Skip to main content
Log in

Dual-time-point O-(2-[18F]fluoroethyl)-L-tyrosine PET for grading of cerebral gliomas

  • Nuclear Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

We aimed to evaluate the diagnostic potential of dual-time-point imaging with positron emission tomography (PET) using O-(2-[18F]fluoroethyl)-L-tyrosine (18F-FET) for non-invasive grading of cerebral gliomas compared with a dynamic approach.

Methods

Thirty-six patients with histologically confirmed cerebral gliomas (21 primary, 15 recurrent; 24 high-grade, 12 low-grade) underwent dynamic PET from 0 to 50 min post-injection (p.i.) of 18F-FET, and additionally from 70 to 90 min p.i. Mean tumour-to-brain ratios (TBRmean) of 18F-FET uptake were determined in early (20–40 min p.i.) and late (70–90 min p.i.) examinations. Time–activity curves (TAC) of the tumours from 0 to 50 min after injection were assigned to different patterns. The diagnostic accuracy of changes of 18F-FET uptake between early and late examinations for tumour grading was compared to that of curve pattern analysis from 0 to 50 min p.i. of 18F-FET.

Results

The diagnostic accuracy of changes of the TBRmean of 18F-FET PET uptake between early and late examinations for the identification of HGG was 81 % (sensitivity 83 %; specificity 75 %; cutoff - 8 %; p < 0.001), and 83 % for curve pattern analysis (sensitivity 88 %; specificity 75 %; p < 0.001).

Conclusion

Dual-time-point imaging of 18F-FET uptake in gliomas achieves diagnostic accuracy for tumour grading that is similar to the more time-consuming dynamic data acquisition protocol.

Key Points

Dual-time-point imaging is equivalent to dynamic FET PET for grading of gliomas.

Dual-time-point imaging is less time consuming than dynamic FET PET.

Costs can be reduced due to higher patient throughput.

Reduced imaging time increases patient comfort and sedation might be avoided.

Quicker image interpretation is possible, as no curve evaluation is necessary.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

11C-MET:

L-[methyl-11C]-methionine

18F-FDOPA:

3,4-dihydroxy-6-[18F]fluoro-L-phenylalanine

18F-FET:

O-(2-18F-fluoroethyl)-L-tyrosine

AUC:

Area under receiver-operating-characteristic curve

HGG:

High-grade glioma

LGG:

Low-grade glioma

OP-OSEM:

Ordinary Poisson ordered subset expectation maximisation

OSEM:

Ordered subset expectation maximisation

ROC:

Receiver-operating-characteristic

SUV:

Standardised uptake value

SUVmean :

Mean standardised uptake value

TAC:

Time-activity curve

TBR:

Tumour-to-brain ratio

TBRmean :

Mean tumour-to-brain ratio

TTP:

Time to peak

VOI:

Volume-of-interest

References

  1. Herholz K, Langen KJ, Schiepers C, Mountz JM (2012) Brain tumors. Semin Nucl Med 42:356–370

    Article  PubMed Central  PubMed  Google Scholar 

  2. Heiss WD (2014) Clinical impact of amino acid PET in gliomas. J Nucl Med 55:1831–1841

    Article  CAS  PubMed  Google Scholar 

  3. Langen KJ, Hamacher K, Weckesser M, Floeth F, Stoffels G, Bauer D et al (2006) O-(2-[18F]fluoroethyl)-L-tyrosine: uptake mechanisms and clinical applications. Nucl Med Biol 33:287–294

    Article  CAS  PubMed  Google Scholar 

  4. McConathy J, Yu W, Jarkas N, Seo W, Schuster DM, Goodman MM (2012) Radiohalogenated nonnatural amino acids as PET and SPECT tumor imaging agents. Med Res Rev 32:868–905

    Article  CAS  PubMed  Google Scholar 

  5. Wester HJ, Herz M, Weber W, Heiss P, Senekowitsch-Schmidtke R, Schwaiger M et al (1999) Synthesis and radiopharmacology of O-(2-[18F]fluoroethyl)-L-tyrosine for tumor imaging. J Nucl Med 40:205–212

    CAS  PubMed  Google Scholar 

  6. Swiss Agency for Therapeutic Products (2014) J Swissmedic 13:651

    Google Scholar 

  7. Dunet V, Rossier C, Buck A, Stupp R, Prior JO (2012) Performance of 18F-fluoro-ethyl-tyrosine (18F-FET) PET for the differential diagnosis of primary brain tumor: a systematic review and Metaanalysis. J Nucl Med 53:207–214

    Article  CAS  PubMed  Google Scholar 

  8. Galldiks N, Langen K, Holy R, Pinkawa M, Stoffels G, Nolte K et al (2012) Assessment of treatment response in patients with glioblastoma using [18F]Fluoroethyl-L-Tyrosine PET in comparison to MRI. J Nucl Med 53:1048–1057

    Article  CAS  PubMed  Google Scholar 

  9. Pauleit D, Floeth F, Hamacher K, Riemenschneider MJ, Reifenberger G, Muller HW et al (2005) O-(2-[18F]fluoroethyl)-L-tyrosine PET combined with MRI improves the diagnostic assessment of cerebral gliomas. Brain 128:678–687

    Article  PubMed  Google Scholar 

  10. Pauleit D, Stoffels G, Bachofner A, Floeth FW, Sabel M, Herzog H et al (2009) Comparison of (18)F-FET and (18)F-FDG PET in brain tumors. Nucl Med Biol 36:779–787

