scholarly journals Negative 18F-FET PET/CT in brain metastasis recurrence: a teaching case report

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Samirah Alshehri ◽  
John Prior ◽  
Mohammed Moshebah ◽  
Luis Schiappacasse ◽  
Vincent Dunet
Keyword(s):  
Brain Metastasis ◽  
Radiation Necrosis ◽  
Brain Mri ◽  
False Negative ◽  
Therapy Outcomes ◽  
Fet Pet ◽  
Positron Emission ◽  
Pet Ct ◽  
Magnetic Resonance Imaging Mri

AbstractPositron emission tomography (PET) using O-(2-[18F]fluoroethyl)-L-tyrosine (18F-FET) PET has been shown to be a useful tool for differentiating radiation therapy outcomes, such as brain metastasis recurrence or radiation necrosis. We present the case of a female patient with brain metastases from pulmonary mucinous adenocarcinoma with suspicion of tumor recurrence on follow-up magnetic resonance imaging (MRI) after radiosurgery. 18F-FET PET/computed tomography (CT) was indicative of radiation necrosis. Due to the patient's medical history and the discrepancy between the brain MRI and PET/CT results, surgical biopsies were decided, which were positive for brain metastasis recurrence. The diagnosis of metastasis recurrence may also be challenging on 18F-FET PET/CT. In case of discrepancies between MRI and PET/CT results, false-negative 18F-FET PET/CT remains a possibility and requires careful follow-up or biopsy.

scholarly journals Negative 18F-FET PET/CT in Brain Metastasis Recurrence: a Teaching Case Report.

2021 ◽  
Author(s):  
Samirah Alshehri ◽  
John Prior ◽  
Mohammed Moshebah ◽  
Luis Schiappacasse ◽  
Vincent Dunet
Keyword(s):  
Positron Emission Tomography ◽  
Brain Metastasis ◽  
Radiation Necrosis ◽  
Brain Mri ◽  
False Negative ◽  
Emission Tomography ◽  
Fet Pet ◽  
Positron Emission ◽  
Pet Ct

Abstract Positron emission tomography (PET) using O-(2-[18F]fluoroethyl)-L-tyrosine (18F-FET) positron emission tomography (PET) has been shown to be a useful tool for differentiating radiation therapy outcomes either brain metastasis recurrence or radiation necrosis. We present the case of a female with known metastatic brain lesion with suspicion of tumor recurrence on follow-up MRI 16 months after radiosurgery. 18F-FET PET was indicative of radiation necrosis. Due to the patient's medical history, the discrepancy between brain MRI and the PET/CT results, surgical biopsies were decided, which were positive for brain metastasis recurrence. Diagnosis of metastasis recurrence may be challenging also on 18F-FET PET/CT. In case of discrepancies between MRI and PET/CT results, false-negative 18F-FET PET/CT is still possible and should lead to careful follow-up or biopsy.

Comparison Between 18F-Dopa and 18F-Fet PET/CT in Patients with Suspicious Recurrent High Grade Glioma: A Literature Review and Our Experience

2019 ◽  
Vol 12 (3) ◽  
pp. 220-228 ◽  
Author(s):  
Laura Evangelista ◽  
Lea Cuppari ◽  
Luisa Bellu ◽  
Daniele Bertin ◽  
Mario Caccese ◽  
...  
Keyword(s):  
Case Series ◽  
High Grade Glioma ◽  
High Grade ◽  
True Negative ◽  
Fet Pet ◽  
Positron Emission ◽  
Pet Ct ◽  
Magnetic Resonance Imaging Mri ◽  
Definition Of ◽  
Sensitivity Specificity

