Dynamic O-(2-18F-fluoroethyl)-L-tyrosine positron emission tomography differentiates brain metastasis recurrence from radiation injury after radiotherapy

Garry Ceccon; Philipp Lohmann; Gabriele Stoffels; Natalie Judov; Christian P Filss; Marion Rapp; Elena Bauer; Christina Hamisch; Maximilian I Ruge; Martin Kocher; Klaus Kuchelmeister; Bernd Sellhaus; Michael Sabel; Gereon R Fink; Nadim J Shah; Karl-Josef Langen; Norbert Galldiks

doi:10.1093/neuonc/now149

Dynamic O-(2-18F-fluoroethyl)-L-tyrosine positron emission tomography differentiates brain metastasis recurrence from radiation injury after radiotherapy

Garry Ceccon, Philipp Lohmann, Gabriele Stoffels, Natalie Judov, Christian P Filss, Marion Rapp, Elena Bauer, Christina Hamisch, Maximilian I Ruge, Martin Kocher, Klaus Kuchelmeister, Bernd Sellhaus, Michael Sabel, Gereon R Fink, Nadim J Shah, Karl-Josef Langen, Norbert Galldiks^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: The aim of this study was to investigate the potential of dynamic O-(2-[(18)F]fluoroethyl)-L-tyrosine ((18)F-FET) PET for differentiating local recurrent brain metastasis from radiation injury after radiotherapy since contrast-enhanced MRI often remains inconclusive.

METHODS: Sixty-two patients (mean age, 55 ± 11 y) with single or multiple contrast-enhancing brain lesions (n = 76) on MRI after radiotherapy of brain metastases (predominantly stereotactic radiosurgery) were investigated with dynamic (18)F-FET PET. Maximum and mean tumor-to-brain ratios (TBRmax, TBRmean) of (18)F-FET uptake were determined (20-40 min postinjection) as well as tracer uptake kinetics (ie, time-to-peak and slope of time-activity curves). Diagnoses were confirmed histologically (34%; 26 lesions in 25 patients) or by clinical follow-up (66%; 50 lesions in 37 patients). Diagnostic accuracies of PET parameters for the correct identification of recurrent brain metastasis were evaluated by receiver-operating-characteristic analyses or the chi-square test.

RESULTS: TBRs were significantly higher in recurrent metastases (n = 36) than in radiation injuries (n = 40) (TBRmax 3.3 ± 1.0 vs 2.2 ± 0.4, P < .001; TBRmean 2.2 ± 0.4 vs 1.7 ± 0.3, P < .001). The highest accuracy (88%) for diagnosing local recurrent metastasis could be obtained with TBRs in combination with the slope of time-activity curves (P < .001).

CONCLUSIONS: The results of this study confirm previous preliminary observations that the combined evaluation of the TBRs of (18)F-FET uptake and the slope of time-activity curves can differentiate local brain metastasis recurrence from radiation-induced changes with high accuracy. (18)F-FET PET may thus contribute significantly to the management of patients with brain metastases.

Original language	English
Pages (from-to)	281-288
Number of pages	8
Journal	Neuro-oncology
Volume	19
Issue number	2
DOIs	https://doi.org/10.1093/neuonc/now149
Publication status	Published - Feb 2017

Keywords

FET PET
kinetic analysis
radiation-induced changes
radionecrosis
stereotactic radiosurgery
LOW-GRADE GLIOMA
STEREOTACTIC RADIOSURGERY
F-18-FET PET
O-(2-F-18-FLUOROETHYL)-L-TYROSINE PET
TUMOR RECURRENCE
IMAGING CHANGES
UPTAKE KINETICS
NECROSIS
DIAGNOSIS

Access to Document

10.1093/neuonc/now149

Cite this

Ceccon, G., Lohmann, P., Stoffels, G., Judov, N., Filss, C. P., Rapp, M., Bauer, E., Hamisch, C., Ruge, M. I., Kocher, M., Kuchelmeister, K., Sellhaus, B., Sabel, M., Fink, G. R., Shah, N. J., Langen, K.-J., & Galldiks, N. (2017). Dynamic O-(2-18F-fluoroethyl)-L-tyrosine positron emission tomography differentiates brain metastasis recurrence from radiation injury after radiotherapy. Neuro-oncology, 19(2), 281-288. https://doi.org/10.1093/neuonc/now149

