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Badve C, Nirappel A, Lo S, Orringer DA, Olson JJ. Congress of neurological surgeons systematic review and evidence-based guidelines for the role of imaging in newly diagnosed WHO grade II diffuse glioma in adults: update. J Neurooncol 2025:10.1007/s11060-025-05043-8. [PMID: 40338482 DOI: 10.1007/s11060-025-05043-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2025] [Accepted: 04/09/2025] [Indexed: 05/09/2025]
Abstract
TARGET POPULATION Adult patients with suspected or histologically proven WHO Grade II diffuse glioma. QUESTION 1: In adult patients with suspected or histologically proven WHO Grade II diffuse glioma, do advanced MRI techniques using magnetic resonance spectroscopy, perfusion weighted imaging or diffusion weighted imaging provide superior assessment of tumor grade, margins, progression, treatment-related effects, and prognosis compared to standard neuroimaging? RECOMMENDATION Level II: The use of diffusion imaging and dynamic susceptibility contrast (DSC), dynamic contrast enhancement (DCE) and arterial spin labeling (ASL) sequences are suggested to differentiate WHO Grade II diffuse glioma from higher grade gliomas when this is not accomplished by T2 weighted and pre- and post-gadolinium contrast enhanced T1 weighted imaging. LEVEL III The use of diffusion and perfusion is suggested for obtaining information in genomics, prognosis, and post treatment monitoring when this information would be of value to the clinician and is not obtained through other methods. LEVEL III The use of MR Spectroscopy is suggested to differentiate WHO Grade II diffuse glioma from higher grade gliomas when this is not accomplished by standard MRI, perfusion and diffusion techniques and when such information would be of value to the clinician. QUESTION 2: In adult patients with suspected or histologically proven WHO Grade II diffuse glioma, does molecular imaging using amino acid PET tracers provide superior assessment of tumor grade, margins, progression, treatment-related effects, and prognosis compared to standard neuroimaging? RECOMMENDATION Level III: If not already evident by MRI studies, the addition of amino acid PET with FET and FDOPA as a tracer is suggested to help determine if a brain lesion is a low grade glioma or high grade glioma. LEVEL III If the standard clinical prognostic parameters are unclear and novel PET tracers are available, the clinician may consider FET to assist in determination of prognosis in an individual with grade II diffuse glioma. LEVEL III Clinicians may use FDOPA PET in addition to MRI if additional information is required for detection of tumor progression.
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Affiliation(s)
- Chaitra Badve
- University Hospitals Cleveland Medical Center, Cleveland, USA.
- Department of Radiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Abraham Nirappel
- Department of Radiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Simon Lo
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Daniel A Orringer
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
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Cruz N, Herculano-Carvalho M, Roque D, Faria CC, Cascão R, Ferreira HA, Reis CP, Matela N. Highlighted Advances in Therapies for Difficult-To-Treat Brain Tumours Such as Glioblastoma. Pharmaceutics 2023; 15:pharmaceutics15030928. [PMID: 36986790 PMCID: PMC10054750 DOI: 10.3390/pharmaceutics15030928] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/25/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023] Open
Abstract
Glioblastoma multiforme (GBM) remains a challenging disease, as it is the most common and deadly brain tumour in adults and has no curative solution and an overall short survival time. This incurability and short survival time means that, despite its rarity (average incidence of 3.2 per 100,000 persons), there has been an increased effort to try to treat this disease. Standard of care in newly diagnosed glioblastoma is maximal tumour resection followed by initial concomitant radiotherapy and temozolomide (TMZ) and then further chemotherapy with TMZ. Imaging techniques are key not only to diagnose the extent of the affected tissue but also for surgery planning and even for intraoperative use. Eligible patients may combine TMZ with tumour treating fields (TTF) therapy, which delivers low-intensity and intermediate-frequency electric fields to arrest tumour growth. Nonetheless, the blood–brain barrier (BBB) and systemic side effects are obstacles to successful chemotherapy in GBM; thus, more targeted, custom therapies such as immunotherapy and nanotechnological drug delivery systems have been undergoing research with varying degrees of success. This review proposes an overview of the pathophysiology, possible treatments, and the most (not all) representative examples of the latest advancements.
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Affiliation(s)
- Nuno Cruz
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal
- iMED.ULisboa, Research Institute for Medicines, Faculdade de Farmácia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal
| | - Manuel Herculano-Carvalho
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
- Department of Neurosurgery, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), 1649-028 Lisboa, Portugal
| | - Diogo Roque
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
- Department of Neurosurgery, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), 1649-028 Lisboa, Portugal
| | - Cláudia C. Faria
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
- Department of Neurosurgery, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), 1649-028 Lisboa, Portugal
| | - Rita Cascão
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Hugo Alexandre Ferreira
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal
| | - Catarina Pinto Reis
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal
- iMED.ULisboa, Research Institute for Medicines, Faculdade de Farmácia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal
- Correspondence: (C.P.R.); (N.M.); Tel.: +351-217-946-400 (ext. 14244) (C.P.R.); Fax: +351-217-946-470 (C.P.R.)
| | - Nuno Matela
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal
- Correspondence: (C.P.R.); (N.M.); Tel.: +351-217-946-400 (ext. 14244) (C.P.R.); Fax: +351-217-946-470 (C.P.R.)