Purpose: The aims of the present study were to: 1- critically assess the utility of L-3,4- dihydroxy-6-18Ffluoro-phenyl-alanine (18F-DOPA) and O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) Positron Emission Tomography (PET)/Computed Tomography (CT) in patients with high grade glioma (HGG) and 2- describe the results of 18F-DOPA and 18F-FET PET/CT in a case series of patients with recurrent HGG. Methods: We searched for studies using the following databases: PubMed, Web of Science and Scopus. The search terms were: glioma OR brain neoplasm and DOPA OR DOPA PET OR DOPA PET/CT and FET OR FET PET OR FET PET/CT. From a mono-institutional database, we retrospectively analyzed the 18F-DOPA and 18F-FET PET/CT of 29 patients (age: 56 ± 12 years) with suspicious for recurrent HGG. All patients underwent 18F-DOPA or 18F-FET PET/CT for a multidisciplinary decision. The final definition of recurrence was made by magnetic resonance imaging (MRI) and/or multidisciplinary decision, mainly based on the clinical data. Results: Fifty-one articles were found, of which 49 were discarded, therefore 2 studies were finally selected. In both the studies, 18F-DOPA and 18F-FET as exchangeable in clinical practice particularly for HGG patients. From our institutional experience, in 29 patients, we found that sensitivity, specificity and accuracy of 18F-DOPA PET/CT in HGG were 100% (95% confidence interval- 95%CI - 81-100%), 63% (95%CI: 39-82%) and 62% (95%CI: 39-81%), respectively. 18F-FET PET/CT was true positive in 4 and true negative in 4 patients. Sensitivity, specificity and accuracy for 18F-FET PET/CT in HGG were 100%. Conclusion: 18F-DOPA and 18F-FET PET/CT have a similar diagnostic accuracy in patients with recurrent HGG. However, 18F-DOPA PET/CT could be affected by inflammation conditions (false positive) that can alter the final results. Large comparative trials are warranted in order to better understand the utility of 18F-DOPA or 18F-FET PET/CT in patients with HGG.

Radiology of the head and neck

2021 ◽  
pp. 973-976
Author(s):  
Ivan Zammit-Maempel
Keyword(s):  
Head And Neck ◽  
Imaging Techniques ◽  
Cone Beam Ct ◽  
Neck Mass ◽  
Positron Emission ◽  
Pet Ct ◽  
Magnetic Resonance Imaging Mri ◽  
Video Fluoroscopy

Various imaging techniques are used in the staging and follow-up of head and neck cancer and evaluating patients presenting with a neck mass. The workhorses in imaging the neck are ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) with positron emission tomography CT (PET-CT) increasingly being requested. Plain radiographs, contrast studies, video fluoroscopy, angiography, and cone beam CT have limited but important roles. This chapter discusses the role of some of these modalities.

scholarly journals CMET-37. CLINICAL UTILITY OF ENCYCLOPEDIC TUMOR ANALYSIS TO TREAT PATIENTS WITH BRAIN METASTASIS IN REFRACTORY CANCERS

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi59-vi60
Author(s):  
Timothy Crook ◽  
Darshana Patil ◽  
Dadasaheb Akolkar ◽  
Anantbhushan Ranade ◽  
Amit Bhatt ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Treatment Options ◽  
Brain Mri ◽  
Gene Mutations ◽  
Solid Organ ◽  
Pet Ct ◽  
The Impact

Abstract Brain metastasis in solid organ cancers is associated with adverse prognosis, which is further aggravated by limited systemic treatment options. Such patients are also often excluded from clinical trials since their poor prognosis is perceived to unfavorably impact trial outcomes and misrepresent efficacy data. We retrospectively evaluated the efficacy of treatment guided by Encyclopedic Tumor Analysis (ETA) in patients with advanced refractory malignancies and brain metastases to determine the impact on outcomes. Freshly biopsied tumor tissue (primary / lymph node / liver) and peripheral blood of patients were used for integrational multi-analyte investigations as part of ETA, which included gene mutations, gene expression, and in vitro chemosensitivity profiling of viable tumor cells. Based on ETA, patients received individualized therapy recommendations. All patients underwent a PET-CT scan as well as MRI scan prior to treatment start to determine extent of disease. All patients underwent follow-up PET-CT scans and brain MRI scans every 6–8 weeks. Of the ten patients with brain metastases, which were evaluated after receiving ETA-guided treatment, the median follow-up duration was 97 days (range 79 – 180 days) during which all ten patients remained progression-free. Median time to progression for these patients on the last (failed) line of treatment was 91 days (range 30 - 176 days). Five patients showed partial response and five patients showed stable disease while on ETA-guided treatment. During the follow-up period, all brain metastases were either stable (n=7) or had regressed (n=3), and none of the patients reported new brain lesions. Personalized ETA guided treatments imparted clinical benefit by halting disease progression in this cohort of high-risk patients who would have otherwise been considered for palliative regimens due to perceived unfavorable prognosis.

