3,4-Dihydroxy-6-[18F]-Fluoro-L-Phenylalanine Positron Emission Tomography in Patients With Central Motor Disorders and in Evaluation of Brain and Other Tumors

https://doi.org/10.1053/j.semnuclmed.2007.08.002Get rights and content

The use of 3,4-dihydroxy-6-[18F]-fluoro-L-phenylalanine (18F-FDOPA) with positron emission tomography initially centered on studying central motor disorders and evaluating patients with Parkinsonian symptoms, based on its uptake into presynaptic dopaminergic terminals in the putamen and caudate nuclei of the brain. The roles of this tracer have since expanded to include monitoring disease progression, potentially contributing to drug development, and even questioning the current gold standard for making the diagnosis of Parkinson’s disease. As with some other amino acids, 18F-FDOPA has also been effective for visualizing brain tumors, either at time of diagnosis or when monitoring for recurrence, with high sensitivity and overall accuracy. 18F-FDOPA may be especially useful for imaging patients with low-grade gliomas, as well in the evaluation of patients with neuroendocrine tumors such as carcinoid and pheochromocytoma, in which its role as a precursor for amine neurotransmitter/neurohormones serves as a basis for its differential uptake.

Section snippets

Pathophysiology and Treatment of Movement Disorders

In the nearly 200 years since the first modern clinical description of the spectrum of bradykinesia, tremor, and gait disturbance by James Parkinson, there has been tremendous progress in the understanding and clinical management of movement disorders.4 Neuroimaging methods, especially positron emission tomography (PET) and single-photon emission computed tomography (SPECT), have now assumed an important role in the refinement in understanding of differential diagnosis and clinical course by

18F-FDOPA in the Evaluation of Brain Tumors

Malignant brain tumors are a heterogeneous group of diseases, each with its own biology, prognosis, and treatment. The most common tumor types are metastatic tumors and malignant gliomas. In 2005, American Cancer Society estimated that primary brain tumor was the cause of death in approximately 12,760 people. Metastatic tumors are more common in that more than 100,000 people die per year with symptomatic intracranial metastases.57 The initial presentation and diagnostic approaches are similar

Other Tumors

In addition to the roles 18F-FDOPA PET has played in the evaluation of patients with central motor disorders and brain tumors, a growing literature has focused on the potential utility of imaging with 18F-FDOPA in the assessment of a number of conditions in which neuroendocrine tumors are suspected or known to be involved.

The neuroendocrine condition for which the role of 18F-FDOPA PET has been most extensively documented is carcinoid. For example, in a recent prospective study of the

Conclusions

The rapid elaboration of imaging biomarkers for PET and SPECT has resulted in significant changes in the potential approach to diagnosis and symptom management in the movement disorders, especially PD. The proliferation of readily available radiopharmaceuticals for assessing dopamine deficits raises the possibility of earlier and more accurate diagnosis with an algorithm which includes a rule-in diagnostic imaging examination, though there remain significant unanswered questions with regard to

Acknowledgment

We are indebted to Victoria Lau for her skillful assistance with manuscript preparation.

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