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Multiparametric Characterization of Intracranial Gliomas Using Dynamic [18F]FET-PET and Magnetic Resonance Spectroscopy. Diagnostics (Basel) 2022; 12:diagnostics12102331. [PMID: 36292019 PMCID: PMC9601276 DOI: 10.3390/diagnostics12102331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/17/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
Both static and dynamic O-(2-[18F]fluoroethyl)-l-tyrosine-(FET)-PET and 1H magnetic resonance spectroscopy (MRS) are useful tools for grading and prognostication in gliomas. However, little is known about the potential of multimodal imaging comprising both procedures. We therefore acquired NAA/Cr and Cho/Cr ratios in multi-voxel MRS as well as FET-PET parameters in 67 glioma patients and determined multiparametric parameter combinations. Using receiver operating characteristics, differentiation between low-grade and high-grade glioma was possible by static FET-PET (area under the curve (AUC) 0.86, p = 0.001), time-to-peak (TTP; AUC 0.79, p = 0.049), and using the Cho/Cr ratio (AUC 0.72, p = 0.039), while the multimodal analysis led to improved discrimination with an AUC of 0.97 (p = 0.001). In order to distinguish glioblastoma from non-glioblastoma, MRS (NAA/Cr ratio, AUC 0.66, p = 0.031), and dynamic FET-PET (AUC 0.88, p = 0.001) were superior to static FET imaging. The multimodal analysis increased the accuracy with an AUC of 0.97 (p < 0.001). In the survival analysis, PET parameters, but not spectroscopy, were significantly correlated with overall survival (OS, static PET p = 0.014, TTP p = 0.012), still, the multiparametric analysis, including MRS, was also useful for the prediction of OS (p = 0.002). In conclusion, FET-PET and MRS provide complementary information to better characterize gliomas before therapy, which is particularly interesting with respect to the increasing use of hybrid PET/MRI for brain tumors.
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Hangel G, Lazen P, Sharma S, Hristoska B, Cadrien C, Furtner J, Rausch I, Lipka A, Niess E, Hingerl L, Motyka S, Gruber S, Strasser B, Kiesel B, Preusser M, Roetzer-Pejrimovsky T, Wöhrer A, Bogner W, Widhalm G, Rössler K, Traub-Weidinger T, Trattnig S. 7T HR FID-MRSI Compared to Amino Acid PET: Glutamine and Glycine as Promising Biomarkers in Brain Tumors. Cancers (Basel) 2022; 14:2163. [PMID: 35565293 PMCID: PMC9101868 DOI: 10.3390/cancers14092163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Recent developments in 7T magnetic resonance spectroscopic imaging (MRSI) made the acquisition of high-resolution metabolic images in clinically feasible measurement times possible. The amino acids glutamine (Gln) and glycine (Gly) were identified as potential neuro-oncological markers of importance. For the first time, we compared 7T MRSI to amino acid PET in a cohort of glioma patients. (2) Methods: In 24 patients, we co-registered 7T MRSI and routine PET and compared hotspot volumes of interest (VOI). We evaluated dice similarity coefficients (DSC), volume, center of intensity distance (CoI), median and threshold values for VOIs of PET and ratios of total choline (tCho), Gln, Gly, myo-inositol (Ins) to total N-acetylaspartate (tNAA) or total creatine (tCr). (3) Results: We found that Gln and Gly ratios generally resulted in a higher correspondence to PET than tCho. Using cutoffs of 1.6-times median values of a control region, DSCs to PET were 0.53 ± 0.36 for tCho/tNAA, 0.66 ± 0.40 for Gln/tNAA, 0.57 ± 0.36 for Gly/tNAA, and 0.38 ± 0.31 for Ins/tNAA. (4) Conclusions: Our 7T MRSI data corresponded better to PET than previous studies at lower fields. Our results for Gln and Gly highlight the importance of future research (e.g., using Gln PET tracers) into the role of both amino acids.
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Affiliation(s)
- Gilbert Hangel
- High-Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (P.L.); (S.S.); (B.H.); (C.C.); (A.L.); (E.N.); (L.H.); (S.M.); (S.G.); (B.S.); (W.B.); (S.T.)
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (B.K.); (G.W.); (K.R.)
| | - Philipp Lazen
- High-Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (P.L.); (S.S.); (B.H.); (C.C.); (A.L.); (E.N.); (L.H.); (S.M.); (S.G.); (B.S.); (W.B.); (S.T.)
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (B.K.); (G.W.); (K.R.)
| | - Sukrit Sharma
- High-Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (P.L.); (S.S.); (B.H.); (C.C.); (A.L.); (E.N.); (L.H.); (S.M.); (S.G.); (B.S.); (W.B.); (S.T.)
| | - Barbara Hristoska
- High-Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (P.L.); (S.S.); (B.H.); (C.C.); (A.L.); (E.N.); (L.H.); (S.M.); (S.G.); (B.S.); (W.B.); (S.T.)
- Department Applied Life Sciences, University of Applied Sciences Campus Vienna, 1100 Vienna, Austria
| | - Cornelius Cadrien
- High-Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (P.L.); (S.S.); (B.H.); (C.C.); (A.L.); (E.N.); (L.H.); (S.M.); (S.G.); (B.S.); (W.B.); (S.T.)
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (B.K.); (G.W.); (K.R.)
| | - Julia Furtner
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Ivo Rausch
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria;
| | - Alexandra Lipka
- High-Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (P.L.); (S.S.); (B.H.); (C.C.); (A.L.); (E.N.); (L.H.); (S.M.); (S.G.); (B.S.); (W.B.); (S.T.)
| | - Eva Niess
- High-Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (P.L.); (S.S.); (B.H.); (C.C.); (A.L.); (E.N.); (L.H.); (S.M.); (S.G.); (B.S.); (W.B.); (S.T.)
| | - Lukas Hingerl
- High-Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (P.L.); (S.S.); (B.H.); (C.C.); (A.L.); (E.N.); (L.H.); (S.M.); (S.G.); (B.S.); (W.B.); (S.T.)
| | - Stanislav Motyka
- High-Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (P.L.); (S.S.); (B.H.); (C.C.); (A.L.); (E.N.); (L.H.); (S.M.); (S.G.); (B.S.); (W.B.); (S.T.)
| | - Stephan Gruber
- High-Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (P.L.); (S.S.); (B.H.); (C.C.); (A.L.); (E.N.); (L.H.); (S.M.); (S.G.); (B.S.); (W.B.); (S.T.)
| | - Bernhard Strasser
- High-Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (P.L.); (S.S.); (B.H.); (C.C.); (A.L.); (E.N.); (L.H.); (S.M.); (S.G.); (B.S.); (W.B.); (S.T.)
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (B.K.); (G.W.); (K.R.)
| | - Matthias Preusser
- Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
| | - Thomas Roetzer-Pejrimovsky
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (T.R.-P.); (A.W.)
| | - Adelheid Wöhrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (T.R.-P.); (A.W.)
| | - Wolfgang Bogner
- High-Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (P.L.); (S.S.); (B.H.); (C.C.); (A.L.); (E.N.); (L.H.); (S.M.); (S.G.); (B.S.); (W.B.); (S.T.)
