Abstract
PET using O-(2-F-18-fluoroethyl)-L-tyrosine (F-18-FET) is useful to detect residual tumor tissue after glioma resection. Recent animal experiments detected reactive changes in F-18-FET uptake at the rim of the resection cavity within the first 2 wk after resection of gliomas. In the present study, we evaluated pre- and postoperative F-18-FET PET scans of glioma patients with particular emphasis on the identification of reactive changes after surgery. Methods: Forty-three patients with cerebral gliomas (9 low-grade, 34 high-grade; 9 primary tumors, 34 recurrent tumors) who had preoperative (time before surgery: median, 23 d; range, 6-44 d) and postoperative F-18-FET PET (time after surgery: median, 14 d; range, 5-28 d) were included. PET scans (20-40 min after injection) were evaluated visually for complete or incomplete resection and compared with MRI. Changes in F-18-FET uptake were evaluated by tumor-to-brain ratios in residual tumor and by maximum lesion-to-brain ratios near the resection cavity. Results: Visual analysis of F-18-FET PET scans revealed complete resection in 16 of 43 patients and incomplete resection in the remaining patients. PET results were concordant with MRI in 69% of the patients. The maximum lesion-to-brain ratio for F-18-FET uptake near the resection cavity was significantly higher than preoperative values (1.59 +/- 0.36 vs. 1.14 +/- 0.17; n = 43; P <0.001). In 11 patients (26%), a flare phenomenon was observed, with a considerable increase in F-18-FET uptake compared with preoperative values in either the residual tumor (n = 5) or areas remote from the tumor on the preoperative PET scan (n = 6) (2.92 +/- 1.24 vs. 1.62 +/- 0.75; P <0.001). Further follow-up in 5 patients showed decreasing F-18-FET uptake in the flare areas in 4 patients and progress in 1 patient. Conclusion: Our study confirmed that F-18-FET PET provides valuable information for assessing the success of glioma resection. Postoperative reactive changes at the rim of the resection cavity appear to be mild. However, in 23% of the patients, a postoperative flare phenomenon was observed that warrants further investigation.
Original language | English |
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Pages (from-to) | 1294-1299 |
Number of pages | 6 |
Journal | Journal of Nuclear Medicine |
Volume | 61 |
Issue number | 9 |
DOIs | |
Publication status | Published - 1 Sept 2020 |
Keywords
- brain tumor surgery
- amino acid PET
- FET
- treatment-related changes
- extent of resection
- POSITRON-EMISSION-TOMOGRAPHY
- TUMOR
- DIAGNOSIS
- SURVIVAL
- SURGERY
- EXTENT