scholarly journals [18F]FET PET Uptake Indicates High Tumor and Low Necrosis Content in Brain Metastasis

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 355
Author(s):  
Hanno S. Meyer ◽  
Friederike Liesche-Starnecker ◽  
Mona Mustafa ◽  
Igor Yakushev ◽  
Benedikt Wiestler ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Proliferation Index ◽  
Fet Pet ◽  
Positron Emission ◽  
Multiple Biopsies ◽  
Increased Sensitivity ◽  
Magnetic Resonance Imaging Mri ◽  
Negative Tumor ◽  
Relationship Of

Amino acid positron emission tomography (PET) has been employed in the management of brain metastases. Yet, histopathological correlates of PET findings remain poorly understood. We investigated the relationship of O-(2-[18F]Fluoroethyl)-L-tyrosine ([18F]FET) PET, magnetic resonance imaging (MRI), and histology in brain metastases. Fifteen patients undergoing brain metastasis resection were included prospectively. Using intraoperative navigation, 39 targeted biopsies were obtained from parts of the metastases that were either PET-positive or negative and MRI-positive or negative. Tumor and necrosis content, proliferation index, lymphocyte infiltration, and vascularization were determined histopathologically. [18F]FET PET had higher specificity than MRI (66% vs. 56%) and increased sensitivity for tumor from 73% to 93% when combined with MRI. Tumor content per sample increased with PET uptake (rs = 0.3, p = 0.045), whereas necrosis content decreased (rs = −0.4, p = 0.014). PET-positive samples had more tumor (median: 75%; interquartile range: 10–97%; p = 0.016) than PET-negative samples. The other investigated histological properties were not correlated with [18F]FET PET intensity. Tumors were heterogeneous at the levels of imaging and histology. [18F]FET PET can be a valuable tool in the management of brain metastases. In biopsies, one should aim for PET hotspots to increase the chance for retrieval of samples with high tumor cell concentrations. Multiple biopsies should be performed to account for intra-tumor heterogeneity. PET could be useful for differentiating treatment-related changes (e.g., radiation necrosis) from tumor recurrence.

scholarly journals Adrenal Hemangioma: A Case of Retroperitoneal Tumor

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Genta Iwamoto ◽  
Kota Shimokihara ◽  
Takashi Kawahara ◽  
Daiji Takamoto ◽  
Masahiro Yao ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Retroperitoneal Tumor ◽  
Histopathological Analysis ◽  
Small Vessels ◽  
Positron Emission ◽  
Pet Ct ◽  
Slight Elevation ◽  
Magnetic Resonance Imaging Mri ◽  
Almost All

Introduction. Adrenal hemangioma is a rare disease, with only some 60 cases reported previously. Due to the difficulty of the preoperative diagnosis of adrenal hemangioma, almost all of the cases were diagnosed by a histopathological analysis of surgical specimens. Case Presentation. A 52-year-old man was referred to our department for further examination of his left retroperitoneal tumor. He had received hemodialysis due to chronic renal failure resulting from membranous nephropathy. Computed tomography revealed a mass around his left hilum. Magnetic resonance imaging (MRI) and positron-emission tomography (PET)-CT were unable to confirm or deny malignancy, and tumor markers, including CEA and CA19-9, showed slight elevation. His tumor grew from 38 mm to 54 mm in diameter in 7 months of follow-up. We therefore planned retroperitoneal tumor resection with left nephrectomy. Histopathologically, hyperplastic small vessels with hemorrhaging and denaturation were seen. The endothelial cells showed no variants or division of the nucleus. Based on this diagnosis, no further therapy was performed. He has had no recurrence in the eight months since the surgery. Conclusion. We herein report a rare case of adrenal hemangioma.