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (B.K.); (G.W.); (K.R.)
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (B.K.); (G.W.); (K.R.)
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Siegfried Trattnig
- High-Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (P.L.); (S.S.); (B.H.); (C.C.); (A.L.); (E.N.); (L.H.); (S.M.); (S.G.); (B.S.); (W.B.); (S.T.)
- Institute for Clinical Molecular MRI, Karl Landsteiner Society, 3100 St. Pölten, Austria
- Christian Doppler Laboratory for Clinical Molecular MR Imaging, Christian Doppler Research Association, 1090 Vienna, Austria
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Jaswal A, Hazari PP, Prakash S, Sethi P, Kaushik A, Roy BG, Kathait S, Singh B, Mishra AK. [ 99mTc]Tc-DTPA-Bis(cholineethylamine) as an Oncologic Tracer for the Detection of Choline Transporter (ChT) and Choline Kinase (ChK) Expression in Cancer. ACS OMEGA 2022; 7:12509-12523. [PMID: 35474820 PMCID: PMC9025991 DOI: 10.1021/acsomega.1c04256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The elevated choline transporters (ChT), choline kinase (ChK), choline uptake, and phosphorylation in certain tumor cells have influenced the development of radiolabeled choline derivatives as diagnostic probes for imaging cell membrane proliferation. We, therefore, aimed to develop a choline-based moiety for imaging choline kinase-overexpressed tumors by single-photon emission tomography (SPECT). A novel choline-based diagnostic probe was synthesized and evaluated preclinically in various ChT- and ChK-overexpressed tumor models for SPECT imaging applications. METHODS The synthesis of diethylenetriaminepentaacetic acid-bis-choline ethylamine [DTPA-bis(ChoEA)] featured the conjugation of dimethylaminoethanol to a bifunctional chelator DTPA anhydride. [99mTc]Tc-DTPA-bis(ChoEA) was prepared, and its in vivo characteristics were evaluated in BALB/c mice and tumor-xenografted PC3, A549, and HCT116 athymic mouse models. The in vitro parameters, including cell binding and cytotoxicity, were assessed in PC3, A549, and HCT116 cell lines. To evaluate the specificity of the radioprobe, competitive binding studies were performed. Small-animal SPECT/CT diagnostic imaging was performed for in vivo evaluation. The mouse biodistribution data was further investigated to estimate the radiation dose in humans. RESULTS In silico studies suggested high binding with enhanced specificity. A standard radiolabeling procedure using stannous chloride as a reducing agent showed a labeling yield of 99.5 ± 0.5%. The in silico studies suggested high binding with enhanced specificity. [99mTc]Tc-DTPA-bis(ChoEA) showed high in vitro stability and specificity. The pharmacokinetic studies of [99mTc]Tc-DTPA-bis(ChoEA) in mice showed an increased tumor-to-background ratio after few minutes of intravenous administration. The first-in-human trial was also conducted. The effective dose was estimated to be 0.00467 mSv/MBq (4.67 mSv/GBq), resulting in a radiation dose of up to 1.73 mSv for the 370 MBq injection of [99mTc]Tc-DTPA-bis(ChoEA). CONCLUSIONS The synthesized radioprobe [99mTc]Tc-DTPA-bis(ChoEA) accumulates specifically in choline kinase-overexpressed tumors with a high signal-to-noise ratio. The preclinical and first-in-man data suggested that [99mTc]Tc-DTPA-bis(ChoEA) could potentially be used as a diagnostic SPECT tracer in the monitoring and staging of cancer.
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Affiliation(s)
- Ambika
Parmar Jaswal
- Division
of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Sciences, Brig S.K. Mazumdar Road, Delhi 110054, India
| | - Puja Panwar Hazari
- Division
of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Sciences, Brig S.K. Mazumdar Road, Delhi 110054, India
| | - Surbhi Prakash
- Division
of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Sciences, Brig S.K. Mazumdar Road, Delhi 110054, India
| | - Pallavi Sethi
- Division
of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Sciences, Brig S.K. Mazumdar Road, Delhi 110054, India
| | - Aruna Kaushik
- Department
of Nuclear Medicine, Institute of Nuclear
Medicine and Allied Sciences, Brig S.K. Mazumdar Road, Delhi 110054, India
| | - Bal G. Roy
- Experimental
Animal Facility, Institute of Nuclear Medicine
and Allied Sciences, Brig S.K. Mazumdar Road, Delhi 110054, India
| | - Swati Kathait
- Division
of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Sciences, Brig S.K. Mazumdar Road, Delhi 110054, India
| | - Baljinder Singh
- Post
Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Anil Kumar Mishra
- Division
of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Sciences, Brig S.K. Mazumdar Road, Delhi 110054, India
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Laudicella R, Bauckneht M, Cuppari L, Donegani MI, Arnone A, Baldari S, Burger IA, Quartuccio N, Young Italian Association of Nuclear Medicine (AIMN) Group. Emerging applications of imaging in glioma: focus on PET/MRI and radiomics. Clin Transl Imaging 2021; 9:609-623. [DOI: 10.1007/s40336-021-00464-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/17/2021] [Indexed: 02/07/2023]
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Schäfer JF, Tsiflikas I, Esser M, Dittmann H, Bender B, Gatidis S. Kombinierte Positronenemissions-Magnetresonanztomographie (PET/MRT) bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00889-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Gliomas are the most common primary brain tumours in children and adults, consisting of a heterogeneous group of neoplastic diseases arise from the supporting cells of the CNS (glial cells). Their histopathological and molecular characteristics vary considerably as do their management and prognosis. Conventional gadolinium-enhanced magnetic resonance imaging (MRI) is considered the primary imaging modality for initial work up and follow up of patients with gliomas, although it has some limitations, especially in differentiating high from low grade tumours and in distinguishing disease recurrence from post-therapy changes. Hybrid positron emission tomography (PET)/MRI is a relatively novel tool that combines MRI sequences with metabolic information from PET, and therefore different PET radiotracers, in a single scan. This article discusses the main advantages and disadvantages of combined PET/MRI compared to other conventional or more widely available imaging tools, such as MRI or combined positron emission tomography-computed tomography. The main uses of PET/MRI and the most commonly used PET radiotracers in providing diagnostic, prognostic and predictive information in patients with glioma are covered.