@article{4d52575e29414fd09c4c117469a03c8f,

title = "Dynamic O-(2-18F-fluoroethyl)-L-tyrosine positron emission tomography differentiates brain metastasis recurrence from radiation injury after radiotherapy",

abstract = "BACKGROUND: The aim of this study was to investigate the potential of dynamic O-(2-[(18)F]fluoroethyl)-L-tyrosine ((18)F-FET) PET for differentiating local recurrent brain metastasis from radiation injury after radiotherapy since contrast-enhanced MRI often remains inconclusive.METHODS: Sixty-two patients (mean age, 55 ± 11 y) with single or multiple contrast-enhancing brain lesions (n = 76) on MRI after radiotherapy of brain metastases (predominantly stereotactic radiosurgery) were investigated with dynamic (18)F-FET PET. Maximum and mean tumor-to-brain ratios (TBRmax, TBRmean) of (18)F-FET uptake were determined (20-40 min postinjection) as well as tracer uptake kinetics (ie, time-to-peak and slope of time-activity curves). Diagnoses were confirmed histologically (34%; 26 lesions in 25 patients) or by clinical follow-up (66%; 50 lesions in 37 patients). Diagnostic accuracies of PET parameters for the correct identification of recurrent brain metastasis were evaluated by receiver-operating-characteristic analyses or the chi-square test.RESULTS: TBRs were significantly higher in recurrent metastases (n = 36) than in radiation injuries (n = 40) (TBRmax 3.3 ± 1.0 vs 2.2 ± 0.4, P < .001; TBRmean 2.2 ± 0.4 vs 1.7 ± 0.3, P < .001). The highest accuracy (88%) for diagnosing local recurrent metastasis could be obtained with TBRs in combination with the slope of time-activity curves (P < .001).CONCLUSIONS: The results of this study confirm previous preliminary observations that the combined evaluation of the TBRs of (18)F-FET uptake and the slope of time-activity curves can differentiate local brain metastasis recurrence from radiation-induced changes with high accuracy. (18)F-FET PET may thus contribute significantly to the management of patients with brain metastases.",

keywords = "FET PET, kinetic analysis, radiation-induced changes, radionecrosis, stereotactic radiosurgery, LOW-GRADE GLIOMA, STEREOTACTIC RADIOSURGERY, F-18-FET PET, O-(2-F-18-FLUOROETHYL)-L-TYROSINE PET, TUMOR RECURRENCE, IMAGING CHANGES, UPTAKE KINETICS, NECROSIS, DIAGNOSIS",

author = "Garry Ceccon and Philipp Lohmann and Gabriele Stoffels and Natalie Judov and Filss, {Christian P} and Marion Rapp and Elena Bauer and Christina Hamisch and Ruge, {Maximilian I} and Martin Kocher and Klaus Kuchelmeister and Bernd Sellhaus and Michael Sabel and Fink, {Gereon R} and Shah, {Nadim J} and Karl-Josef Langen and Norbert Galldiks",

year = "2017",

month = feb,

doi = "10.1093/neuonc/now149",

language = "English",

volume = "19",

pages = "281--288",

journal = "Neuro-oncology",

issn = "1522-8517",

publisher = "Oxford University Press",

number = "2",

}

Ceccon, G, Lohmann, P, Stoffels, G, Judov, N, Filss, CP, Rapp, M, Bauer, E, Hamisch, C, Ruge, MI, Kocher, M, Kuchelmeister, K, Sellhaus, B, Sabel, M, Fink, GR, Shah, NJ, Langen, K-J & Galldiks, N 2017, 'Dynamic O-(2-18F-fluoroethyl)-L-tyrosine positron emission tomography differentiates brain metastasis recurrence from radiation injury after radiotherapy', Neuro-oncology, vol. 19, no. 2, pp. 281-288. https://doi.org/10.1093/neuonc/now149

TY - JOUR

T1 - Dynamic O-(2-18F-fluoroethyl)-L-tyrosine positron emission tomography differentiates brain metastasis recurrence from radiation injury after radiotherapy

