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Guglielmo P, Quartuccio N, Rossetti V, Celli M, Alongi P, Boero M, Arnone G, Baldari S, Matteucci F, Laudicella R. [ 18F] Fluorothymidine Positron Emission Tomography Imaging in Primary Brain Tumours: A Systematic Review. Curr Med Imaging 2022; 18:363-371. [PMID: 34533446 DOI: 10.2174/1573405617666210917123012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE This review aimed to summarize the available literature on the clinical application of [18F] FLT PET imaging in primary brain tumours. METHODS A comprehensive search strategy based on Pubmed/Medline, Scopus, Web of Science, Cochrane Library, Google Scholar, and the Embase databases was carried on using the following search string: ('3` Fluorothymidine'/exp OR 'FLT' OR '[81F]-FLT' OR '[18F] Fluorothymidine') AND ('pet'/exp OR 'pet' OR 'positron emission tomography') AND ('glioma'/exp OR 'glioma' OR 'brain tumour'/exp OR 'brain tumour'). The search was updated till March 2021 and only articles in English and studies investigating the clinical applications of [18F] FLT PET and PET/CT in primary brain tumours were considered eligible for inclusion. RESULTS The literature search ultimately yielded 52 studies included in the systematic review, with main results as follows: a) the uptake of [18F] FLT may guide stereotactic biopsy but does not discriminate between grade II and III glioma. b) [18F] FLT uptake and texture parameters correlate with overall survival (OS) in newly diagnosed gliomas. c) In patients with recurrent glioma, proliferative volume (PV) and tumour-to-normal brain (T/N) uptake ratio are independent predictors of survival. d) Patients demonstrating response to therapy at [18F] FLT PET scan show longer OS compared to non-responders. e) [18F] FLT PET demonstrated good performance in discriminating tumour recurrence from radionecrosis. However, controversial results exist in comparative literature examining the performance of [18F] FLT vs. other radiotracers in the assessment of recurrence. CONCLUSION [18F] FLT PET imaging has demonstrated potential benefits for grading, diagnostic and prognostic purposes, despite the small sample size studies due to the relatively low availability of the radiotracer.
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Affiliation(s)
| | - Natale Quartuccio
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico Di Cristina Benfratelli, Italy
| | - Virginia Rossetti
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Monica Celli
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Pierpaolo Alongi
- Nuclear Medicine Unit, Fondazione Istituto G. Giglio, Ct. da Pietra Pollastra-pisciotto, Cefalù. Italy
| | - Michele Boero
- Nuclear Medicine Unit, AO Brotzu, 09134 Cagliari, Italy
| | - Gaspare Arnone
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico Di Cristina Benfratelli, Italy
| | - Sergio Baldari
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Federica Matteucci
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Riccardo Laudicella
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
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Villena Martín M, Pena Pardo FJ, Jiménez Aragón F, Borras Moreno JM, García Vicente AM. Metabolic targeting can improve the efficiency of brain tumor biopsies. Semin Oncol 2020; 47:148-154. [DOI: 10.1053/j.seminoncol.2020.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 12/27/2022]
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Hu LS, Hawkins-Daarud A, Wang L, Li J, Swanson KR. Imaging of intratumoral heterogeneity in high-grade glioma. Cancer Lett 2020; 477:97-106. [PMID: 32112907 DOI: 10.1016/j.canlet.2020.02.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 12/19/2022]
Abstract
High-grade glioma (HGG), and particularly Glioblastoma (GBM), can exhibit pronounced intratumoral heterogeneity that confounds clinical diagnosis and management. While conventional contrast-enhanced MRI lacks the capability to resolve this heterogeneity, advanced MRI techniques and PET imaging offer a spectrum of physiologic and biophysical image features to improve the specificity of imaging diagnoses. Published studies have shown how integrating these advanced techniques can help better define histologically distinct targets for surgical and radiation treatment planning, and help evaluate the regional heterogeneity of tumor recurrence and response assessment following standard adjuvant therapy. Application of texture analysis and machine learning (ML) algorithms has also enabled the emerging field of radiogenomics, which can spatially resolve the regional and genetically distinct subpopulations that coexist within a single GBM tumor. This review focuses on the latest advances in neuro-oncologic imaging and their clinical applications for the assessment of intratumoral heterogeneity.
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Affiliation(s)
- Leland S Hu
- Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Andrea Hawkins-Daarud
- Mathematical NeuroOncology Lab, Precision Neurotherapeutics Innovation Program, Mayo Clinic, 5777 East Mayo Blvd, Support, Services Building Suite 2-700, Phoenix, AZ, 85054, USA.
| | - Lujia Wang
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, 699 S Mill Ave, Tempe, AZ, 85281, USA.
| | - Jing Li
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, 699 S Mill Ave, Tempe, AZ, 85281, USA.
| | - Kristin R Swanson
- Mathematical NeuroOncology Lab, Precision Neurotherapeutics Innovation Program, Mayo Clinic, 5777 East Mayo Blvd, Support, Services Building Suite 2-700, Phoenix, AZ, 85054, USA.