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Affiliation(s)
- Karar O Almansory
- Specialist Registrar, Institute of Nuclear Medicine, University College London Hospitals, London NW1 2BU
| | - Francesco Fraioli
- Consultant Radiologist and Nuclear Medicine Physician, Institute of Nuclear Medicine, University College London Hospitals, London
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Radionuclide Imaging of Children. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Jooma R, Waqas M, Khan I. Diffuse Low-Grade Glioma - Changing Concepts in Diagnosis and Management: A Review. Asian J Neurosurg 2019; 14:356-363. [PMID: 31143247 PMCID: PMC6516028 DOI: 10.4103/ajns.ajns_24_18] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Though diffuse low-grade gliomas (dLGGs) represent only 15% of gliomas, they have been receiving increasing attention in the past decade. Significant advances in knowledge of the natural history and clinical diversity have been documented, and an improved pathological classification of gliomas that integrates histological features with molecular markers has been issued by the WHO. Advances in the radiological assessment of dLGG, particularly new magnetic resonance imaging scanning sequences, allow improved diagnostic and prognostic information. The management paradigms are evolving from “wait and watch” of the past to more active interventional therapy to obviate the risk of malignant transformation. New surgical technologies allow more aggressive surgical resections with a reduction of morbidity. Many reports suggest the association of gross total resection with longer overall survival and progression-free survival in addition to better seizure control. The literature also shows the use of chemotherapeutics and radiation therapy as important adjuncts to surgery. The goals of management have has been increasing survival with increasing stress on quality of life. Our review highlights the recent advances in the molecular diagnosis and management of dLGG with trends toward multidisciplinary and multimodality management of dLGG with an aim to surgically resect the primary disease, followed by chemoradiation in cases of progressive or recurrent disease.
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Affiliation(s)
- Rashid Jooma
- Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Waqas
- Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Inamullah Khan
- Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
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Näslund O, Smits A, Förander P, Laesser M, Bartek J, Gempt J, Liljegren A, Daxberg EL, Jakola AS. Amino acid tracers in PET imaging of diffuse low-grade gliomas: a systematic review of preoperative applications. Acta Neurochir (Wien) 2018; 160:1451-1460. [PMID: 29797098 PMCID: PMC5995993 DOI: 10.1007/s00701-018-3563-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/09/2018] [Indexed: 11/28/2022]
Abstract
Positron emission tomography (PET) imaging using amino acid tracers has in recent years become widely used in the diagnosis and prediction of disease course in diffuse low-grade gliomas (LGG). However, implications of preoperative PET for treatment and prognosis in this patient group have not been systematically studied. The aim of this systematic review was to evaluate the preoperative diagnostic and prognostic value of amino acid PET in suspected diffuse LGG. Medline, Cochrane Library, and Embase databases were systematically searched using keywords "PET," "low-grade glioma," and "amino acids tracers" with their respective synonyms. Out of 2137 eligible studies, 28 met the inclusion criteria. Increased amino acid uptake (lesion/brain) was consistently reported among included studies; in 25-92% of subsequently histopathology-verified LGG, in 83-100% of histopathology-verified HGG, and also in some non-neoplastic lesions. No consistent results were found in studies reporting hot spot areas on PET in MRI-suspected LGG. Thus, the diagnostic value of amino acid PET imaging in suspected LGG has proven difficult to interpret, showing clear overlap and inconsistencies among reported results. Similarly, the results regarding the prognostic value of PET in suspected LGG and the correlation between uptake ratios and the molecular tumor status of LGG were conflicting. This systematic review illustrates the difficulties with prognostic studies presenting data on group-level without adjustment for established clinical prognostic factors, leading to a loss of additional prognostic information. We conclude that the prognostic value of PET is limited to analysis of histological subgroups of LGG and is probably strongest when using kinetic analysis of dynamic FET uptake parameters.
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Affiliation(s)
- Olivia Näslund
- Sahlgrenska Academy, Medicinaregatan 3, 41390, Gothenburg, Sweden.
| | - Anja Smits
- Institute of Physiology and Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Petter Förander
- Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Laesser
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jiri Bartek
- Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ann Liljegren
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva-Lotte Daxberg
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Asgeir Store Jakola
- Institute of Physiology and Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden
- Medical Library, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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12
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PET/MRI in children. Eur J Radiol 2017; 94:A64-A70. [DOI: 10.1016/j.ejrad.2017.01.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 01/30/2023]
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13
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Mauler J, Maudsley AA, Langen KJ, Nikoubashman O, Stoffels G, Sheriff S, Lohmann P, Filss C, Galldiks N, Kops ER, Shah NJ. Spatial Relationship of Glioma Volume Derived from 18F-FET PET and Volumetric MR Spectroscopy Imaging: A Hybrid PET/MRI Study. J Nucl Med 2017; 59:603-609. [PMID: 28848036 DOI: 10.2967/jnumed.117.196709] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/01/2017] [Indexed: 11/16/2022] Open
Abstract
PET imaging of amino acid transport using O-(2-18F-fluoroethyl)-l-tyrosine (18F-FET) and proton MR spectroscopy (MRS) imaging of cell turnover measured by the ratio of choline to N-acetyl-aspartate (Cho/NAA) may provide additional information on tumor extent of cerebral gliomas compared with anatomic imaging; however, comparative studies are rare. Methods: In this prospective study, 41 patients (16 women, 25 men; mean age ± SD, 48 ± 14 y) with cerebral gliomas (World Health Organization [WHO] grade II: 10 [including 1 patient with 2 lesions], WHO III: 17, WHO IV: 13, without biopsy low-grade: 1, high-grade: 1) were investigated with a hybrid PET/MR scanner. Tumor extent, spatial overlap, and the distance between the corresponding centers of mass in 18F-FET PET and MRS imaging of Cho/NAA, determined by simultaneously acquired, 3-dimensional spatially resolved MRS imaging data, were compared. Results: The average tumor volumes for 18F-FET uptake and increased Cho/NAA were 19 ± 20 cm3 (mean ± SD) and 22 ± 24 cm3, respectively, with an overlap of 40% ± 25% and separation of the centers of mass by 9 ± 8 mm. None of the parameters showed a significant correlation with tumor grade. Conclusion:18F-FET uptake and increased Cho/NAA ratio are not always congruent and may represent different properties of glioma metabolism. The relationship to histologic tumor extent needs to be further analyzed.
