  A 45-y-old woman with recurrent right temporal glioblastoma. MRI shows contrast enhancement. Tumor–to–gray matter delineation is more prominent later, at 473 min, than at 90 min. (Adapted from (44).)

View larger version (91K): [in this window] [in a new window]   FIGURE 4.  MRI and 18F-FDG PET of recurrent tumors. (A) Anaplastic transformation in previously resected and irradiated grade II astrocytoma. Intense 18F-FDG uptake corresponds to new contrast-enhancing lesion on MRI. (B) Recurrent grade II oligodendroglioma. No increased 18F-FDG uptake is seen. (C) Patient with previously resected and irradiated right frontal grade II astrocytoma. New contrast-enhancing lesion in left frontal lobe corresponds to minimally increased 18F-FDG uptake. This lesion was resected, and grade IV tumor was found.

View larger version (101K): [in this window] [in a new window]   FIGURE 5.  MRI, 18F-FET PET, and fused images. (A) A 30-y-old man who had undergone initial surgery, radiation therapy, and intralesional radioimmunotherapy for anaplastic astrocytoma. Biopsy-proven recurrent tumor (WHO grade IV) occurred 20 mo after initial diagnosis. MRI shows no contrast enhancement and was rated normal. PET shows focal 18F-FET uptake. Maximal SUV is 3.0, with ratio of 4.0 to background. (B) A 42-y-old woman who had undergone initial surgery and radiation therapy for WHO II astrocytoma. This patient was proven free of tumor by biopsy 67 mo after initial diagnosis. MRI shows suggestive contrast enhancement at border of cavity, whereas only moderate 18F-FET uptake is present on PET. Maximal SUV is 1.7, with ratio of 1.75 to background. (Adapted from Figure 1 of (71) with the kind permission of Springer Science and Business Media.)

View larger version (109K): [in this window] [in a new window]   FIGURE 6.  MRI, 18F-FDG PET, and 18F-FDOPA PET of newly diagnosed tumors: glioblastoma (A) and grade II oligodendroglioma (B). (Reprinted from (52).)

View larger version (114K): [in this window] [in a new window]   FIGURE 7.  Use of MRI, 18F-FDG PET, and 18F-FDOPA PET in evaluating recurrent tumors: glioblastoma (A) and grade II oligodendroglioma (B). (Reprinted from (52).)