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Kong Z, Li J, Liu Z, Liu Z, Zhao D, Cheng X, Li L, Lin Y, Wang Y, Tian J, Ma W. Radiomics signature based on FDG-PET predicts proliferative activity in primary glioma. Clin Radiol 2019; 74:815.e15-815.e23. [DOI: 10.1016/j.crad.2019.06.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/26/2019] [Indexed: 01/04/2023]
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Combining 3'-Deoxy-3'-[18F] fluorothymidine and MRI increases the sensitivity of glioma volume detection. Nucl Med Commun 2019; 40:1066-1071. [PMID: 31469809 DOI: 10.1097/mnm.0000000000001056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE 3'-Deoxy-3'-[18F] fluorothymidine (18F-FLT) is a marker of cell proliferation and displays a high tumor-to-background ratio in brain tumor lesions. We determined whether combining 18F-FLT PET and MRI study improves the detection of tumoral tissue compared to MRI alone and whether 18F-FLT uptake has a prognostic value by studying its association with histopathological features. METHODS Thirteen patients with a supratentorial malignant glioma were recruited and scheduled for surgery. The tumor volume was defined in all patients on both 18F-FLT PET and MRI images. The images were coregistered and uploaded onto a neuronavigation system. During surgery, an average of 11 biopsies per patient were taken in regions of the brain that were positive to one or both imaging modalities, as well as from control peritumoral regions. The standardized uptake values (SUVs) of each biopsy region were correlated to histopathological data (i.e., proliferation index and number of mitoses) and the SUV values of high and low-grade samples were compared. RESULTS Out of a total of 149 biopsies, 109 contained tumoral tissue at histopathological analysis. The positive predictive value was 93.1% for MRI alone and 78.3% for MRI and PET combined. In addition, 40% of the biopsy samples taken from areas of the brain that were negative at both PET and MRI had evidence of malignancy at pathology. The SUV values were not significantly correlated to either the proliferation index or the number of mitoses, and could not differentiate between high- and low-grade samples. CONCLUSION In patients with newly diagnosed glioma, a combination of MRI and 18F-FLT-PET detects additional tumoral tissue and this may lead to a more complete surgical resection. Also, the addition of a negative PET to a negative MRI increases the negative predictive value. However, 18F-FLT still underestimated the margins of the lesion and did not correlate with histopathological features.
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Serial FLT PET imaging to discriminate between true progression and pseudoprogression in patients with newly diagnosed glioblastoma: a long-term follow-up study. Eur J Nucl Med Mol Imaging 2018; 45:2404-2412. [PMID: 30032322 PMCID: PMC6208814 DOI: 10.1007/s00259-018-4090-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/09/2018] [Indexed: 12/23/2022]
Abstract
Purpose Response evaluation in patients with glioblastoma after chemoradiotherapy is challenging due to progressive, contrast-enhancing lesions on MRI that do not reflect true tumour progression. In this study, we prospectively evaluated the ability of the PET tracer 18F-fluorothymidine (FLT), a tracer reflecting proliferative activity, to discriminate between true progression and pseudoprogression in newly diagnosed glioblastoma patients treated with chemoradiotherapy. Methods FLT PET and MRI scans were performed before and 4 weeks after chemoradiotherapy. MRI scans were also performed after three cycles of adjuvant temozolomide. Pseudoprogression was defined as progressive disease on MRI after chemoradiotherapy with stabilisation or reduction of contrast-enhanced lesions after three cycles of temozolomide, and was compared with the disease course during long-term follow-up. Changes in maximum standardized uptake value (SUVmax) and tumour-to-normal uptake ratios were calculated for FLT and are presented as the mean SUVmax for multiple lesions. Results Between 2009 and 2012, 30 patients were included. Of 24 evaluable patients, 7 showed pseudoprogression and 7 had true progression as defined by MRI response. FLT PET parameters did not significantly differ between patients with true progression and pseudoprogression defined by MRI. The correlation between change in SUVmax and survival (p = 0.059) almost reached the standard level of statistical significance. Lower baseline FLT PET uptake was significantly correlated with improved survival (p = 0.022). Conclusion Baseline FLT uptake appears to be predictive of overall survival. Furthermore, changes in SUVmax over time showed a tendency to be associated with improved survival. However, further studies are necessary to investigate the ability of FLT PET imaging to discriminate between true progression and pseudoprogression in patients with glioblastoma.
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Nikaki A, Angelidis G, Efthimiadou R, Tsougos I, Valotassiou V, Fountas K, Prasopoulos V, Georgoulias P. 18F-fluorothymidine PET imaging in gliomas: an update. Ann Nucl Med 2017; 31:495-505. [PMID: 28612247 PMCID: PMC5517561 DOI: 10.1007/s12149-017-1183-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/31/2017] [Indexed: 01/18/2023]
Abstract
Brain neoplasms constitute a group of tumors with discrete differentiation grades, and therefore, course of disease and prognosis. Magnetic resonance imaging (MRI) remains the gold standard method for the investigation of central nervous system tumors. However, MRI suffers certain limitations, especially if radiation therapy or chemotherapy has been previously applied. On the other hand, given the development of newer radiopharmaceuticals, positron emission tomography (PET) aims to a better investigation of brain tumors, assisting in the clinical management of the patients. In the present review, the potential contribution of radiolabeled fluorothymidine (FLT) imaging for the evaluation of brain tumors will be discussed. In particular, we will present the role of FLT-PET imaging in the depiction of well and poorly differentiated lesions, the assessment of patient prognosis and treatment response, and the recognition of disease recurrence. Moreover, related semi-quantitative and kinetic parameters will be discussed.
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Affiliation(s)
- Alexandra Nikaki
- Department of Clinical Physiology, KHSHP, 20 Ahvenistontie Str., 13530, Hämeenlinna, Finland.,Department of Nuclear Medicine, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - George Angelidis
- Department of Nuclear Medicine, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - Roxani Efthimiadou
- PET/CT Department, Hygeia Hospital, 4 Erythrou Stavrou Str., 15123, Athens, Greece
| | - Ioannis Tsougos
- Department of Nuclear Medicine, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - Varvara Valotassiou
- Department of Nuclear Medicine, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - Konstantinos Fountas
- Department of Neurosurgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - Vasileios Prasopoulos
- PET/CT Department, Hygeia Hospital, 4 Erythrou Stavrou Str., 15123, Athens, Greece.,Department of Nuclear Medicine, Hygeia Hospital, 4 Erythrou Stavrou Str., 15123, Athens, Greece
| | - Panagiotis Georgoulias
- Department of Nuclear Medicine, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece.
