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18F-FDOPA PET/CT for detection of recurrence in patients with glioma: prospective comparison with 18F-FDG PET/CT

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Abstract

Purpose

Differentiation between recurrence and radiation necrosis in patients with glioma is crucial, since the two entities have completely different management and prognosis. The purpose of the present study was to compare the efficacies of 18F-FDG PET/CT and 3,4-dihydroxy-6-[18F]fluoro-phenylalanine (18F-FDOPA) PET/CT in detection of recurrent gliomas.

Methods

A total of 28 patients (age 38.82 ± 1.25 years; 85.7 % men) with histopathologically proven glioma with clinical/imaging suspicion of recurrence were evaluated using 18F-FDG PET/CT and 18F-FDOPA PET/CT. 18F-FDG PET/CT and 18F-FDOPA PET/CT images were evaluated qualitatively and semiquantitatively. The combination of clinical follow-up, repeat imaging and/or biopsy (when available) was taken as the reference standard.

Results

Based on the reference standard, 21 patients were positive and 7 were negative for tumour recurrence. The sensitivity, specificity and accuracy of 18F-FDG PET/CT were 47.6 %, 100 % and 60.7 %, respectively, and those of 18F-FDOPA PET/CT were 100 %, 85.7 % and 96.4 %, respectively. The results of 18F-FDG PET/CT and 18F-FDOPA PET/CT were concordant in 57.1 % of patients (16 of 28) and discordant in 42.9 % (12 of 28). The difference in the findings between 18F-FDG PET/CT and 18F-FDOPA PET/CT was significant (P = 0.0005, McNemar’s test). The difference was significant for low-grade tumours (P = 0.0039) but not for high-grade tumours (P = 0.250).

Conclusion

18F-FDOPA PET/CT is highly sensitive and specific for detection of recurrence in glioma patients. It is superior to 18F-FDG PET/CT for this purpose and is especially advantageous in patients with low-grade gliomas.

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References

  1. Levin VA, Prados MD. Treatment of recurrent gliomas and, metastatic brain tumors with a polydrug protocol designed to combat nitrosourea resistance. J Clin Oncol. 1992;10:766–71.

    PubMed  CAS  Google Scholar 

  2. Warnick RE, Prados MD, Mack EE, Chandler KL, Doz F, Rabbitt JE, et al. A phase II study of intravenous carboplatin for the treatment of recurrent gliomas. J Neurooncol. 1994;19:69–74.

    Article  PubMed  CAS  Google Scholar 

  3. Patronas NJ, Di Chiro G, Brooks RA, DeLaPaz RL, Kornblith PL, Smith BH, et al. Work in progress: [18F]fluorodeoxyglucose and positron emission tomography in the evaluation of radiation necrosis of the brain. Radiology. 1982;144:885–9.

    PubMed  CAS  Google Scholar 

  4. Devaux BC, O’Fallon JR, Kelly PJ. Resection, biopsy and survival in malignant glioma, a retrospective study of clinical parameters, therapy and outcomes. J Neurosurg. 1993;78:767–75.

    Article  PubMed  CAS  Google Scholar 

  5. Delbeke D, Meyerowitz C, Lapidus RL, Maciunas RJ, Jennings MT, Moots PL, et al. Optimum cut off levels of FDG uptake in differentiation of low grade from high grade brain tumors with PET. Radiology. 1995;195:47–52.

    PubMed  CAS  Google Scholar 

  6. Alavi JB, Alavi A, Chawluk J, Kushner M, Powe J, Hickey W, et al. PET in patients of glioma, a predictor of prognosis. Cancer. 1988;62:1074–8.

    Article  PubMed  CAS  Google Scholar 

  7. Jager PL, Vaalburg W, Pruim J, de Vries EG, Langen KJ, Piers DA. Radiolabeled amino acids: basic aspects and clinical applications in oncology. J Nucl Med. 2001;42:432–45.

    PubMed  CAS  Google Scholar 

  8. Herholz K, Holzer T, Bauer B, Schröder R, Voges J, Ernestus RI, et al. 11C-methionine PET for differential diagnosis of low-grade gliomas. Neurology. 1998;50:1316–22.

    Article  PubMed  CAS  Google Scholar 

  9. Coope DJ, Cizek J, Eggers C, Vollmar S, Heiss WD, Herholz K. Evaluation of primary brain tumors using 11Cmethionine PET with reference to a normal methionine uptake map. J Nucl Med. 2007;48:1971–80.

    Article  PubMed  CAS  Google Scholar 

  10. Laverman P, Boerman OC, Corstens FH, Oyen WJ. Fluorinated amino acids for tumour imaging with positron emission tomography. Eur J Nucl Med Mol Imaging. 2002;29:681–90.

    Article  PubMed  CAS  Google Scholar 

  11. Bethien-Baumann B, Bredow J, Burchert W, Füchtner F, Bergmann R, Alheit HD, et al. 3-O-Methyl-6-[18F]fluoro-LDOPA and its evaluation in brain tumour imaging. Eur J Nucl Med Mol Imaging. 2003;30:1004–8.

    Article  Google Scholar 

  12. Chen W, Silverman DH, Delaloye S, Czernin J, Kamdar N, Pope W, et al. 18F-FDOPA PET imaging of brain tumors: comparison study with 18F-FDG PET and evaluation of diagnostic accuracy. J Nucl Med. 2006;47:904–11.

    PubMed  CAS  Google Scholar 

  13. Becherer A, Karanikas G, Szabo M, Zettinig G, Asenbaum S, Marosi C, et al. Brain tumour imaging with PET: a comparison between [18F]fluorodopa and [11C]methionine. Eur J Nucl Med Mol Imaging. 2003;30:1561–7.

