Journal Article

FZJ-2020-00214

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Flare phenomenon in O-(2-[ 18 F]-Fluoroethyl)-L-Tyrosine PET after resection of gliomas

Filss, C. P.FZJ* ; Schmitz, A. k. ; Stoffels, G.FZJ* ; Stegmayr, C.FZJ* ; Lohmann, P.FZJ* ; Werner, J. M. ; Sabel, M. ; Rapp, M. ; Goldbrunner, R. ; Neumaier, B.FZJ* ; Mottaghy, F. M.FZJ* ; Shah, N. J.FZJ* ; Fink, G. R.FZJ* ; Galldiks, N.FZJ* ; Langen, K. J. (Corresponding author)FZJ*

2020
Soc. New York, NY

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Please use a persistent id in citations: http://hdl.handle.net/2128/25658  doi:10.2967/jnumed.119.238568

Abstract: PET using O-(2-[18F]Fluoroethyl)-L-tyrosine (18F-FET) is useful to detect residual tumor tissue after glioma resection. Recent animal experiments detected reactive changes of 18F-FET uptake at the rim of the resection cavity within the first two weeks after resection of gliomas. In the present study, we evaluated pre- and postoperative 18F-FET PET scans of glioma patients with particular emphasis on the identification of reactive changes after surgery. Methods: Forty-three patients with cerebral gliomas (9 low-grade, 34 high-grade; 9 primary tumors, 34 recurrent tumors) who had preoperative (time before surgery, median 23 d, range 6-44 d) and postoperative 18F-FET-PET (time after surgery, median 14, range 5–28 d) were included. PET scans (20-40 min p.i.) were evaluated visually for complete or incomplete resection (CR, IR) and compared with MRI. Changes of 18F-FET-uptake in residual tumor were evaluated by tumor-to-brain ratios (TBRmax) and in the vicinity of the resection cavity by maximum lesion-to-brain ratios (LBRmax). Results: Visual analysis of 18F-FET PET scans revealed CR in 16/43 patients and IR in the remaining patients. PET results were concordant with MRI in 69% of the patients. LBRmax of 18F-FET uptake in the vicinity of the resection cavity was significantly higher compared with preoperative values (1.59 ± 0.36 versus 1.14 ± 0.17; n = 43, p<0.001). In 11 patients (26%) a “flare phenomenon” was observed with a considerable increase of 18F-FET uptake compared with preoperative values in either the residual tumor (n = 5) or in areas remote from tumor in the preoperative PET scan (n = 6) (2.92 ± 1.24 versus 1.62 ± 0.75; p<0.001). Further follow-up in five patients showed decreasing 18F-FET uptake in the flare areas in four and progress in one case. Conclusion: Our study confirms that 18F-FET PET provides valuable information for assessing the success of glioma resection. Postoperative reactive changes at the rim of the resection cavity appear to be mild. However, in 23 % of the patients, a postoperative “flare phenomenon” was observed that warrants further investigation.

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Contributing Institute(s):

1. Physik der Medizinischen Bildgebung (INM-4)
2. Kognitive Neurowissenschaften (INM-3)
3. Nuklearchemie (INM-5)

Research Program(s):

1. 572 - (Dys-)function and Plasticity (POF3-572) (POF3-572)

Appears in the scientific report 2020

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