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The diagnostic value of high-frequency power-based diffusion-weighted imaging in prediction of neuroepithelial tumour grading. Eur Radiol 2017; 27:5056-5063. [PMID: 28608161 DOI: 10.1007/s00330-017-4899-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/23/2017] [Accepted: 05/16/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To retrospectively evaluate the diagnostic value of high-frequency power (HFP) compared with the minimum apparent diffusion coefficient (MinADC) in the prediction of neuroepithelial tumour grading. METHODS Diffusion-weighted imaging (DWI) data were acquired on 115 patients by a 3.0-T MRI system, which included b0 images and b1000 images over the whole brain in each patient. The HFP values and MinADC values were calculated by an in-house script written on the MATLAB platform. RESULTS There was a significant difference among each group excluding grade I (G1) vs. grade II (G2) (P = 0.309) for HFP and among each group for MinADC. ROC analysis showed a higher discriminative accuracy between low-grade glioma (LGG) and high-grade glioma (HGG) for HFP with area under the curve (AUC) value 1 compared with that for MinADC with AUC 0.83 ± 0.04 and also demonstrated a higher discriminative ability among the G1-grade IV (G4) group for HFP compared with that for MinADC except G1 vs. G2. CONCLUSIONS HFP could provide a simple and effective optimal tool for the prediction of neuroepithelial tumour grading based on diffusion-weighted images in routine clinical practice. KEY POINTS • HFP shows positive correlation with neuroepithelial tumour grading. • HFP presents a good diagnostic efficacy for LGG and HGG. • HFP is helpful in the selection of brain tumour boundary.
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Abstract
OBJECTIVE The purpose of this review is to summarize the applications of PET molecular imaging-directed biopsy of a variety of organs in the management of various diseases with a focus on cancers. CONCLUSION PET can yield metabolic information at the cellular and molecular levels, and PET-directed biopsy is playing an increasing role in the diagnosis and staging of diseases.
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Malignant transformation of low-grade gliomas in patients undergoing adjuvant therapy. Acta Neurol Belg 2017; 117:235-239. [PMID: 27271289 DOI: 10.1007/s13760-016-0657-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/23/2016] [Indexed: 01/06/2023]
Abstract
Low-grade gliomas (LGG) comprise nearly 15-20 % of all central nervous system glial tumors. Several factors have been recognized as playing role in LGG malignant transformation (MT). A breakthrough analysis of a multidisciplinary group pointed that temozolomide may play a role in MT of LGGs. We analyzed the prevalence of MT in LGG patients submitted to adjuvant therapy (AT). We analyzed the medical charts of 43 patients with LGG submitted to surgery or biopsy and attending at Hospital do Servidor Público Estadual de São Paulo (São Paulo, Brazil), consecutively diagnosed from 1995 to 2013. 43 patients (24 women and 19 men) were evaluated, with mean age of 45.3 years. According to histology, 30 were astrocytomas (70 %), 12 (27 %) were oligodendrogliomas, and 1 (3 %) were mixed glioma. Mean follow-up time was 4.2 years with the standard deviation of 2.1. Twenty-eight patients did not receive adjuvant therapy and 15 received adjuvant therapy. From 43 patients with complete follow-up, 21 (48 %) experienced malignant transformation. Among such patients, nine were users of AT. Forty-eight percent of patients presented MT, being 60 % in the AT group and 42.8 % without AT. Our analysis revealed a high prevalence of MT in patients undergoing AT, higher than in patients without AT.
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Abstract
This article provides an overview of the key considerations for the development and application of molecular imaging agents for brain tumors and the major classes of PET tracers that have been used for imaging brain tumors in humans. The mechanisms of uptake, biological implications, primary applications, and limitations of PET tracers in neuro-oncology are reviewed. The available data indicate that several of these classes of tracers, including radiolabeled amino acids, have imaging properties superior to those of (18)F-fluorodeoxyglucose, and can complement contrast-enhanced magnetic resonance imaging in the evaluation of brain tumors.
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Boonzaier NR, Piccirillo SGM, Watts C, Price SJ. Assessing and monitoring intratumor heterogeneity in glioblastoma: how far has multimodal imaging come? CNS Oncol 2015; 4:399-410. [PMID: 26497327 DOI: 10.2217/cns.15.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Glioblastoma demonstrates imaging features of intratumor heterogeneity that result from underlying heterogeneous biological properties. This stems from variations in cellular behavior that result from genetic mutations that either drive, or are driven by, heterogeneous microenvironment conditions. Among all imaging methods available, only T1-weighted contrast-enhancing and T2-weighted fluid-attenuated inversion recovery are used in standard clinical glioblastoma assessment and monitoring. Advanced imaging modalities are still considered emerging techniques as appropriate end points and robust methodologies are missing from clinical trials. Discovering how these images specifically relate to the underlying tumor biology may aid in improving quality of clinical trials and understanding the factors involved in regional responses to treatment, including variable drug uptake and effect of radiotherapy. Upon validation and standardization of emerging MR techniques, providing information based on the underlying tumor biology, these images may allow for clinical decision-making that is tailored to an individual's response to treatment.