    Article  PubMed  CAS  Google Scholar 

  14. Ledezma CJ, Chen W, Sai V, Freitas B, Cloughesy T, Czernin J, et al. 18F-FDOPA PET/MRI fusion in patients with primary/recurrent gliomas: initial experience. Eur J Radiol. 2009;71:242–8.

    Article  PubMed  Google Scholar 

  15. Fueger BJ, Czernin J, Cloughesy T, Silverman DH, Geist CL, Walter MA, et al. Correlation of 6-18F-fluoro-L-dopa PET uptake with proliferation and tumor grade in newly diagnosed and recurrent gliomas. J Nucl Med. 2010;51:1532–8.

    Article  PubMed  Google Scholar 

  16. Schiepers C, Chen W, Cloughesy T, Dahlbom M, Huang SC. 18F-FDOPA kinetics in brain tumors. J Nucl Med. 2007;48:1651–61.

    Article  PubMed  Google Scholar 

  17. Di Chiro G, Oldfield E, Wright DC, De Michele D, Katz DA, Patronas NJ, et al. Cerebral necrosis after radiotherapy and/or intraarterial chemotherapy for brain tumors: PET and neuropathologic studies. AJR Am J Roentgenol. 1988;150:189–97.

    Article  PubMed  Google Scholar 

  18. Chao ST, Suh JH, Raja S, Lee SY, Barnett G. The sensitivity and specificity of FDG PET in distinguishing recurrent brain tumor from radionecrosis in patients treated with stereotactic radiosurgery. Int J Cancer. 2001;96:191–7.

    Article  PubMed  CAS  Google Scholar 

  19. Ricci PE, Karis JP, Heiserman JE, Fram EK, Bice AN, Drayer BP. Differentiating recurrent tumor from radiation necrosis: time for re-evaluation of positron emission tomography? AJNR Am J Neuroradiol. 1998;19:407–13.

    PubMed  CAS  Google Scholar 

  20. Asensio C, Pérez-Castejón MJ, Maldonado A, Montz R, Ruiz JA, Santos M, et al. The role of PET-FDG in questionable diagnosis of relapse in the presence of radionecrosis of brain tumors. Rev Neurol. 1998;27:447–52.

    PubMed  CAS  Google Scholar 

  21. Belohlávek O, Klener J, Vymazal J, Dbalý V, Tovarys F. The diagnostics of recurrent gliomas using FDG-PET: still questionable? Nucl Med Rev Cent East Eur. 2002;5:127–30.

    PubMed  Google Scholar 

  22. Doyle WK, Budinger TF, Valk PE, Levin VA, Gutin PH. Differentiation of cerebral radiation necrosis from tumor recurrence by [18F]FDG and 82Rb positron emission tomography. J Comput Assist Tomogr. 1987;11:563–70.

    Article  PubMed  CAS  Google Scholar 

  23. Kaschten B, Stevenaert A, Sadzot B, Deprez M, Degueldre C, Del Fiore G, et al. Preoperative evaluation of 54 gliomas by PET with fluorine-18-fluorodeoxyglucose and/or carbon-11-methionine. J Nucl Med. 1998;39:778–85.

    PubMed  CAS  Google Scholar 

  24. Chung JK, Kim YK, Kim SK, Lee YJ, Paek S, Yeo JS, et al. Usefulness of 11C-methionine PET in the evaluation of brain lesions that are hypo- or isometabolic on 18F-FDG PET. Eur J Nucl Med Mol Imaging. 2002;29:176–82.

    Article  PubMed  CAS  Google Scholar 

  25. Pirotte B, Goldman S, Massager N, David P, Wikler D, Vandesteene A, et al. Comparison of 18F-FDG and 11C-methionine for PET-guided stereotactic brain biopsy of gliomas. J Nucl Med. 2004;45:1293–8.

    PubMed  CAS  Google Scholar 

  26. Van Laere K, Ceyssens S, Van Calenbergh F, de Groot T, Menten J, Flamen P, et al. Direct comparison of 18F-FDG and 11C-methionine PET in suspected recurrence of glioma: sensitivity, inter-observer variability and prognostic value. Eur J Nucl Med Mol Imaging. 2005;32:39–51.

    Article  PubMed  CAS  Google Scholar 

  27. Henze M, Mohammed A, Schlemmer HP, Herfarth KK, Hoffner S, Haufe S, et al. PET and SPECT for detection of tumor progression in irradiated low-grade astrocytoma: a receiver-operating-characteristic analysis. J Nucl Med. 2004;45:579–86.

    PubMed  Google Scholar 

  28. Tripathi M, Sharma R, D’Souza M, Jaimini A, Panwar P, Varshney R, et al. Comparative evaluation of F-18 FDOPA, F-18 FDG, and F-18 FLT-PET/CT for metabolic imaging of low grade gliomas. Clin Nucl Med. 2009;34:878–83.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Sellam Karunanithi, Punit Sharma, Abhishek Kumar, Bangkim Chandra Khangembam, Guru Pada Bandopadhyaya, Rakesh Kumar, Arun Malhotra & Chandrasekhar Bal

  2. Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

    Deepak Kumar Gupta

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  1. Sellam Karunanithi
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  2. Punit Sharma
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Correspondence to Chandrasekhar Bal.

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Karunanithi, S., Sharma, P., Kumar, A. et al. 18F-FDOPA PET/CT for detection of recurrence in patients with glioma: prospective comparison with 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging 40, 1025–1035 (2013). https://doi.org/10.1007/s00259-013-2384-0

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  • DOI: https://doi.org/10.1007/s00259-013-2384-0

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