NIMG-02. 18F-FLUCICLOVINE POSITRON EMISSION TOMOGRAPHY TO DISTINGUISH TUMOR PROGRESSION FROM RADIATION NECROSIS FOLLOWING STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASIS: A QUALITATIVE ANALYSIS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi127-vi127
Author(s):  
Timothy Smile ◽  
Martin Tom ◽  
Nancy Obuchowski ◽  
Frank DiFilippo ◽  
Stephen Jones ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Radiation Necrosis ◽  
Brain Mri ◽  
Final Diagnosis ◽  
Blood Pool ◽  
Tumor Board ◽  
Visual Score ◽  
Pet Ct

Abstract PURPOSE/OBJECTIVE(S) To assess the ability of 18F-Fluciclovine PET/CT to distinguish radiation necrosis (RN) from tumor progression (TP) among patients with brain metastases (BM) treated with stereotactic radiosurgery (SRS) in a prospective pilot study. MATERIALS/METHODS Adults with post-SRS BM presenting with follow-up brain MRI equivocal for RN versus TP underwent 18F-Fluciclovine PET/CT within 30 days of equivocal MRI. PET images were reconstructed using a point-spread-function algorithm. Three physician reviewers independently performed qualitative analyses of each lesion using a three-point visual score relative to PET-avidity of blood pool and parotid. Quantitative metrics for each lesion were documented. Reference standard was clinical follow-up with brain MRI until tumor board consensus or tissue confirmation. Nonparametric estimates of area under the receiver operating characteristic curve (AUC) for clustered data were estimated, with diagnostic performance based on visual score. RESULTS In 15 subjects with 20 lesions, final diagnosis was RN in 16 (80%) lesions and TP in 4 (20%). Visual score significantly correlated with final diagnosis (AUC range 0.836-0.906 [p≤0.037]). A threshold score of 2 (lesion 18F-fluciclovine uptake above blood pool to parotid) and higher produced sensitivities and specificities of 75-100% and 38-56% respectively among the reviewer majority. Conversely, a threshold of 3 (uptake higher than parotid) produced sensitivities and specificities of 50-75% and 100% respectively. CONCLUSION In this prospective pilot, basic visual analysis of 18F-Fluciclovine PET/CT provided high sensitivity and specificity in detection of TP in post-SRS BM based on different threshold scores, suggesting room for visual threshold optimization. A low TP event rate limited the ability to estimate sensitivity/specificity and to perform combined qualitative/quantitative analyses. Further study to refine interpretation criteria is ongoing.

Brain FDG PET for the Etiological Diagnosis of Clinically Uncertain Cognitive Impairment During Delirium in Remission

2020 ◽  
Vol 77 (4) ◽  
pp. 1609-1622
Author(s):  
Franziska Mathies ◽  
Catharina Lange ◽  
Anja Mäurer ◽  
Ivayla Apostolova ◽  
Susanne Klutmann ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Fdg Pet ◽  
False Negative ◽  
Ground Truth ◽  
Etiological Diagnosis ◽  
Geriatric Unit ◽  
Positron Emission ◽  
The Brain ◽  
Hospitalized Geriatric Patients

Background: Positron emission tomography (PET) of the brain with 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG) is widely used for the etiological diagnosis of clinically uncertain cognitive impairment (CUCI). Acute full-blown delirium can cause reversible alterations of FDG uptake that mimic neurodegenerative disease. Objective: This study tested whether delirium in remission affects the performance of FDG PET for differentiation between neurodegenerative and non-neurodegenerative etiology of CUCI. Methods: The study included 88 patients (82.0±5.7 y) with newly detected CUCI during hospitalization in a geriatric unit. Twenty-seven (31%) of the patients were diagnosed with delirium during their current hospital stay, which, however, at time of enrollment was in remission so that delirium was not considered the primary cause of the CUCI. Cases were categorized as neurodegenerative or non-neurodegenerative etiology based on visual inspection of FDG PET. The diagnosis at clinical follow-up after ≥12 months served as ground truth to evaluate the diagnostic performance of FDG PET. Results: FDG PET was categorized as neurodegenerative in 51 (58%) of the patients. Follow-up after 16±3 months was obtained in 68 (77%) of the patients. The clinical follow-up diagnosis confirmed the FDG PET-based categorization in 60 patients (88%, 4 false negative and 4 false positive cases with respect to detection of neurodegeneration). The fraction of correct PET-based categorization did not differ between patients with delirium in remission and patients without delirium (86% versus 89%, p = 0.666). Conclusion: Brain FDG PET is useful for the etiological diagnosis of CUCI in hospitalized geriatric patients, as well as in patients with delirium in remission.