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Affiliation(s)
- Natalie R Boonzaier
- Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Sara G M Piccirillo
- Cambridge Centre for Brain Repair, Department of Clinical Neurosciences, Forvie Site, Robinson Way, Cambridge CB2 0PY, UK
| | - Colin Watts
- Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Stephen J Price
- Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0QQ, UK
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Imaging biomarkers in primary brain tumours. Eur J Nucl Med Mol Imaging 2014; 42:597-612. [PMID: 25520293 DOI: 10.1007/s00259-014-2971-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 12/03/2014] [Indexed: 12/18/2022]
Abstract
We are getting used to referring to instrumentally detectable biological features in medical language as "imaging biomarkers". These two terms combined reflect the evolution of medical imaging during recent decades, and conceptually comprise the principle of noninvasive detection of internal processes that can become targets for supplementary therapeutic strategies. These targets in oncology include those biological pathways that are associated with several tumour features including independence from growth and growth-inhibitory signals, avoidance of apoptosis and immune system control, unlimited potential for replication, self-sufficiency in vascular supply and neoangiogenesis, acquired tissue invasiveness and metastatic diffusion. Concerning brain tumours, there have been major improvements in neurosurgical techniques and radiotherapy planning, and developments of novel target drugs, thus increasing the need for reproducible, noninvasive, quantitative imaging biomarkers. However, in this context, conventional radiological criteria may be inappropriate to determine the best therapeutic option and subsequently to assess response to therapy. Integration of molecular imaging for the evaluation of brain tumours has for this reason become necessary, and an important role in this setting is played by imaging biomarkers in PET and MRI. In the current review, we describe most relevant techniques and biomarkers used for imaging primary brain tumours in clinical practice, and discuss potential future developments from the experimental context.
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Simoncic U, Jeraj R. Heterogeneity in stabilization phenomena in FLT PET images of canines. Phys Med Biol 2014; 59:7937-55. [PMID: 26009642 DOI: 10.1088/0031-9155/59/24/7937] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
3'-((18)F)fluoro-3'-deoxy-L-thymidine (FLT) is a PET marker of cellular proliferation. Its tissue uptake rate is often quantified with a Standardized Uptake Value (SUV), although kinetic analysis provides a more accurate quantification. The purpose of this study is to investigate the heterogeneity in FLT stabilization phenomena. The study was done on 15 canines with spontaneously occurring sinonasal tumours. They were imaged dynamically for 90 min with FLT PET/CT twice; before and during the radiotherapy. Images were analyzed for kinetics on a voxel basis through compartmental analysis. Stabilization curves were calculated as a time-dependant correlation between the time-dependant SUV and the kinetic parameters (voxel values within the tumour were correlated). Stabilization curves were analyzed for stabilization speed, maximal correlation and correlation decrease following the maximal correlation. These stabilization parameters were correlated with the region-averaged kinetic parameters. The FLT SUV was highly correlated with vasculature fraction immediately post-injection, followed by maximum in correlation with the perfusion/permeability. At later times post-injection the FLT SUV was highly correlated (Pearson correlation coefficient above 0.95) with the FLT influx parameter for cases with tumour-averaged SUV(30-50 min) above 2, while others were indeterminate (correlation coefficients from 0.1 to 0.97). All cases with highly correlated SUV and FLT influx parameter had correlation coefficient within 0.5% of its maximum in the period of 30-50 min post-injection. Stabilization time was inversely proportional to the FLT influx rate. Correlation between the FLT SUV and FLT influx parameter dropped at later times post-injection with drop being proportional to the dephosphorylation rate. The FLT was found to be metabolically stable in canines. FLT PET imaging protocol should define minimal and maximal FLT uptake period, which would be 30-50 min for our patients. Additionally, kinetic analysis should be used when low FLT avidity is expected. Low SUVs should be treated with great caution.
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Affiliation(s)
- Urban Simoncic
- Jozef Stefan Institute, Jamova 39, SI-1000 Ljubljana, Slovenia. Medical Physics Department, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705-2275, USA. The Centre of Excellence for Biosensors, Instrumentation and Process Control-COBIK, Tovarniska 26, 5270 Ajdovscina, Slovenia
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Dhermain F. Radiotherapy of high-grade gliomas: current standards and new concepts, innovations in imaging and radiotherapy, and new therapeutic approaches. CHINESE JOURNAL OF CANCER 2014; 33:16-24. [PMID: 24384237 PMCID: PMC3905086 DOI: 10.5732/cjc.013.10217] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The current standards in radiotherapy of high-grade gliomas (HGG) are based on anatomic imaging techniques, usually computed tomography (CT) scanning and magnetic resonance imaging (MRI). The guidelines vary depending on whether the HGG is a histological grade 3 anaplastic glioma (AG) or a grade 4 glioblastoma multiforme (GBM). For AG, T2-weighted MRI sequences plus the region of contrast enhancement in T1 are considered for the delineation of the gross tumor volume (GTV), and an isotropic expansion of 15 to 20 mm is recommended for the clinical target volume (CTV). For GBM, the Radiation Therapy Oncology Group favors a two-step technique, with an initial phase (CTV1) including any T2 hyperintensity area (edema) plus a 20 mm margin treated with up to 46 Gy in 23 fractions, followed by a reduction in CTV2 to the contrast enhancement region in T1 with an additional 25 mm margin. The European Organisation of Research and Treatment of Cancer recommends a single-phase technique with a unique GTV, which comprises the T1 contrast enhancement region plus a margin of 20 to 30 mm. A total dose of 60 Gy in 30 fractions is usually delivered for GBM, and a dose of 59.4 Gy in 33 fractions is typically given for AG. As more than 85% of HGGs recur in field, dose-escalation studies have shown that 70 to 75 Gy can be delivered in 6 weeks with relevant toxicities developing in < 10% of the patients. However, the only randomized dose-escalation trial, in which the boost dose was guided by conventional MRI, did not show any survival advantage of this treatment over the reference arm. HGGs are amongst the most infiltrative and heterogeneous tumors, and it was hypothesized that the most highly aggressive areas were missed; thus, better visualization of these high-risk regions for radiation boost could decrease the recurrence rate. Innovations in imaging and linear accelerators (LINAC) could help deliver the right doses of radiation to the right subvolumes according to the dose-painting concept. Advanced imaging techniques provide functional information on cellular density (diffusion MRI), angiogenesis (perfusion MRI), metabolic activity and cellular proliferation [positron emission tomography (PET) and magnetic resonance spectroscopy (MRS)]. All of these non-invasive techniques demonstrated good association between the images and histology, with up to 40% of HGGs functionally presenting a high activity within the non-contrast-enhanced areas in T1. New LINAC technologies, such as intensity-modulated and stereotactic radiotherapy, help to deliver a simultaneous integrated boost (SIB) > 60 Gy. Trials delivering a SIB into a biological GTV showed the feasibility of this treatment, but the final results, in terms of clinical benefits for HGG patients, are still pending. Many issues have been identified: the variety of MRI and PET machines (and amino-acid tracers), the heterogeneity of the protocols used for image acquisition and post-treatment, the geometric distortion and the unreliable algorithms for co-registration of brain anatomy with functional maps, and the semi-quiescent but highly invasive HGG cells. These issues could be solved by the homogenization of the protocols and software applications, the simultaneous acquisition of anatomic and functional images (PET-MRI machines), the combination of complementary imaging tools (perfusion and diffusion MRI), and the concomitant addition of some ad hoc targeted drugs against angiogenesis and invasiveness to chemoradiotherapy. The integration of these hybrid data will construct new synthetic metrics for fully individualized treatments.
