n-n-dimethyl-n-(18f)fluoromethyl-2-hydroxyethylammonium and Brain-Neoplasms

To determine the optimal timing for imaging brain tumours and other brain lesions with 18F-labelled fluoromethylcholine (18F-FCho) PET.. Dynamic PET imaging with 18F-FCho (acquisition time of 28 min) was performed in 24 patients with space-occupying lesions in the brain. On the coregistered PET and MRI, lesion-to-normal tissue uptake ratios (LNRs) were calculated. Time-activity curves (TACs) were generated on the basis of the LNRs. Changes in LNR over time were calculated on the basis of the linear part of the TAC (last 22 min of the acquisition).. TACs for 18F-FCho in gliomas of different grading showed that, after a rapid uptake phase, the mean increase in LNR was 1.07 ± 0.93 for glioblastomas, -0.52 ± 1.56 for anaplastic astrocytomas, 0.04 ± 0.13 for grade 2 oligoastrocytomas and 0.37 in a case of a pilocytic astrocytoma. The average increase in LNR was 0.46 for a brain metastasis, 0.41 ± 0.69 for radiation-induced mass lesions and 1.07 for a tumefactive demyelinating lesion. In contrast, TACs for 18F-FCho in meningiomas showed that, after a rapid uptake phase, the average change in LNR was -5.25 ± 4.19 for typical meningiomas and -3.04 in a case of a mixed angiomatous and clear cell meningioma.. On the basis of the TACs, PET imaging with 18F-FCho starting within minutes after the administration of the tracer is preferred for the detection of brain tumours and other brain lesions. If discrimination between meningioma and other brain tumours is of concern, both 'early' and 'late' PET imaging could be helpful.

Topics: Adult; Aged; Brain Neoplasms; Choline; Female; Glioma; Humans; Male; Middle Aged; Neoplasm Grading; Positron-Emission Tomography; Time Factors

To investigate the diagnostic accuracy of O-(2-[18F]-fluoroethyl)-L-tyrosine (18F-FET) and fluoromethyl-(18F)-dimethyl-2-hydroxyethyl-ammonium chloride (18F-FCH) computed tomography (CT) in patients with primary low-grade gliomas (LGG).. The study enrolled patients with magnetic resonance imaging (MRI)-suspected LGG. Patients underwent both 18F-FET and 18F-FCH positron emission tomography (PET)-CT. Brain PET-CT was performed according to standard protocol - 20 minutes after intravenous injection of 185 MBq of 18F-FET and 185 MBq of 18F-FCH PET. Surgery and pathohistological diagnosis were performed in the next two weeks.. We observed significantly better concordance between tumor histology and 18F-FET PET (weighted Kappa 0.74) compared with both 18F-FCH (weighted Kappa 0.15) and MRI (weighted Kappa 0.00). Tumor histology was significantly associated with 18F-FET (odds ratio 12.87; 95% confidence interval [CI], 0.49-333.70; P=0.013, logistic regression analysis). Receiver operating characteristic curve analysis comparing 18F-FCH (area under the curve [AUC] 0.625, 95% CI 0.298-0.884) and 18F-FET (AUC 0.833, 95% CI 0.499-0.982) showed better diagnostic properties of 18F-FET (AUC difference 0.208, 95% CI -0.145 to 0.562, P=0.248).. Performing PET-CT in patients with newly diagnosed LGG should be preceded by a selection of an appropriate radiopharmaceutical. 18F-FET seems to be more accurate than 18F-FCH in the LGG diagnosis.

Topics: Brain Neoplasms; Choline; Glioma; Humans; Magnetic Resonance Imaging; Pilot Projects; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Tyrosine

Topics: Brain Neoplasms; Choline; Female; Humans; Lymphoma; Middle Aged; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals

We report the case of a 50-year-old man, with previous history of grade 3 intracranial hemangiopericytoma with initial complete surgical resection, addressed for local recurrence. Surgical revision performed 18 months after initial surgery allowed only partial resection, leaving residual disease along the optic nerve. Complementary radiotherapy with proton was decided. F-FDG PET/CT and F-choline PET/CT were both performed for treatment planning. F-FDG PET showed no uptake of the residual tumor, whereas F-choline depicted highly metabolic residual disease uptake with excellent delineation of local recurrence. F-choline PET/CT appears as a useful PET tracer for hemagiopericytoma imaging.