AU - Ceccon, Garry

AU - Lohmann, Philipp

AU - Stoffels, Gabriele

AU - Judov, Natalie

AU - Filss, Christian P

AU - Rapp, Marion

AU - Bauer, Elena

AU - Hamisch, Christina

AU - Ruge, Maximilian I

AU - Kocher, Martin

AU - Kuchelmeister, Klaus

AU - Sellhaus, Bernd

AU - Sabel, Michael

AU - Fink, Gereon R

AU - Shah, Nadim J

AU - Langen, Karl-Josef

AU - Galldiks, Norbert

PY - 2017/2

Y1 - 2017/2

N2 - BACKGROUND: The aim of this study was to investigate the potential of dynamic O-(2-[(18)F]fluoroethyl)-L-tyrosine ((18)F-FET) PET for differentiating local recurrent brain metastasis from radiation injury after radiotherapy since contrast-enhanced MRI often remains inconclusive.METHODS: Sixty-two patients (mean age, 55 ± 11 y) with single or multiple contrast-enhancing brain lesions (n = 76) on MRI after radiotherapy of brain metastases (predominantly stereotactic radiosurgery) were investigated with dynamic (18)F-FET PET. Maximum and mean tumor-to-brain ratios (TBRmax, TBRmean) of (18)F-FET uptake were determined (20-40 min postinjection) as well as tracer uptake kinetics (ie, time-to-peak and slope of time-activity curves). Diagnoses were confirmed histologically (34%; 26 lesions in 25 patients) or by clinical follow-up (66%; 50 lesions in 37 patients). Diagnostic accuracies of PET parameters for the correct identification of recurrent brain metastasis were evaluated by receiver-operating-characteristic analyses or the chi-square test.RESULTS: TBRs were significantly higher in recurrent metastases (n = 36) than in radiation injuries (n = 40) (TBRmax 3.3 ± 1.0 vs 2.2 ± 0.4, P < .001; TBRmean 2.2 ± 0.4 vs 1.7 ± 0.3, P < .001). The highest accuracy (88%) for diagnosing local recurrent metastasis could be obtained with TBRs in combination with the slope of time-activity curves (P < .001).CONCLUSIONS: The results of this study confirm previous preliminary observations that the combined evaluation of the TBRs of (18)F-FET uptake and the slope of time-activity curves can differentiate local brain metastasis recurrence from radiation-induced changes with high accuracy. (18)F-FET PET may thus contribute significantly to the management of patients with brain metastases.

AB - BACKGROUND: The aim of this study was to investigate the potential of dynamic O-(2-[(18)F]fluoroethyl)-L-tyrosine ((18)F-FET) PET for differentiating local recurrent brain metastasis from radiation injury after radiotherapy since contrast-enhanced MRI often remains inconclusive.METHODS: Sixty-two patients (mean age, 55 ± 11 y) with single or multiple contrast-enhancing brain lesions (n = 76) on MRI after radiotherapy of brain metastases (predominantly stereotactic radiosurgery) were investigated with dynamic (18)F-FET PET. Maximum and mean tumor-to-brain ratios (TBRmax, TBRmean) of (18)F-FET uptake were determined (20-40 min postinjection) as well as tracer uptake kinetics (ie, time-to-peak and slope of time-activity curves). Diagnoses were confirmed histologically (34%; 26 lesions in 25 patients) or by clinical follow-up (66%; 50 lesions in 37 patients). Diagnostic accuracies of PET parameters for the correct identification of recurrent brain metastasis were evaluated by receiver-operating-characteristic analyses or the chi-square test.RESULTS: TBRs were significantly higher in recurrent metastases (n = 36) than in radiation injuries (n = 40) (TBRmax 3.3 ± 1.0 vs 2.2 ± 0.4, P < .001; TBRmean 2.2 ± 0.4 vs 1.7 ± 0.3, P < .001). The highest accuracy (88%) for diagnosing local recurrent metastasis could be obtained with TBRs in combination with the slope of time-activity curves (P < .001).CONCLUSIONS: The results of this study confirm previous preliminary observations that the combined evaluation of the TBRs of (18)F-FET uptake and the slope of time-activity curves can differentiate local brain metastasis recurrence from radiation-induced changes with high accuracy. (18)F-FET PET may thus contribute significantly to the management of patients with brain metastases.

KW - FET PET

KW - kinetic analysis

KW - radiation-induced changes

KW - radionecrosis

KW - stereotactic radiosurgery

KW - LOW-GRADE GLIOMA

KW - STEREOTACTIC RADIOSURGERY

KW - F-18-FET PET

KW - O-(2-F-18-FLUOROETHYL)-L-TYROSINE PET

KW - TUMOR RECURRENCE

KW - IMAGING CHANGES

KW - UPTAKE KINETICS

KW - NECROSIS

KW - DIAGNOSIS

U2 - 10.1093/neuonc/now149

DO - 10.1093/neuonc/now149

M3 - Article

C2 - 27471107

SN - 1522-8517

VL - 19

SP - 281

EP - 288

JO - Neuro-oncology

JF - Neuro-oncology

IS - 2

ER -

Dynamic O-(2-18F-fluoroethyl)-L-tyrosine positron emission tomography differentiates brain metastasis recurrence from radiation injury after radiotherapy

Abstract

Keywords

Access to Document

Fingerprint

Cite this