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Affiliation(s)
- Frederic Dhermain
- Department of Radiation Oncology, Institut Gustave Roussy University Hospital, Villejuif 94805, France.
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Zhao F, Cui Y, Li M, Fu Z, Chen Z, Kong L, Yang G, Yu J. Prognostic value of 3′-Deoxy-3′-18F-Fluorothymidine ([18F] FLT PET) in patients with recurrent malignant gliomas. Nucl Med Biol 2014; 41:710-5. [DOI: 10.1016/j.nucmedbio.2014.04.134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 04/25/2014] [Accepted: 04/30/2014] [Indexed: 10/25/2022]
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Hoefnagels FWA, De Witt Hamer P, Sanz-Arigita E, Idema S, Kuijer JPA, Pouwels PJW, Barkhof F, Vandertop WP. Differentiation of edema and glioma infiltration: proposal of a DTI-based probability map. J Neurooncol 2014; 120:187-98. [PMID: 25079117 DOI: 10.1007/s11060-014-1544-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 07/05/2014] [Indexed: 12/22/2022]
Abstract
Conflicting results on differentiating edema and glioma by diffusion tensor imaging (DTI) are possibly attributable to dissimilar spatial distribution of the lesions. Combining DTI-parameters and enhanced registration might improve prediction. Regions of edema surrounding 22 metastases were compared to tumor-infiltrated regions from WHO grade 2 (12), 3 (10) and 4 (18) gliomas. DTI data was co-registered using Tract Based Spatial Statistics (TBSS), to measure Fractional Anisotropy (FA) and Mean Diffusivity (MD) for white matter only, and relative changes compared to matching reference regions (dFA and dMD). A two-factor principal component analysis (PCA) on metastasis and grade 2 glioma was performed to explore a possible differentiating combined factor. Edema demonstrated equal MD and higher FA compared to grade 2 and 3 glioma (P < 0.001), but did not differ from glioblastoma. Differences were non-significant when corrected for spatial distribution, since reference regions differed strongly (P < 0.001). The second component of the PCA (PCA-C2) did differentiate edema and low-grade tumor (sensitivity 91.7%, specificity 86.4%). PCA-C2 scores were plotted voxel-wise as a probability-map, discerning distinct areas of presumed edema or tumor infiltration. Correction of spatial dependency appears essential when differentiating glioma from edema. A tumor-infiltration probability-map is presented, based on supplementary information of multiple DTI parameters and spatial normalization.
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Affiliation(s)
- Friso W A Hoefnagels
- Department Neurosurgery, Neurosurgical Center Amsterdam, VU University Medical Center, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands,
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Nguyen N, Montagnese J, Rogers LR, Sher A, Wolansky L. Positron emission tomography-magnetic resonance imaging in the evaluation of brain tumors: current status and future prospects. Semin Roentgenol 2014; 49:275-89. [PMID: 25497912 DOI: 10.1053/j.ro.2014.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Nghi Nguyen
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jesse Montagnese
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Lisa R Rogers
- Department of Neurology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Andrew Sher
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Leo Wolansky
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
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Goggi JL, Bejot R, Moonshi SS, Bhakoo KK. Stratification of 18F-Labeled PET Imaging Agents for the Assessment of Antiangiogenic Therapy Responses in Tumors. J Nucl Med 2013; 54:1630-6. [DOI: 10.2967/jnumed.112.115824] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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20
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Asklund T, Henriksson R, Axelsson J, Bergström Å, Kasper M, Ögren M, Toftgård R, Riklund KÅ. Early and persisting response to vismodegib in a patient with bone metastasizing medulloblastoma. Acta Oncol 2013; 52:862-6. [PMID: 23013267 DOI: 10.3109/0284186x.2012.724537] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Idema AJ, Hoffmann AL, Boogaarts HD, Troost EG, Wesseling P, Heerschap A, van der Graaf WT, Grotenhuis JA, Oyen WJ. 3′-Deoxy-3′-18F-Fluorothymidine PET–Derived Proliferative Volume Predicts Overall Survival in High-Grade Glioma Patients. J Nucl Med 2012; 53:1904-10. [DOI: 10.2967/jnumed.112.105544] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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22
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Correlation between Ki-67 immunohistochemistry and 18F-fluorothymidine uptake in patients with cancer: A systematic review and meta-analysis. Eur J Cancer 2012; 48:3499-513. [PMID: 22658807 DOI: 10.1016/j.ejca.2012.05.001] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 05/01/2012] [Accepted: 05/01/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND Positron emission tomography (PET) imaging using the radiotracer 18F-Fluorothymidine (FLT) has been proposed as an imaging biomarker of tumour proliferation. If FLT-PET can be established as such it will provide a non-invasive, quantitative measurement of tumour proliferation across the entire tumour. Results from validation studies have so far been conflicting with some studies confirming a good correlation between FLT uptake and Ki-67 score and others presenting negative results. METHODS Firstly we performed