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@ARTICLE{Galldiks:22779,
      author       = {Galldiks, N. and Stoffels, G. and Filss, C.P. and Piroth,
                      M.D. and Sabel, M. and Ruge, M.I. and Herzog, H. and Shah,
                      N.J. and Fink, G.R. and Coenen, H.H. and Langen, K.J.},
      title        = {{R}ole of {O}-(2-18 {F}-{F}luoroethyl)-{L}-{T}yrosine {PET}
                      for differentiation of local recurrent brain metastasis from
                      radiation necrosis},
      journal      = {Journal of nuclear medicine},
      volume       = {53},
      number       = {9},
      issn         = {0161-5505},
      address      = {New York, NY},
      publisher    = {Society of Nuclear Medicine},
      reportid     = {PreJuSER-22779},
      pages        = {1367-1374},
      year         = {2012},
      note         = {Record converted from VDB: 12.11.2012},
      abstract     = {The aim of this study was to investigate the potential of
                      O-(2-(18)F-fluoroethyl)-L-tyrosine ((18)F-FET) PET for
                      differentiating local recurrent brain metastasis from
                      radiation necrosis after radiation therapy because the use
                      of contrast-enhanced MRI for this issue is often
                      difficult.Thirty-one patients (mean age ± SD, 53 ± 11 y)
                      with single or multiple contrast-enhancing brain lesions (n
                      = 40) on MRI after radiation therapy of brain metastases
                      were investigated with dynamic (18)F-FET PET. Maximum and
                      mean tumor-to-brain ratios (TBR(max) and TBR(mean),
                      respectively; 20-40 min after injection) of (18)F-FET uptake
                      were determined. Time-activity curves were generated, and
                      the time to peak (TTP) was calculated. Furthermore,
                      time-activity curves of each lesion were assigned to one of
                      the following curve patterns: (I) constantly increasing
                      (18)F-FET uptake, (II) (18)F-FET uptake peaking early (TTP
                      ≤ 20 min) followed by a plateau, and (III) (18)F-FET
                      uptake peaking early (TTP ≤ 20 min) followed by a constant
                      descent. The diagnostic accuracy of the TBR(max) and
                      TBR(mean) of (18)F-FET uptake and the curve patterns for the
                      correct identification of recurrent brain metastasis were
                      evaluated by receiver-operating-characteristic analyses or
                      Fisher exact test for 2 × 2 contingency tables using
                      subsequent histologic analysis (11 lesions in 11 patients)
                      or clinical course and MRI findings (29 lesions in 20
                      patients) as reference.Both TBR(max) and TBR(mean) were
                      significantly higher in patients with recurrent metastasis
                      (n = 19) than in patients with radiation necrosis (n = 21)
                      (TBR(max), 3.2 ± 0.9 vs. 2.3 ± 0.5, P < 0.001; TBR(mean),
                      2.1 ± 0.4 vs. 1.8 ± 0.2, P < 0.001). The diagnostic
                      accuracy of (18)F-FET PET for the correct identification of
                      recurrent brain metastases reached $78\%$ using TBR(max)
                      (area under the ROC curve [AUC], 0.822 ± 0.07; sensitivity,
                      $79\%;$ specificity, $76\%;$ cutoff, 2.55; P = 0.001),
                      $83\%$ using TBR(mean) (AUC, 0.851 ± 0.07; sensitivity,
                      $74\%;$ specificity, $90\%;$ cutoff, 1.95; P < 0.001), and
                      $92\%$ for curve patterns II and III versus curve pattern I
                      (sensitivity, $84\%;$ specificity, $100\%;$ P < 0.0001). The
                      highest accuracy $(93\%)$ to diagnose local recurrent
                      metastasis was obtained when both a TBR(mean) greater than
                      1.9 and curve pattern II or III were present (AUC, 0.959 ±
                      0.03; sensitivity, $95\%;$ specificity, $91\%;$ P <
                      0.001).Our findings suggest that the combined evaluation of
                      the TBR(mean) of (18)F-FET uptake and the pattern of the
                      time-activity curve can differentiate local brain metastasis
                      recurrence from radionecrosis with high accuracy. (18)F-FET
                      PET may thus contribute significantly to the management of
                      patients with brain metastases.},
      keywords     = {Adolescent / Adult / Aged / Biological Transport / Brain
                      Neoplasms: metabolism / Brain Neoplasms: radionuclide
                      imaging / Brain Neoplasms: secondary / Diagnosis,
                      Differential / Humans / Male / Middle Aged / Necrosis:
                      metabolism / Necrosis: radionuclide imaging / Neoplasm
                      Recurrence, Local: metabolism / Neoplasm Recurrence, Local:
                      radionuclide imaging / Positron-Emission Tomography / ROC
                      Curve / Radiation Injuries: metabolism / Radiation Injuries:
                      radionuclide imaging / Tyrosine: analogs $\&$ derivatives /
                      Tyrosine: diagnostic use / Tyrosine: metabolism / Young
                      Adult / O-(2-fluoroethyl)tyrosine (NLM Chemicals) / Tyrosine
                      (NLM Chemicals) / J (WoSType)},
      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          = {Funktion und Dysfunktion des Nervensystems (FUEK409) /
                      89572 - (Dys-)function and Plasticity (POF2-89572)},
      pid          = {G:(DE-Juel1)FUEK409 / G:(DE-HGF)POF2-89572},
      shelfmark    = {Radiology, Nuclear Medicine $\&$ Medical Imaging},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:22872742},
      UT           = {WOS:000308685100019},
      doi          = {10.2967/jnumed.112.103325},
      url          = {https://juser.fz-juelich.de/record/22779},
}