Topics: Brain Neoplasms; Choline; Hemangiopericytoma; Humans; Male; Middle Aged; Neoplasm, Residual; Positron Emission Tomography Computed Tomography; Recurrence

In this study, we investigated fluorine-18 fluoromethylcholine (F-FCho) PET and contrast-enhanced MRI for predicting therapy response in glioblastoma (GB) patients according to the Response Assessment in Neuro-Oncology criteria. Our second aim was to investigate which imaging modality enabled prediction of treatment response first.. Eleven GB patients who underwent no surgery or debulking only and received concomitant radiation therapy (RT) and temozolomide were included. The gold standard Response Assessment in Neuro-Oncology criteria were applied 6 months after RT to define responders and nonresponders. F-FCho PET and MRI were performed before RT, during RT (week 2, 4, and 6), and 1 month after RT. The contrast-enhancing tumor volume on T1-weighted MRI (GdTV) and the metabolic tumor volume (MTV) were calculated. GdTV, standardized uptake value (SUV)mean, SUVmax, MTV, MTV×SUVmean, and percentage change of these variables between all time-points were assessed to differentiate responders from nonresponders.. Absolute SUV values did not predict response. MTV must be taken into account. F-FCho PET could predict response with a 100% sensitivity and specificity using MTV×SUVmean 1 month after RT. A decrease in GdTV between week 2 and 6, week 4 and 6 during RT and week 2 during RT, and 1 month after RT of at least 31%, at least 18%, and at least 53% predicted response with a sensitivity and specificity of 100%. As such, the parameter that predicts therapy response first is MR derived, namely, GdTV.. Our data indicate that both F-FCho PET and contrast-enhanced T1-weighted MRI can predict response early in GB patients treated with RT and temozolomide.

Topics: Adult; Aged; Brain Neoplasms; Choline; Female; Glioblastoma; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Treatment Outcome; Tumor Burden

Discrimination between (high-grade) brain tumor recurrence and radiation necrosis (RN) remains a diagnostic challenge because both entities have similar imaging characteristics on conventional magnetic resonance imaging (MRI). Metabolic imaging, such as positron emission tomography (PET) could overcome this diagnostic dilemma. In this study, we investigated the potential of 2-[(18)F]-fluoro-2-deoxy-D-glucose ((18)F-FDG), O-(2-[(18)F]-fluoroethyl)-L-tyrosine ((18)F-FET), and [(18)F]-Fluoromethyl-dimethyl-2-hydroxyethylammonium ((18)F-fluoromethylcholine, (18)F-FCho) PET in discriminating high-grade tumor from RN.. We developed a glioblastoma (GB) rat model by inoculating F98 GB cells into the right frontal region. Induction of RN was achieved by irradiating the right frontal region with 60 Gy using three arcs with a beam aperture of 3×3 mm (n=3). Dynamic PET imaging with (18)F-FDG, (18)F-FET, and (18)F-FCho, as well as (18)F-FDG PET at a delayed time interval (240 min postinjection), was acquired.. MRI revealed contrast-enhancing tumors at 15 days after inoculation (n=4) and contrast-enhancing RN lesions 5-6 months postirradiation (n=3). On (18)F-FDG PET, the mean lesion-to-normal ratio (LNRmean) was significantly higher in GB than in RN (p=0.034). The difference in the LNRmean between tumors and RN was higher on the late (18)F-FDG PET images than on the PET images reconstructed from the last time frame of the dynamic acquisition (this is at a conventional time interval). LNRs obtained from (18)F-FCho PET were not significantly different between GB and RN (p=1.000). On (18)F-FET PET, the LNRmean was significantly higher in GB compared to RN (p=0.034).. Unlike (18)F-FCho, (18)F-FDG and (18)F-FET PET were effective in discriminating GB from RN. Interestingly, in the case of (18)F-FDG, delayed PET seems particularly useful.. Our results suggest that (delayed) (18)F-FDG and (18)F-FET PET can be used to discriminate GB (recurrence) from RN. Confirmation of these results in clinical studies is needed.

Topics: Animals; Brain Neoplasms; Cell Line, Tumor; Choline; Diagnosis, Differential; Female; Fluorodeoxyglucose F18; Glioblastoma; Necrosis; Neoplasm Grading; Positron-Emission Tomography; Radiation Injuries; Radioactive Tracers; Radiopharmaceuticals; Rats; Recurrence; Tyrosine

Brain metastases are a rare complication of prostate cancer. They are usually diagnosed in an end-stage disease when the tumor has already spread to the other organs and tissues. We present a case of a male with castration-resistant prostate cancer with bone metastases visualized in ¹⁸F-fluorocholine PET/CT scan.