a systematic review of published studies between 1998 and 2011 that explored the correlation between FLT uptake and Ki-67 score and examined possible variations in the methods used. Studies were eligible if they: (a) included patients with cancer, (b) investigated the correlation between Ki-67 measured by immunohistochemistry and FLT uptake measured with PET scanning, and (c) were published as a full paper in a peer-reviewed scientific journal. Secondly a meta-analysis of the correlation coefficient values reported from each study was performed. Correlation coefficient (r) values were extracted from each study and 95% confidence intervals (CIs) were calculated after applying Fisher's z transformation. For subgroup analysis, studies were classified by the index used to characterise Ki-67 expression (average or maximum expression), the nature of the sample (whole specimen or biopsy) and the cancer type. FINDINGS Twenty-seven studies were identified as eligible for the meta-analysis. In the studies we examined there were variations in aspects of the methods and reporting. The meta-analysis showed that given an appropriate study design the FLT/Ki-67 correlation is significant and independent of cancer type. Specifically subgroup analysis showed that FLT/Ki-67 correlation was high in studies measuring the Ki-67 average expression regardless of use of surgery or biopsy samples (r=0.70, 95% CI=0.43-0.86, p<0.001). Of the studies that measured Ki-67 maximum expression, only those that used the whole surgical specimen provided a significant r value (r=0.72, 95% CI=0.54-0.84, p<0.001). Studies that used biopsy samples for Ki-67 maximum measurements did not produce a significant r value (r=0.04, 95% CI=-0.18-0.26, p=0.71). In terms of the cancer type subgroup analysis there is sufficient data to support a strong FLT/Ki-67 correlation for brain, lung and breast cancer. No publication bias was detected. INTERPRETATION This systematic review and meta-analysis highlights the importance of the methods used in validation studies comparing FLT-PET imaging with the biomarker Ki-67. The correlation is significant and independent of cancer type provided a study design that uses Ki-67 average measurements, regardless of nature of sample, or whole surgical samples when measuring Ki-67 maximum expression. Sufficient data to support a strong correlation for brain, lung and breast cancer exist. However, larger, prospective studies with improved study design are warranted to validate these findings for the rest of the cancer types.
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Abstract
In recent years, advances in the understanding of low-grade glioma (LGG) biology have driven new paradigms in molecular markers, diagnostic imaging, operative techniques and technologies, and adjuvant therapies. Taken together, these developments are collectively pushing the envelope toward improved quality of life and survival. In this article, the authors evaluate the recent literature to synthesize a comprehensive review of LGGs in the modern neurosurgical era.
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Affiliation(s)
- Nader Sanai
- Barrow Brain Tumor Research Center, Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
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25
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Price SJ, Gillard JH. Imaging biomarkers of brain tumour margin and tumour invasion. Br J Radiol 2011; 84 Spec No 2:S159-67. [PMID: 22433826 PMCID: PMC3473903 DOI: 10.1259/bjr/26838774] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Invasion of tumour cells into the normal brain is one of the major reasons of treatment failure for gliomas. Although there is a good understanding of the molecular and cellular processes that occur during this invasion, it is not possible to detect the extent of the tumour with conventional imaging. However, there is an understanding that the degree of invasion differs with individual tumours, and yet they are all treated the same. Newer imaging techniques that probe the pathological changes within tumours may be suitable biomarkers for invasion. Imaging methods are now available that can detect subtle changes in white matter organisation (diffusion tensor imaging), tumour metabolism and cellular proliferation (using MR spectroscopy and positron emission tomography) occurring in regions of tumour that cannot be detected by conventional imaging. The role of such biomarkers of invasion should allow better delineation of tumour margins, which should improve treatment planning (especially surgery and radiotherapy) and provide information on the invasiveness of an individual tumour to help select the most appropriate therapy and help stratify patients for clinical trials.
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Affiliation(s)
- S J Price
- Academic Neurosurgery Division, Department of Clinical Neuroscience, Addenbrooke's Hospital, Cambridge, UK.
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26
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Abstract
In recent years, advances in the understanding of low-grade glioma (LGG) biology have driven new paradigms in molecular markers, diagnostic imaging, operative techniques and technologies, and adjuvant therapies. Taken together, these developments are collectively pushing the envelope toward improved quality of life and survival. In this article, the authors evaluate the recent literature to synthesize a comprehensive review of LGGs in the modern neurosurgical era.
