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@ARTICLE{Rapp:133044,
      author       = {Rapp, M. and Heinzel, Alexander and Galldiks, Norbert and
                      Stoffels, Gabriele and Felsberg, Jörg and Ewelt, Christian
                      and Sabel, Michael and Steiger, Hans J and Reifenberger,
                      Guido and Beez, Thomas and Coenen, Heinrich Hubert and
                      Floeth, Frank W and Langen, Karl-Josef},
      title        = {{D}iagnostic {P}erformance of 18{F}-{FET} {PET} in {N}ewly
                      {D}iagnosed {C}erebral {L}esions {S}uggestive of {G}lioma},
      journal      = {Journal of nuclear medicine},
      volume       = {54},
      number       = {2},
      issn         = {0161-5505},
      address      = {Reston, Va.},
      publisher    = {SNM84042},
      reportid     = {FZJ-2013-01608},
      pages        = {229-235},
      year         = {2013},
      abstract     = {The aim of this study was to assess the clinical value of
                      O-(2-(18)F-fluoroethyl)-l-tyrosine ((18)F-FET) PET in the
                      initial diagnosis of cerebral lesions suggestive of
                      glioma.In a retrospective study, we analyzed the clinical,
                      radiologic, and neuropathologic data of 174 patients (77
                      women and 97 men; mean age, 45 ± 15 y) who had been
                      referred for neurosurgical assessment of unclear brain
                      lesions and had undergone (18)F-FET PET. Initial histology
                      (n = 168, confirmed after surgery or biopsy) and the
                      clinical course and follow-up MR imaging in 2 patients
                      revealed 66 high-grade gliomas (HGG), 77 low-grade gliomas
                      (LGG), 2 lymphomas, and 25 nonneoplastic lesions (NNL). In a
                      further 4 patients, initial histology was unspecific, but
                      during the course of the disease all patients developed an
                      HGG. The diagnostic value of maximum and mean tumor-to-brain
                      ratios (TBR(max/)TBR(mean)) of (18)F-FET uptake was assessed
                      using receiver-operating-characteristic (ROC) curve analyses
                      to differentiate between neoplastic lesions and NNL, between
                      HGG and LGG, and between high-grade tumor (HGG or lymphoma)
                      and LGG or NNL.Neoplastic lesions showed significantly
                      higher (18)F-FET uptake than NNL (TBR(max), 3.0 ± 1.3 vs.
                      1.8 ± 0.5; P < 0.001). ROC analysis yielded an optimal
                      cutoff of 2.5 for TBR(max) to differentiate between
                      neoplastic lesions and NNLs (sensitivity, $57\%;$
                      specificity, $92\%;$ accuracy, $62\%;$ area under the curve
                      [AUC], 0.76; $95\%$ confidence interval [CI], 0.68-0.84).
                      The positive predictive value (PPV) was $98\%,$ and the
                      negative predictive value (NPV) was $27\%.$ ROC analysis for
                      differentiation between HGG and LGG (TBR(max), 3.6 ± 1.4
                      vs. 2.4 ± 1.0; P < 0.001) yielded an optimal cutoff of 2.5
                      for TBR(max) (sensitivity, $80\%;$ specificity, $65\%;$
                      accuracy, $72\%;$ AUC, 0.77; PPV, $66\%;$ NPV, $79\%;$
                      $95\%$ CI, 0.68-0.84). Best differentiation between
                      high-grade tumors (HGG or lymphoma) and both NNL and LGG was
                      achieved with a TBR(max) cutoff of 2.5 (sensitivity, $79\%;$
                      specificity, $72\%;$ accuracy, $75\%;$ AUC, 0.79; PPV,
                      $65\%;$ NPV, $84\%;$ $95\%$ CI, 0.71-0.86). The results for
                      TBR(mean) were similar with a cutoff of 1.9.(18)F-FET uptake
                      ratios provide valuable additional information for the
                      differentiation of cerebral lesions and the grading of
                      gliomas. TBR(max) of (18)F-FET uptake beyond the threshold
                      of 2.5 has a high PPV for detection of a neoplastic lesion
                      and supports the necessity of an invasive procedure, for
                      example, biopsy or surgical resection. Low (18)F-FET uptake
                      (TBR(max) < 2.5) excludes a high-grade tumor with high
                      probability.},
      cin          = {INM-3 / INM-4 / INM-5},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-3-20090406 / I:(DE-Juel1)INM-4-20090406 /
                      I:(DE-Juel1)INM-5-20090406},
      pnm          = {333 - Pathophysiological Mechanisms of Neurological and
                      Psychiatric Diseases (POF2-333)},
      pid          = {G:(DE-HGF)POF2-333},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:23232275},
      UT           = {WOS:000314691200023},
      doi          = {10.2967/jnumed.112.109603},
      url          = {https://juser.fz-juelich.de/record/133044},
}