Benefit of Static FET PET in Pretreated Pediatric Brain Tumor Patients with Equivocal Conventional MRI Results

2021 ◽  
Author(s):  
Frederik Grosse ◽  
Florian Wedel ◽  
Ulrich-Wilhelm Thomale ◽  
Ingo Steffen ◽  
Arend Koch ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Tumor Tissue ◽  
Pediatric Brain Tumor ◽  
Ct Scans ◽  
Tumor Patients ◽  
Fet Pet ◽  
Conventional Mri ◽  
Pet Ct ◽  
Pediatric Brain

Abstract Background MRI has shortcomings in differentiation between tumor tissue and post-therapeutic changes in pretreated brain tumor patients. Patients We assessed 22 static FET-PET/CT-scans of 17 pediatric patients (median age 12 years, range 2–16 years, ependymoma n=4, medulloblastoma n=4, low-grade glioma n=6, high-grade glioma n=3, germ cell tumor n=1, choroid plexus tumor n=1, median follow-up: 112 months) with multimodal treatment. Method FET-PET/CT-scans were analyzed visually by 3 independent nuclear medicine physicians. Additionally quantitative FET-Uptake for each lesion was determined by calculating standardized uptake values (SUVmaxT/SUVmeanB, SUVmeanT/SUVmeanB). Histology or clinical follow-up served as reference. Results Static FET-PET/CT reliably distinguished between tumor tissue and post-therapeutic changes in 16 out of 17 patients. It identified correctly vital tumor tissue in 13 patients and post-therapeutic changes in 3 patients. SUV-based analyses were less sensitive than visual analyses. Except from a choroid plexus carcinoma, all tumor entities showed increased FET-uptake. Discussion Our study comprises a limited number of patients but results corroborate the ability of FET to detect different brain tumor entities in pediatric patients and discriminate between residual/recurrent tumor and post-therapeutic changes. Conclusions We observed a clear benefit from additional static FET-PET/CT-scans when conventional MRI identified equivocal lesions in pretreated pediatric brain tumor patients. These results warrant prospective studies that should include dynamic scans.

scholarly journals 18F-Fluciclovine Positron Emission Tomography in Prostate Cancer: A Systematic Review and Diagnostic Meta-Analysis

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 304
Author(s):  
Giuseppina Biscontini ◽  
Cinzia Romagnolo ◽  
Chiara Cottignoli ◽  
Andrea Palucci ◽  
Fabio Massimo Fringuelli ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Meta Analysis ◽  
False Negative ◽  
Final Analysis ◽  
Emission Tomography ◽  
True Negative ◽  
Positron Emission ◽  
Pet Ct

Background: to explore the diagnostic accuracy of 18F-Fluciclovine positron-emission tomography (PET) in prostate cancer (PCa), considering both primary staging prior to radical therapy, biochemical recurrence, and advanced setting. Methods: A systematic web search through Embase and Medline was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies performed from 2011 to 2020 were evaluated. The terms used were “PET” or “positron emission tomography” or “positron emission tomography/computed tomography” or “PET/CT” or “positron emission tomography-computed tomography” or “PET-CT” and “Fluciclovine” or “FACBC” and “prostatic neoplasms” or “prostate cancer” or “prostate carcinoma”. Only studies reporting about true positive (TP), true negative (TN), false positive (FP) and false negative (FN) findings of 18F-fluciclovine PET were considered eligible. Results: Fifteen out of 283 studies, and 697 patients, were included in the final analysis. The pooled sensitivity for 18F-Fluciclovine PET/CT for diagnosis of primary PCa was 0.83 (95% CI: 0.80–0.86), the specificity of 0.77 (95% CI: 0.74–0.80). The pooled sensitivity for preoperative LN staging was 0.57 (95% CI: 0.39–0.73) and specificity of 0.99 (95% CI: 0.94–1.00). The pooled sensitivity for the overall detection of recurrence in relapsed patients was 0.68 (95% CI: 0.63–0.73), and specificity of 0.68 (95% CI: 0.60–0.75). Conclusion: This meta-analysis showed promising results in term of sensitivity and specificity for 18F-Fluciclovine PET/CT to stage the primary lesion and in the assessment of nodal metastases, and for the detection of PCa locations in the recurrent setting. However, the limited number of studies and the broad heterogeneity in the selected cohorts and in different investigation protocols are limitation affecting the strength of these results.

Sign in / Sign up

Export Citation Format

Share Document