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Affiliation(s)
- Jörg Mauler
- Institute of Neuroscience and Medicine, Medical Imaging Physics (INM-4), Forschungszentrum Jülich, Jülich, Germany
| | - Andrew A Maudsley
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine, Medical Imaging Physics (INM-4), Forschungszentrum Jülich, Jülich, Germany.,Department of Nuclear Medicine, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,JARA-Jülich Aachen Research Alliance, Aachen, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine, Medical Imaging Physics (INM-4), Forschungszentrum Jülich, Jülich, Germany
| | - Sulaiman Sheriff
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine, Medical Imaging Physics (INM-4), Forschungszentrum Jülich, Jülich, Germany
| | - Christian Filss
- Institute of Neuroscience and Medicine, Medical Imaging Physics (INM-4), Forschungszentrum Jülich, Jülich, Germany.,Department of Nuclear Medicine, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Forschungszentrum Jülich, Jülich, Germany.,Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany.,Department of Neurology, University of Cologne, Cologne, Germany; and
| | - Elena Rota Kops
- Institute of Neuroscience and Medicine, Medical Imaging Physics (INM-4), Forschungszentrum Jülich, Jülich, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine, Medical Imaging Physics (INM-4), Forschungszentrum Jülich, Jülich, Germany.,JARA-Jülich Aachen Research Alliance, Aachen, Germany.,Department of Neurology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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14
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Abstract
PET/MR imaging benefits neurologic clinical care and research by providing spatially and temporally matched anatomic MR imaging, advanced MR physiologic imaging, and metabolic PET imaging. MR imaging sequences and PET tracers can be modified to target physiology specific to a neurologic disease process, with applications in neurooncology, epilepsy, dementia, cerebrovascular disease, and psychiatric and neurologic research. Simultaneous PET/MR imaging provides efficient acquisition of multiple temporally matched datasets, and opportunities for motion correction and improved anatomic assignment of PET data. Current challenges include optimizing MR imaging-based attenuation correction and necessity for dual expertise in PET and MR imaging.
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Affiliation(s)
- Michelle M Miller-Thomas
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Campus Box 8131, St Louis, MO 63110, USA.
| | - Tammie L S Benzinger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Campus Box 8131, St Louis, MO 63110, USA
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15
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Pyka T, Gempt J, Bette S, Ringel F, Förster S. Positron emission tomography and magnetic resonance spectroscopy in cerebral gliomas. Clin Transl Imaging 2017. [DOI: 10.1007/s40336-017-0222-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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16
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Marner L, Henriksen OM, Lundemann M, Larsen VA, Law I. Clinical PET/MRI in neurooncology: opportunities and challenges from a single-institution perspective. Clin Transl Imaging 2016; 5:135-149. [PMID: 28936429 PMCID: PMC5581366 DOI: 10.1007/s40336-016-0213-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 10/31/2016] [Indexed: 01/17/2023]
Abstract
Purpose Magnetic resonance imaging (MRI) plays a key role in neurooncology, i.e., for diagnosis, treatment evaluation and detection of recurrence. However, standard MRI cannot always separate malignant tissue from other pathologies or treatment-induced changes. Advanced MRI techniques such as diffusion-weighted imaging, perfusion imaging and spectroscopy show promising results in discriminating malignant from benign lesions. Further, supplemental imaging with amino acid positron emission tomography (PET) has been shown to increase accuracy significantly and is used routinely at an increasing number of sites. Several centers are now implementing hybrid PET/MRI systems allowing for multiparametric imaging, combining conventional MRI with advanced MRI and amino acid PET imaging. Neurooncology is an obvious focus area for PET/MR imaging. Methods Based on the literature and our experience from more than 300 PET/MRI examinations of brain tumors with 18F-fluoro-ethyl-tyrosine, the clinical use of PET/MRI in adult and pediatric neurooncology is critically reviewed. Results Although the results are increasingly promising, the added value and range of indications for multiparametric imaging with PET/MRI are yet to be established. Robust solutions to overcome the number of issues when using a PET/MRI scanner are being developed, which is promising for a more routine use in the future. Conclusions In a clinical setting, a PET/MRI scan may increase accuracy in discriminating recurrence from treatment changes, although sequential same-day imaging on separate systems will often constitute a reliable and cost-effective alternative. Pediatric patients who require general anesthesia will benefit the most from simultaneous PET and MR imaging.
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Affiliation(s)
- Lisbeth Marner
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark
| | - Otto M Henriksen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark
| | - Michael Lundemann
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark
| | - Vibeke Andrée Larsen
- Department of Radiology, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark
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17
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18
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19
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Abstract
Metabolic imaging enhances understanding of disease metabolisms and holds great potential as a measurement tool for evaluating disease prognosis and treatment effectiveness. Advancement of techniques, such as magnetic resonance spectroscopy, positron emission tomography, and mass spectrometry, allows for improved accuracy for quantification of metabolites and present unique possibilities for use in clinic. This article reviews and discusses literature reports of metabolic imaging in humans published since 2010 according to disease type, including cancer, degenerative disorders, psychiatric disorders, and others, as well as the current application of the various related techniques.