    Article  CAS  PubMed  Google Scholar 

  11. Pöpperl G, Gotz C, Rachinger W, Gildehaus FJ, Tonn JC, Tatsch K (2004) Value of O-(2-[18F]fluoroethyl)- L-tyrosine PET for the diagnosis of recurrent glioma. Eur J Nucl Med Mol Imaging 31:1464–1470

  12. Kratochwil C, Combs SE, Leotta K, Afshar-Oromieh A, Rieken S, Debus J et al (2014) Intra-individual comparison of (1)(8)F-FET and (1)(8)F-DOPA in PET imaging of recurrent brain tumors. Neuro Oncol 16:434–440

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Moulin-Romsee G, D'Hondt E, de Groot T, Goffin J, Sciot R, Mortelmans L et al (2007) Non-invasive grading of brain tumours using dynamic amino acid PET imaging: does it work for 11C-methionine? Eur J Nucl Med Mol Imaging 34:2082–2087

    Article  PubMed  Google Scholar 

  14. Weckesser M, Langen KJ, Rickert CH, Kloska S, Straeter R, Hamacher K et al (2005) O-(2-[18F]fluorethyl)-L-tyrosine PET in the clinical evaluation of primary brain tumours. Eur J Nucl Med Mol Imaging 32:422–429

    Article  CAS  PubMed  Google Scholar 

  15. Paulus W, Peiffer J (1989) Intratumoral histologic heterogeneity of gliomas. A quantitative study. Cancer 64:442–447

    Article  CAS  PubMed  Google Scholar 

  16. Kunz M, Thon N, Eigenbrod S, Hartmann C, Egensperger R, Herms J et al (2011) Hot spots in dynamic (18)FET-PET delineate malignant tumor parts within suspected WHO grade II gliomas. Neuro Oncol 13:307–316

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Hamacher K, Coenen HH (2002) Efficient routine production of the 18F-labelled amino acid O-2-18F fluoroethyl-L-tyrosine. Appl Radiat Isot 57:853–856

    Article  CAS  PubMed  Google Scholar 

  18. Langen KJ, Bartenstein P, Boecker H, Brust P, Coenen HH, Drzezga A et al (2011) [German guidelines for brain tumour imaging by PET and SPECT using labelled amino acids]. Nuklearmedizin 50:167–173

    Article  PubMed  Google Scholar 

  19. Herzog H, Langen KJ, Weirich C, Rota Kops E, Kaffanke J, Tellmann L et al (2011) High resolution BrainPET combined with simultaneous MRI. Nuklearmedizin 50:74–82

    Article  CAS  PubMed  Google Scholar 

  20. Calcagni ML, Galli G, Giordano A, Taralli S, Anile C, Niesen A et al (2011) Dynamic O-(2-[18F]fluoroethyl)-L-tyrosine (F-18 FET) PET for glioma grading: assessment of individual probability of malignancy. Clin Nucl Med 36:841–847

    Article  PubMed  Google Scholar 

  21. Kim DW, Jung SA, Kim CG, Park SA (2010) The efficacy of dual time point F-18 FDG PET imaging for grading of brain tumors. Clin Nucl Med 35:400–403

    Article  PubMed  Google Scholar 

  22. Prieto E, Marti-Climent JM, Dominguez-Prado I, Garrastachu P, Diez-Valle R, Tejada S et al (2011) Voxel-based analysis of dual-time-point 18F-FDG PET images for brain tumor identification and delineation. J Nucl Med 52:865–872

    Article  PubMed  Google Scholar 

  23. Pöpperl G, Kreth FW, Herms J, Koch W, Mehrkens JH, Gildehaus FJ et al (2006) Analysis of 18F-FET PET for grading of recurrent gliomas: is evaluation of uptake kinetics superior to standard methods? J Nucl Med 47:393–403

    PubMed  Google Scholar 

  24. Pöpperl G, Kreth FW, Mehrkens JH, Herms J, Seelos K, Koch W et al (2007) FET PET for the evaluation of untreated gliomas: correlation of FET uptake and uptake kinetics with tumour grading. Eur J Nucl Med Mol Imaging 34:1933–1942

    Article  PubMed  Google Scholar 

  25. Jansen NL, Graute V, Armbruster L, Suchorska B, Lutz J, Eigenbrod S et al (2012) MRI-suspected low-grade glioma: is there a need to perform dynamic FET PET? Eur J Nucl Med Mol Imaging 39:1021–1029

    Article  CAS  PubMed  Google Scholar 

  26. Galldiks N, Stoffels G, Filss CP, Piroth MD, Sabel M, Ruge MI et al (2012) Role of O-(2-18F-Fluoroethyl)-L-Tyrosine PET for Differentiation of Local Recurrent Brain Metastasis from Radiation Necrosis. J Nucl Med 53:1367–1374

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Suzanne Schaden, Elisabeth Theelen and Kornelia Frey for assistance in the patient studies; and Johannes Ermert, Silke Grafmüller, Erika Wabbals and Sascha Rehbein for radiosynthesis of 18F-FET. The scientific guarantor of this publication is Prof. Dr. Karl-Josef Langen. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic study, performed at one institution.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Karl-Josef Langen.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOC 52.5 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lohmann, P., Herzog, H., Rota Kops, E. et al. Dual-time-point O-(2-[18F]fluoroethyl)-L-tyrosine PET for grading of cerebral gliomas. Eur Radiol 25, 3017–3024 (2015). https://doi.org/10.1007/s00330-015-3691-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-015-3691-6

Keywords

Navigation