Topics: Aged; Brain Neoplasms; Choline; Humans; Male; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Tomography, X-Ray Computed

An 18-year-old man presented with 6 weeks' history of diplopia, early morning headaches, and blurred vision; on ophthalmologic examination, Parinaud syndrome was revealed. Brain MRI scan showed a calcified pineal mass. Brain simultaneous PET/MRI with 18F-choline showed an avid enhancing mass occupying the pineal region with restricted diffusion. A second examination after chemotherapy demonstrated reduction in both size and radiotracer activity of the mass. Our study emphasizes the potential of simultaneous 18F-choline PET/MRI being a useful tool for contribution in the diagnosis and treatment assessment in a convenient way with minimal radiation exposure and reduced throughput patient time.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Choline; Cisplatin; Cyclophosphamide; Etoposide; Humans; Magnetic Resonance Imaging; Male; Multimodal Imaging; Neoplasms, Germ Cell and Embryonal; Pineal Gland; Pinealoma; Positron-Emission Tomography; Radiopharmaceuticals; Treatment Outcome

Positron emission tomography (PET) with radiolabeled amino acids provides information on biopsy target and chemotherapy response in patients with low-grade gliomas (LGG). In this article, we addressed whether PET with F-18 choline (CHO) detects increased metabolism in F-18 fluoroethyltyrosine (FET)-negative LGG patients.. Six LGG patients with nongadolinium-enhancing (magnetic resonance) FET-negative LGG were imaged with CHO PET. Regions of interest were positioned over tumor and contralateral brain. Uptake of FET and CHO was quantified as count ratio of tumor to contralateral brain.. The mean FET uptake ratio for FET-negative LGG was 0.95 ± 0.03 (mean ± standard deviation). Five tumors did not show increased uptake ratios for CHO (0.96 ± 0.12). Slightly increased CHO uptake was found in 1 patient (1.24), which, however, was not associated with tumor visualization.. Amino acid and choline uptake appear to behave similar in nongadolinium-enhancing LGG. For clinical purposes, CHO PET is not superior to FET PET.

Topics: Adult; Brain Neoplasms; Choline; False Negative Reactions; Female; Glioma; Humans; Male; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Tyrosine

To evaluate the distribution of 18F-labelled fluoromethylcholine (FCho) in normal structures and tumors of the head region using positron emission tomography (PET) and magnetic resonance imaging.. We retrospectively reviewed the positron emission tomography, magnetic resonance imaging, and the coregistered images obtained in 17 patients with suspected high-grade gliomas. The accumulation of 18F-FCho in the normal structures and in brain lesions was visually and semiquantitatively assessed. A 4-point grading system was used for the visual analysis. A standardized uptake value (SUV) was used to quantify uptake.. In the normal brain parenchyma, 18F-FCho uptake was faint (SUVmean, 0.15 ± 0.03 (SD)). Uptake was generally moderate in the choroid plexus (SUVmean, 0.82 ± 0.16), cavernous sinus (SUVmean, 0.87 ± 0.19), extraocular eye muscles (SUVmean, 1.10 ± 0.27), masticatory muscles (SUVmean, 0.99 ± 0.22), and bone marrow (SUVmean, 1.06 ± 0.26), whereas uptake was usually moderately intense in the pituitary gland (SUVmean, 1.90 ± 0.21). Uptake was variable in the lacrimal glands and the mucosa of the nasal cavity (for SUVmean of subgroups see text). Intense uptake was observed in the parotid glands (SUVmean, 3.27 ± 0.73). (Moderately) intense 18F-FCho uptake was observed in glioblastomas (range SUVmax, 2.26-6.37) and typical meningiomas (range SUVmax, 3.75-5.81). Uptake was globally faint in grade II and III gliomas (range SUVmax, 0.33-0.78). 18F-FCho uptake was also demonstrated in benign lesions, such as a tumefactive demyelinating brain lesion.. 18F-FCho uptake was faint in the normal brain parenchyma and usually moderate in the choroid plexus, cavernous sinus, extraocular eye muscles, masticatory muscles, and bone marrow. Uptake in the pituitary gland was generally moderately intense, whereas uptake in the lacrimal glands and the mucosa of the nasal cavity was variable. Parotid glands had intense uptake. Also, uptake in glioblastomas and meningiomas was usually (moderately) intense, whereas uptake in grade II and III gliomas was globally faint. However, 18F-FCho uptake was not tumor specific.

Topics: Adult; Aged; Brain; Brain Neoplasms; Choline; Female; Fluorine Radioisotopes; Gadolinium; Head; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Muscles; Positron-Emission Tomography