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Affiliation(s)
- Taylor L. Fuss
- Departments of Radiology and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114 USA
| | - Leo L. Cheng
- Departments of Radiology and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114 USA
- Corresponding Author: Leo L. Cheng, PhD, 149 13 Street, CNY-6, Charlestown, MA 02129, Ph.617-724-6593, Fax.617-726-5684,
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20
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Abstract
A previous review published in 2012 demonstrated the role of clinical PET for diagnosis and management of brain tumors using mainly FDG, amino acid tracers, and 18F-fluorothymidine. This review provides an update on clinical PET studies, most of which are motivated by prediction of prognosis and planning and monitoring of therapy in gliomas. For FDG, there has been additional evidence supporting late scanning, and combination with 13N ammonia has yielded some promising results. Large neutral amino acid tracers have found widespread applications mostly based on 18F-labeled compounds fluoroethyltyrosine and fluorodopa for targeting biopsies, therapy planning and monitoring, and as outcome markers in clinical trials. 11C-alpha-methyltryptophan (AMT) has been proposed as an alternative to 11C-methionine, and there may also be a role for cyclic amino acid tracers. 18F-fluorothymidine has shown strengths for tumor grading and as an outcome marker. Studies using 18F-fluorocholine (FCH) and 68Ga-labeled compounds are promising but have not yet clearly defined their role. Studies on radiotherapy planning have explored the use of large neutral amino acid tracers to improve the delineation of tumor volume for irradiation and the use of hypoxia markers, in particular 18F-fluoromisonidazole. Many studies employed the combination of PET with advanced multimodal MR imaging methods, mostly demonstrating complementarity and some potential benefits of hybrid PET/MR.
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Affiliation(s)
- Karl Herholz
- The University of Manchester, Division of Neuroscience and Experimental Psychology Wolfson Molecular Imaging Centre, Manchester, England, United Kingdom.
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21
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Abstract
The introduction of hybrid PET/MRI systems allows simultaneous multimodality image acquisition of high technical quality. This technique is well suited for the brain, and particularly in dementia and neuro-oncology. In routine use combinations of well-established MRI sequences and PET tracers provide the most optimal and clinically valuable protocols. For dementia the [18F]-fluorodeoxyglucose (FDG) has merit with a simultaneous four sequence MRI protocol of 20 min supported by supplementary statistical reading tools and quantitative measurements of the hippocampal volume. Clinical PET/MRI using [18F]-fluoro-ethyl-tyrosine (FET) also abide to the expectations of the adaptive and versatile diagnostic tool necessary in neuro-oncology covering both simple 20 min protocols for routine treatment surveillance and complicated 90 min brain and spinal cord protocols in pediatric neuro-oncology under general anesthesia. The clinical value of adding advanced MRI sequences in multiparametric imaging setting, however, is still undocumented.
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Affiliation(s)
- Otto M Henriksen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, 9, Blegdamsvej, Copenhagen 2100-DK, Denmark
| | - Lisbeth Marner
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, 9, Blegdamsvej, Copenhagen 2100-DK, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, 9, Blegdamsvej, Copenhagen 2100-DK, Denmark.
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22
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Hirano Y, Nishikido F, Kokuryo D, Yamaya T. After-pulsing, cross-talk, dark-count, and gain of MPPC under 7-T static magnetic field. Radiol Phys Technol 2016; 9:245-53. [PMID: 27188511 DOI: 10.1007/s12194-016-0356-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/28/2016] [Accepted: 05/04/2016] [Indexed: 11/28/2022]
Abstract
Multi-pixel photon counters (MPPCs) have been used instead of photomultiplier tubes for positron emission tomography combined with magnetic resonance (PET-MR). However, the effects of the magnetic field (MF) on the intrinsic properties-gain, cross-talk, after-pulsing, and dark-count-have not been sufficiently investigated. Therefore, we measured these properties for two types of MPPCs-S10931-50P and S12572-50P-in a static 7-T MF. These properties were measured with a pulse-shape analysis using pulse data acquired by a digital oscilloscope in the presence of the MF (w/MF) and the absence of the MF (w/o MF) by changing the supplied over-voltages (from 0.95 to 2.1 V for S10931 and from 2.1 to 3.3 V for S12572). No significant differences between the w/MF and w/o MF cases were observed for either MPPC, suggesting that the gain, cross-talk, after-pulsing, and dark-count are insensitive to a 7-T MF. The present work shows that constant MPPC performance is expected under a strong MF and demonstrates positive results for PET-MR.
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Affiliation(s)
- Yoshiyuki Hirano
- Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan. .,Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
| | - Fumihiko Nishikido
- Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Daisuke Kokuryo
- Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Taiga Yamaya
- Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
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23
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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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24
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Bailey DL, Antoch G, Bartenstein P, Barthel H, Beer AJ, Bisdas S, Bluemke DA, Boellaard R, Claussen CD, Franzius C, Hacker M, Hricak H, la Fougère C, Gückel B, Nekolla SG, Pichler BJ, Purz S, Quick HH, Sabri O, Sattler B, Schäfer J, Schmidt H, van den Hoff J, Voss S, Weber W, Wehrl HF, Beyer T. Combined PET/MR: The Real Work Has Just Started. Summary Report of the Third International Workshop on PET/MR Imaging; February 17-21, 2014, Tübingen, Germany. Mol Imaging Biol 2016; 17:297-312. [PMID: 25672749 PMCID: PMC4422837 DOI: 10.1007/s11307-014-0818-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This paper summarises the proceedings and discussions at the third annual workshop held in Tübingen, Germany, dedicated to the advancement of the technical, scientific and clinical applications of combined PET/MRI systems in humans. Two days of basic scientific and technical instructions with "hands-on" tutorials were followed by 3 days of invited presentations from active researchers in this and associated fields augmented by round-table discussions and dialogue boards with specific themes. These included the use of PET/MRI in paediatric oncology and in adult neurology, oncology and cardiology, the development of multi-parametric analyses, and efforts to standardise PET/MRI examinations to allow pooling of data for evaluating the technology. A poll taken on the final day demonstrated that over 50 % of those present felt that while PET/MRI technology underwent an inevitable slump after its much-anticipated initial launch, it was now entering a period of slow, progressive development, with new key applications emerging. In particular, researchers are focusing on exploiting the complementary nature of the physiological (PET) and biochemical (MRI/MRS) data within the morphological framework (MRI) that these devices can provide. Much of the discussion was summed up on the final day when one speaker commented on the state of PET/MRI: "the real work has just started".