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Affiliation(s)
- Nader Sanai
- 1Barrow Brain Tumor Research Center, Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - Susan Chang
- 2Brain Tumor Research Center, Department of Neurological Surgery, University of California at San Francisco, California
| | - Mitchel S. Berger
- 2Brain Tumor Research Center, Department of Neurological Surgery, University of California at San Francisco, California
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27
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la Fougère C, Suchorska B, Bartenstein P, Kreth FW, Tonn JC. Molecular imaging of gliomas with PET: opportunities and limitations. Neuro Oncol 2011; 13:806-19. [PMID: 21757446 DOI: 10.1093/neuonc/nor054] [Citation(s) in RCA: 190] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Neuroimaging enables the noninvasive evaluation of glioma and is considered to be one of the key factors for individualized therapy and patient management, since accurate diagnosis and demarcation of viable tumor tissue is required for treatment planning as well as assessment of treatment response. Conventional imaging techniques like MRI and CT reveal morphological information but are of limited value for the assessment of more specific and reproducible information about biology and activity of the tumor. Molecular imaging with PET is increasingly implemented in neuro-oncology, since it provides additional metabolic information of the tumor, both for patient management as well as for evaluation of newly developed therapeutics. Different molecular processes have been proposed to be useful, like glucose consumption, expression of amino acid transporters, proliferation rate, membrane biosynthesis, and hypoxia. Thus, PET might help neuro-oncologists gain further insights into tumor biology by "true molecular imaging" as well as understand treatment-related phenomena. This review describes the method of PET acquisition as well as the tracers used to image biological processes in gliomas. Furthermore, it considers the clinical impact of PET on the use of currently available radiotracers, which were shown to be potentially valuable for discrimination between neoplastic and nonneoplastic tissue, as well as on tumor grading, determinination of treatment response, and providing an outlook toward further developments.
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Affiliation(s)
- Christian la Fougère
- Department of Nuclear Medicine, University of Munich – Campus Grosshadern, Marchioninistr 15, 81377 Munich, Germany
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28
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Abstract
For tumors of the central nervous system (CNS), the ability to accurately delineate the extent of tumor has implications for diagnosis, prognosis, and treatment. PET, mainly with (18)F-fluorodeoxyglucose (FDG), has become commonplace in the work-up of many extracranial tumors. However, the relative high background of FDG-PET activity of normal brain tissue has limited the applicability of this modality in CNS tumors to date. More recently, novel PET tracers for imaging of CNS tumors have been developed. This article outlines recent advances in PET as a complementary imaging modality with implications for diagnosis, prognosis, surgical and radiation treatment planning, and post-therapy surveillance in malignancies of the CNS. Pharmacokinetic properties of the radiotracers and the influence of blood-brain-barrier integrity are also incorporated into the discussion.
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Affiliation(s)
- Donald M Cannon
- Department of Human Oncology and Radiation Oncology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, K4/B100, Madison, WI 53792, USA
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Price SJ, Green HAL, Dean AF, Joseph J, Hutchinson PJ, Gillard JH. Correlation of MR relative cerebral blood volume measurements with cellular density and proliferation in high-grade gliomas: an image-guided biopsy study. AJNR Am J Neuroradiol 2011; 32:501-6. [PMID: 21163880 DOI: 10.3174/ajnr.a2312] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE As newer MR imaging techniques are used to assist with tumor grading, biopsy planning, and therapeutic response assessment, there is a need to relate the imaging characteristics to underlying pathologic processes. The aim of this study was to see how rCBV, a known marker of tumor vascularity, relates to cellular packing attenuation and cellular proliferation. MATERIALS AND METHODS Nine patients with histologically proved high-grade gliomas and 1 with a supratentorial PNET requiring an image-guided biopsy were recruited. Patients underwent a DSC study. The rCBV at the intended biopsy sites was determined by using a histogram measure to derive the mean, maximum, and 75th centile and 90th centile values. This measure was correlated with histologic markers of the MIB-1 labeling index (as a marker of glioma cell proliferation) and the total number of neoplastic cells in a high-power field (cellular packing attenuation). RESULTS There was a good correlation between rCBV and MIB-1 by using all the measures of rCBV. The mean rCBV provided the best results (r = 0.66, P < .001). The only correlation with cellular packing attenuation was with the 90% centile (rCBV(90%), r = 0.36, P = .03). The increase in rCBV could be seen over 1 cm from the edge of enhancement in 4/10 cases, and at 2 cm in 1/10. CONCLUSIONS rCBV correlated with cellular proliferation in high-grade gliomas but not with cellular packing attenuation. The increase in rCBV extended beyond the contrast-enhancing region in 50% of our patients.
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Affiliation(s)
- S J Price
- Academic Neurosurgery Division, Department of Clinical Neurosciences, University of Cambridge, UK.
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18F-FLT and 18F-FDG positron emission tomography for the imaging of advanced well-differentiated gastro-entero-pancreatic endocrine tumours. Nucl Med Commun 2011; 32:91-7. [DOI: 10.1097/mnm.0b013e3283412143] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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31
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Kalinyak JE, Schilling K, Berg WA, Narayanan D, Mayberry JP, Rai R, Dupree EB, Shusterman DK, Gittleman MA, Luo W, Matthews CG. PET-guided breast biopsy. Breast J 2011; 17:143-51. [PMID: 21276128 DOI: 10.1111/j.1524-4741.2010.01044.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Molecular imaging, using positron emission tomography (PET), has become an integral step in the evaluation of many patients with malignancy. However, its use in patients with breast cancer has been limited by the lower levels of (18) F-fluorodeoxyglucose (FDG) uptake in some breast malignancies compared to other cancers, the small size of many breast cancers, and the need for biopsy under PET guidance. High-resolution breast PET, or positron emission mammography (PEM), with biopsy guidance software, now addresses these issues. We report a prospective, multicenter study designed to test the efficacy and safety of PEM biopsy guidance software in women with FDG-avid breast lesions worrisome for malignancy. The intervention chosen was vacuum-assisted core biopsy. Nineteen subjects underwent a total of 24 PEM-guided biopsies. All lesions were successfully targeted and sampled as determined by post-biopsy image scan evaluation, specimen imaging, and pathologic concordance. Invasive cancer was identified in 13 of 24 lesions (54%), while four (17%) were high-risk lesions and three of these were upgraded to malignancy at excision. No serious adverse events occurred and all patients found the procedure to cause only minimal to mild discomfort. High-resolution PEM-guided breast biopsy is both safe and effective for the sampling of PET-depicted breast lesions.
