Abstract
PET/CT and PET/MR can be used with various radiopharmaceuticals to assess the mechanisms underlying biochemical changes and physiopathology of brain tumors.
Amino acid tracers are frequently used for most clinical questions. These tracers include, among others, [11C]methionine, L-3,4-dihydroxy-6[18F]fluorophenylalanine ([18F]FDOPA and O-(2-18F-fluoroethyl)-L-tyrosine (18F-FLT). Amino acid tracers are particularly accurate to distinguish tumor recurrence and radiation necrosis. The role of [18F]FDG, the earliest PET tracer used for diagnosis and monitoring of brain tumors, is being redefined, due to the availability of amino acid tracers. For in vivo prediction of tumor grade however [18F]FDG is still more accurate than most amino acid tracers.
Higher baseline values of tracer uptake as well as lower percent changes after therapy in treated patients predict shorter survival – this has been shown for several tracers.
PET/CT and PET/MR can be used after surgery to assess the presence of residual tumor. PET, in combination with MR, is increasingly used for the definition of the tumor volume that has to be irradiated. Identification of the part of the tumor that displays highest metabolic activity can also be used to direct stereotaxic biopsy.
Other tracers have been synthetized to explore different biochemical processes, for example, hypoxia (e.g., [18F]-fluoromisonidazole), DNA synthesis (3-deoxy-3-[18F]-fluorothymidine), and membrane proliferation (radiolabeled choline). However, these tracers have a less established role in clinical practice.
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Abbreviations
- [11C]MET:
-
[11C]methionine
- [18F]FDG:
-
2-Deoxy-2-[18F]fluoro-d-glucose
- [18F]FDOPA:
-
L-3,4-dihydroxy-6-[18F]fluorophenylalanine
- 123I-IAZA:
-
123I-iodoazomycin arabinoside
- 123I-IMT:
-
123I-alpha-methyltyrosine, a tyrosine analog transported as L-tyrosine by the neutral amino acid transporter
- 18F-FAZA:
-
18F-azomycin arabinoside
- 18F-FES:
-
16α-18F-fluoro-17β-oestradiol
- 18F-FET:
-
O-(2-18F-Fluoroethyl)-L-Tyrosine, a tyrosine analog
- 18F-FLT:
-
18F-fluorothymidine
- 18F-FMAU:
-
18F-2-fluoro-5-methyl-1-beta-d-arabinofuranosyluracil
- 18F-MISO:
-
18F-fluoromisonidazole
- 64Cu-ATSM:
-
64Cu-diacetyl-bis(N4-methylsemicarbazone)
- 99mTc-ECD:
-
99mTc-ethylcisteinate dimer
- 99mTc-HMPAO:
-
99mTc-hexamethylpropyleneamine oxime
- ADC:
-
Apparent diffusion coefficient, a parameter of MR imaging
- AJCC:
-
American Joint Committee on Cancer
- BBB:
-
Blood–brain barrier
- BTV:
-
Biological tumor volume (the extent of tumor based on PET imaging); the combination of GTV and BTV provides the planning target volume for radiation therapy
- CBF:
-
Cerebral blood flow
- CI:
-
Confidence interval
- CMRglc :
-
Cerebral metabolic rate for glucose
- CNS:
-
Central nervous system
- CSF:
-
Cerebrospinal fluid
- CT:
-
X-ray computed tomography
- DG:
-
2-Deoxyglucose
- DOTA:
-
1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetraacetic acid
- DOTANOC:
-
DOTA-1-Nal3-octreotide
- DOTATATE:
-
DOTA- Tyr3-octreotate
- DOTATOC:
-
DOTA-octreotate
- DTPA:
-
Diethylenetriaminepentaacetic acid
- DWI:
-
Diffusion-weighted imaging, an MR imaging technique
- EGFR:
-
Epidermal growth factor receptor; the mutated form EGFRvIII plays a prominent role in tumorigenesis and proangiogenic signaling
- FLAIR:
-
Fluid-attenuated inversion recovery, an MR imaging technique
- GBM:
-
Glioblastoma multiforme
- GTV:
-
Gross tumor voume (the extent of the tumor on morphologic imaging)
- IDH:
-
Isocitrate dehydrogenase; mutations of this enzyme occur more frequently in oligodendroglial and astrocytic tumors
- KPS:
-
Karnofsky performance status
- LAT1:
-
L-type amino acid transporter 1
- M:
-
Metastasis status according to the AJCC/UICC TNM staging system
- MDR1:
-
Multidrug resistance gene 1, a characteristic associated with aggressive tumors; this gene encodes for P-glyoprotein
- MGMT:
-
Methyl guanine DNA methyl transferase, a DNA repair enzyme; methylation of MGMT promoter is associated with increased overall survival
- MIB-1:
-
Marker of cell proliferation used for stratification of grades of brain tumors
- MoAb:
-
Monoclonal antibody
- MPNST:
-
Malignant peripheral nerve sheath tumor
- MR:
-
Magnetic resonance
- MRI:
-
Magnetic resonance imaging
- N:
-
Lymph node status according to the AJCC/UICC TNM staging system
- PET:
-
Positron emission tomography
- PET/CT:
-
Positron emission tomography/computed tomography
- PET/MR:
-
Positron emission tomography/magnetic resonance
- PI3K:
-
Phosphatidylinositol 3-kinase
- PNET:
-
Primitive neuroectodermic tumor
- pRIT:
-
Pretargeting radioimmunotherapy
- PTEN:
-
Phosphatase and tensin homolog is a tumor suppressor; PTEN deletions indicate a poor prognosis
- RIT:
-
Radioimmunotherapy
- ROC:
-
Receiver operating characteristic, a statistical analysis to assess the performance of a binary classifier
- ROI:
-
Region of interest
- SPECT:
-
Single photon emission computed tomography
- SPECT/CT:
-
Single photon emission computed tomography/computed tomography
- SST:
-
Somatostatin
- SSTR:
-
Somatostatin receptors
- SUV:
-
Standardized uptake value
- T:
-
Tumor status according to the AJCC/UICC TNM staging system
- T/N:
-
Ratio of tumor uptake to normal brain uptake
- TBR:
-
Tumor-to-background ratio
- TNM:
-
AJCC/UICC staging system based on parameters “T” (tumor status), “N” (lymph node status), and “M” (distant metastasis status)
- TP53:
-
Tumor protein p53, also known as cellular tumor antigen p53, phosphoprotein p53, tumor suppressor p53, antigen NY-CO-13, or transformation-related protein 53 (TRP53)
- UICC:
-
Union Internationale Contre le Cancer (International Union Against Cancer)
- VEGF:
-
Vascular endothelial growth factor
- VOI:
-
Volume of interest
- WHO:
-
World Health Organization
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Giovacchini, G., Riondato, M., Giovannini, E., Ciarmiello, A. (2016). Diagnostic Applications of Nuclear Medicine: Brain Tumors. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-26067-9_9-1
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Diagnostic Applications of Nuclear Medicine: Brain Tumors- Published:
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DOI: https://doi.org/10.1007/978-3-319-26067-9_9-2
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Diagnostic Applications of Nuclear Medicine: Brain Tumors- Published:
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DOI: https://doi.org/10.1007/978-3-319-26067-9_9-1