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Affiliation(s)
- D L Bailey
- Department of Nuclear Medicine, Royal North Shore Hospital, and Faculty of Health Sciences, University of Sydney, Sydney, Australia
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25
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Early static 18F-FET-PET scans have a higher accuracy for glioma grading than the standard 20–40 min scans. Eur J Nucl Med Mol Imaging 2015; 43:1105-14. [DOI: 10.1007/s00259-015-3276-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/27/2015] [Indexed: 12/31/2022]
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Nensa F, Beiderwellen K, Heusch P, Wetter A. Clinical applications of PET/MRI: current status and future perspectives. Diagn Interv Radiol 2015; 20:438-47. [PMID: 25010371 DOI: 10.5152/dir.2014.14008] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Fully integrated positron emission tomography (PET)/magnetic resonance imaging (MRI) scanners have been available for a few years. Since then, the number of scanner installations and published studies have been growing. While feasibility of integrated PET/MRI has been demonstrated for many clinical and preclinical imaging applications, now those applications where PET/MRI provides a clear benefit in comparison to the established reference standards need to be identified. The current data show that those particular applications demanding multiparametric imaging capabilities, high soft tissue contrast and/or lower radiation dose seem to benefit from this novel hybrid modality. Promising results have been obtained in whole-body cancer staging in non-small cell lung cancer and multiparametric tumor imaging. Furthermore, integrated PET/MRI appears to have added value in oncologic applications requiring high soft tissue contrast such as assessment of liver metastases of neuroendocrine tumors or prostate cancer imaging. Potential benefit of integrated PET/MRI has also been demonstrated for cardiac (i.e., myocardial viability, cardiac sarcoidosis) and brain (i.e., glioma grading, Alzheimer's disease) imaging, where MRI is the predominant modality. The lower radiation dose compared to PET/computed tomography will be particularly valuable in the imaging of young patients with potentially curable diseases.However, further clinical studies and technical innovation on scanner hard- and software are needed. Also, agreements on adequate refunding of PET/MRI examinations need to be reached. Finally, the translation of new PET tracers from preclinical evaluation into clinical applications is expected to foster the entire field of hybrid PET imaging, including PET/MRI.
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Affiliation(s)
- Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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27
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Henriksen OM, Larsen VA, Muhic A, Hansen AE, Larsson HBW, Poulsen HS, Law I. Simultaneous evaluation of brain tumour metabolism, structure and blood volume using [(18)F]-fluoroethyltyrosine (FET) PET/MRI: feasibility, agreement and initial experience. Eur J Nucl Med Mol Imaging 2015; 43:103-112. [PMID: 26363903 DOI: 10.1007/s00259-015-3183-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/24/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Both [(18)F]-fluoroethyltyrosine (FET) PET and blood volume (BV) MRI supplement routine T1-weighted contrast-enhanced MRI in gliomas, but whether the two modalities provide identical or complementary information is unresolved. The aims of the study were to investigate the feasibility of simultaneous structural MRI, BV MRI and FET PET of gliomas using an integrated PET/MRI scanner and to assess the spatial and quantitative agreement in tumour imaging between BV MRI and FET PET. METHODS A total of 32 glioma patients underwent a 20-min static simultaneous PET/MRI acquisition on a Siemens mMR system 20 min after injection of 200 MBq FET. The MRI protocol included standard structural MRI and dynamic susceptibility contrast (DSC) imaging for BV measurements. Maximal relative tumour FET uptake (TBRmax) and BV (rBVmax), and Dice coefficients were calculated to assess the quantitative and spatial congruence in the tumour volumes determined by FET PET, BV MRI and contrast-enhanced MRI. RESULTS FET volume and TBRmax were higher in BV-positive than in BV-negative scans, and both VOLBV and rBVmax were higher in FET-positive than in FET-negative scans. TBRmax and rBVmax were positively correlated (R (2) = 0.59, p < 0.001). FET and BV positivity were in agreement in only 26 of the 32 patients and in 42 of 63 lesions, and spatial congruence in the tumour volumes as assessed by the Dice coefficients was generally poor with median Dice coefficients exceeding 0.1 in less than half the patients positive on at least one modality for any pair of modalities. In 56 % of the patients susceptibility artefacts in DSC BV maps overlapped the tumour on MRI. CONCLUSION The study demonstrated that although tumour volumes determined by BV MRI and FET PET were quantitatively correlated, their spatial congruence in a mixed population of treated glioma patients was generally poor, and the modalities did not provide the same information in this population of patients. Combined imaging of brain tumour metabolism and perfusion using hybrid PET/MR systems may provide complementary information on tumour biology, but the potential clinical value remains to be determined in future trials.
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Affiliation(s)
- Otto M Henriksen
- Department of Clinical Physiology Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet Blegdamsvej, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Vibeke A Larsen
- Department of Radiology, Copenhagen University Hospital Rigshospitalet Blegdamsvej, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Aida Muhic
- Department of Oncology, Copenhagen University Hospital Rigshospitalet Blegdamsvej, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Adam E Hansen
- Department of Clinical Physiology Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet Blegdamsvej, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Henrik B W Larsson
- Functional Imaging Unit, Department of Clinical Physiology Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet Glostrup, Ndr. Ringvej 57, 2600, Glostrup, Denmark
| | - Hans S Poulsen
- Department of Oncology, Copenhagen University Hospital Rigshospitalet Blegdamsvej, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet Blegdamsvej, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Magnetic Resonance Imaging and Computed Tomography of the Brain—50 Years of Innovation, With a Focus on the Future. Invest Radiol 2015; 50:551-6. [DOI: 10.1097/rli.0000000000000170] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Fink JR, Muzi M, Peck M, Krohn KA. Multimodality Brain Tumor Imaging: MR Imaging, PET, and PET/MR Imaging. J Nucl Med 2015; 56:1554-61. [PMID: 26294301 DOI: 10.2967/jnumed.113.131516] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 08/18/2015] [Indexed: 01/16/2023] Open
Abstract
Standard MR imaging and CT are routinely used for anatomic diagnosis in brain tumors. Pretherapy planning and posttreatment response assessments rely heavily on gadolinium-enhanced MR imaging. Advanced MR imaging techniques and PET imaging offer physiologic, metabolic, or functional information about tumor biology that goes beyond the diagnostic yield of standard anatomic imaging. With the advent of combined PET/MR imaging scanners, we are entering an era wherein the relationships among different elements of tumor metabolism can be simultaneously explored through multimodality MR imaging and PET imaging. The purpose of this review is to provide a practical and clinically relevant overview of current anatomic and physiologic imaging of brain tumors as a foundation for further investigations, with a primary focus on MR imaging and PET techniques that have demonstrated utility in the current care of brain tumor patients.