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Chen Z, Ma L, Lou X, Zhou Z. Diagnostic value of minimum apparent diffusion coefficient values in prediction of neuroepithelial tumor grading. J Magn Reson Imaging 2010; 31:1331-8. [PMID: 20512884 DOI: 10.1002/jmri.22175] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To retrospectively evaluate the diagnostic accuracy of diffusion weighted image (DWI) in the prediction of neuroepithelial tumors grading, and to appraise the apparent diffusion coefficient (ADC) value of neuroepithelial tumors with histologic findings as a reference standard. MATERIALS AND METHODS ADC values in 110 patients with pathologically proved neuroepithelial tumors, including 77 astrocytic tumors, 16 oligodendroglial tumors, 11 oligoastrocytic tumors, and 6 ependymal tumors, were investigated retrospectively. The minimum ADC (MinADC) value of tumors was measured postoperatively on ADC maps, avoiding cystic, necrotic, or hemorrhagic components. The Ki-67 Labeling Index (Ki-67 LI) was determined by immunohistochemistry. The patients were classified into low (WHO II) and high (WHO III or IV) grade groups. Correlation analysis, Student t-test, Welch test, receiver operating characteristic (ROC) analysis, and analysis of variance were used for statistical evaluation. RESULTS There was a negative correlation between MinADC value and Ki-67 LI (P < 0.001). The mean MinADC value (1.057 x 10(-3) mm(2)/s) of low grade group was higher than that (0.773 x 10(-3) mm(2)/s) of high grade group. The area under the ROC curve (AUC) was 0.809, and the cutoff MinADC value of 0.900 x 10(-3) mm(2)/s for the differentiation between high and low grade neuroepithelial tumors provided the best combination of sensitivity (85.4%) and specificity (71.0%). CONCLUSION MinADC value may be a simple and effective optional tool for the prediction of neuroepithelial tumor grading.
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Affiliation(s)
- Zhiye Chen
- Department of Radiology, PLA General Hospital, Beijing 100853, China
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The pre-requisite of a second-generation glioma PET biomarker. J Neurol Sci 2010; 298:11-6. [PMID: 20739034 DOI: 10.1016/j.jns.2010.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 07/23/2010] [Accepted: 07/27/2010] [Indexed: 11/20/2022]
Abstract
UNLABELLED Since the introduction of FDG into the field of molecular imaging with positron emission tomography (PET) more than three decades ago, FDG has been the tracer of choice for oncology PET imaging. Despite the relative disadvantages of FDG and the relative benefits of its challengers, FDG remains the most commonly used glioma tracer nowadays. The present article surveys the expectations of the field and gives a concise summary of recent developments; including the issues pertaining to the continued search for an optimal second-generation PET biomarker for glioma. MINI-ABSTRACT The present article gives a concise summary of recent developments; including the issues pertaining to the continued search for an optimal PET biomarker for glioma.
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Alexiou GA, Tsiouris S, Kyritsis AP, Argyropoulou MI, Voulgaris S, Fotopoulos AD. Assessment of glioma proliferation using imaging modalities. J Clin Neurosci 2010; 17:1233-8. [PMID: 20638283 DOI: 10.1016/j.jocn.2010.03.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 01/30/2010] [Accepted: 03/07/2010] [Indexed: 11/30/2022]
Abstract
The assessment of glioma proliferation rate is important to predict tumor behavior, response to therapy and prognosis. Various methods, largely involving immunohistological markers in tissue samples, have been proposed to this aim; however, they all require tissue removal through a biopsy or during a surgical procedure. Consequently, non-invasive imaging modalities that could reliably assess the proliferative potential of intracranial space-occupying lesions in vivo would be of obvious significance. In the present study we review the contribution of MRI, positron emission tomography and single-photon emission CT for the assessment of the proliferative potential of gliomas.
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Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, P.O. Box 1186, Ioannina 45110, Greece.
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Bisdas S, Nägele T, Schlemmer HP, Boss A, Claussen CD, Pichler B, Ernemann U. Switching on the lights for real-time multimodality tumor neuroimaging: The integrated positron-emission tomography/MR imaging system. AJNR Am J Neuroradiol 2010; 31:610-4. [PMID: 19942710 DOI: 10.3174/ajnr.a1900] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A recent report of the feasibility of simultaneous PET/MR imaging of the healthy human brain has sparked excitement in the field of neuroimaging because of its potential influence and utility in clinical neuroscience research. The aim of this communication is to discuss the benefits and current drawbacks of the hybrid imaging system and to highlight some perspectives of the new technique for brain neoplasms.
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Affiliation(s)
- S Bisdas
- Department of Diagnostic and Interventional Neuroradiology, Eberhard Karls University, Tübingen, Germany.
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Abstract
Imaging plays a key role in the management of low-grade gliomas. The traditional view of these tumours as non-enhancing areas of increased signal on T2-weighted imaging is now accepted as being incorrect. Using new MR and PET techniques that can probe the pathological changes with in these tumours by assessing vascularity (perfusion MR), cellularity and infiltration (diffusion weighted and diffusion tensor MR), metabolism (MR spectroscopy and FDG PET) and proliferation (MR spectroscopy, methionine PET and 18F-fluorothymidine FLT PET). These tools will allow improvements in tumour grading, biopsy/therapy guidance and earlier assessment of the response to therapy.
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Affiliation(s)
- Stephen J Price
- Academic Neurosurgery Division, Department of Clinical Neurosciences, Addenbrooke's Hospital, Cambridge, UK
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