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Affiliation(s)
- James R Fink
- Department of Radiology, University of Washington, Seattle, Washington
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, Washington
| | - Melinda Peck
- Department of Radiology, University of Washington, Seattle, Washington
| | - Kenneth A Krohn
- Department of Radiology, University of Washington, Seattle, Washington
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Bisdas S, lá Fougere C, Ernemann U. Hybrid MR-PET in Neuroimaging. Clin Neuroradiol 2015; 25 Suppl 2:275-81. [DOI: 10.1007/s00062-015-0427-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/25/2015] [Indexed: 12/27/2022]
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Gómez-Río M, Testart Dardel N, Santiago Chinchilla A, Rodríguez-Fernández A, Olivares Granados G, Luque Caro R, Zurita Herrera M, Chamorro Santos CE, Lardelli-Claret P, Llamas-Elvira JM. 18F-Fluorocholine PET/CT as a complementary tool in the follow-up of low-grade glioma: diagnostic accuracy and clinical utility. Eur J Nucl Med Mol Imaging 2015; 42:886-95. [DOI: 10.1007/s00259-015-2997-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/14/2015] [Indexed: 11/30/2022]
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Werner P, Barthel H, Drzezga A, Sabri O. Current status and future role of brain PET/MRI in clinical and research settings. Eur J Nucl Med Mol Imaging 2015; 42:512-26. [PMID: 25573629 DOI: 10.1007/s00259-014-2970-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/03/2014] [Indexed: 12/11/2022]
Abstract
Hybrid PET/MRI systematically offers a complementary combination of two modalities that has often proven itself superior to the single modality approach in the diagnostic work-up of many neurological and psychiatric diseases. Emerging PET tracers, technical advances in multiparametric MRI and obvious workflow advantages may lead to a significant improvement in the diagnosis of dementia disorders, neurooncological diseases, epilepsy and neurovascular diseases using PET/MRI. Moreover, simultaneous PET/MRI is well suited to complex studies of brain function in which fast fluctuations of brain signals (e.g. related to task processing or in response to pharmacological interventions) need to be monitored on multiple levels. Initial simultaneous studies have already demonstrated that these complementary measures of brain function can provide new insights into the functional and structural organization of the brain.
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Affiliation(s)
- P Werner
- Department of Nuclear Medicine, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany
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Heiss WD. Clinical Impact of Amino Acid PET in Gliomas. J Nucl Med 2014; 55:1219-20. [DOI: 10.2967/jnumed.114.142661] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 06/23/2014] [Indexed: 01/23/2023] Open
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On the Quantification Accuracy, Homogeneity, and Stability of Simultaneous Positron Emission Tomography/Magnetic Resonance Imaging Systems. Invest Radiol 2014; 49:373-81. [DOI: 10.1097/rli.0000000000000021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Heiss WD. [PET in gliomas. Overview of current studies]. Nuklearmedizin 2014; 53:163-71; quiz N32. [PMID: 24853278 DOI: 10.3413/nukmed-0662-14-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 05/20/2014] [Indexed: 11/20/2022]
Abstract
Gliomas which represent 30% of intracranial tumours are morphologic lesions and therefore CT and MRI are the first line diagnostic procedures with MRI giving better soft tissue resolution and permitting additional functional information. These mainly morphologic imaging modalities yield only restricted information on grade of malignancy, on infiltration into and effects on surrounding brain tissue, on differentiation between necrotic and recurrent tumour, on prognosis and on efficacy of treatment. Information on these important issues for patient management can be obtained by PET-studies of glucose metabolism with FDG, of aminoacid-uptake and protein synthesis with 11C-methionin, 18F-fluorethyltyrosin and 18F-fluor-deoxyphenylalanin and of proliferation by 18F-deoxythymidin. With the increasing availability of 18F-tracers PET has obtained wider spread clinical application. In all these applications a coregistration with morphologic imaging should be obtained, and for that purpose hybrid installations (PET-MR) are already being used.
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Affiliation(s)
- W-D Heiss
- Prof. Dr. W.-D. Heiss, Max-Planck-Institut für neurologische Forschung, Gleueler Str. 50, 50931 Köln, Tel. 02 21/472 62 20, Fax 02 21/472 63 49, E-Mail:
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Quick HH. Integrated PET/MR. J Magn Reson Imaging 2013; 39:243-58. [DOI: 10.1002/jmri.24523] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/27/2013] [Indexed: 01/01/2023] Open
Affiliation(s)
- Harald H. Quick
- Institute of Medical Physics (IMP); Friedrich Alexander-University Erlangen-Nürnberg; Erlangen Germany
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Fraioli F, Punwani S. Clinical and research applications of simultaneous positron emission tomography and MRI. Br J Radiol 2013; 87:20130464. [PMID: 24234585 DOI: 10.1259/bjr.20130464] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Evaluation of the molecular processes responsible for disease pathogenesis and progression represents the new frontier of clinical radiology. Multimodality imaging lies at the cutting edge, combining the power of MRI for tissue characterization, microstructural appraisal and functional assessment together with new positron emission tomography (PET) tracers designed to target specific metabolic processes. The recent commercial availability of an integrated clinical whole-body PET-MRI provides a hybrid platform for exploring and exploiting the synergies of multimodal imaging. First experiences on the clinical and research application of hybrid PET-MRI are emerging. This article reviews the rapidly evolving field and speculates on the potential future direction.
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Affiliation(s)
- F Fraioli
- Institute of Nuclear Medicine, University College London, London, UK
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