The usefulness of dynamic O-(2-18F-fluoroethyl)-L-tyrosine PET in the clinical evaluation of brain tumors in children and adolescents

Veronika Dunkl; Corvin Cleff; Gabriele Stoffels; Natalie Judov; Sevgi Sarikaya-Seiwert; Ian Law; Lars Bøgeskov; Karsten Nysom; Sofie B Andersen; Hans-Jakob Steiger; Gereon R Fink; Guido Reifenberger; Nadim J Shah; Heinz H Coenen; Karl-Josef Langen; Norbert Galldiks

doi:10.2967/jnumed.114.148734

The usefulness of dynamic O-(2-18F-fluoroethyl)-L-tyrosine PET in the clinical evaluation of brain tumors in children and adolescents

Veronika Dunkl, Corvin Cleff, Gabriele Stoffels, Natalie Judov, Sevgi Sarikaya-Seiwert, Ian Law, Lars Bøgeskov, Karsten Nysom, Sofie B Andersen, Hans-Jakob Steiger, Gereon R Fink, Guido Reifenberger, Nadim J Shah, Heinz H Coenen, Karl-Josef Langen, Norbert Galldiks

Department of Clinical Medicine

30 Citations (Scopus)

Abstract

Experience regarding O-(2-¹⁸F-fluoroethyl)-L-tyrosine (¹⁸F-FET) PET in children and adolescents with brain tumors is limited.

Methods: Sixty-nine ¹⁸F-FET PET scans of 48 children and adolescents (median age, 13 y; range, 1-18 y) were analyzed retrospectively. Twenty-six scans to assess newly diagnosed cerebral lesions, 24 scans for diagnosing tumor progression or recurrence, 8 scans for monitoring of chemotherapy effects, and 11 scans for the detection of residual tumor after resection were obtained. Maximum and mean tumor-tobrain ratios (TBRs) were determined at 20-40 min after injection, and time-activity curves of ¹⁸F-FET uptake were assigned to 3 different patterns: constant increase; peak at greater than 20-40 min after injection, followed by a plateau; and early peak (≤20 min), followed by a constant descent. The diagnostic accuracy of ¹⁸F-FET PET was assessed by receiver-operating-characteristic curve analyses using histology or clinical course as a reference.

Results: In patients with newly diagnosed cerebral lesions, the highest accuracy (77%) to detect neoplastic tissue (19/26 patients) was obtained when the maximum TBR was 1.7 or greater (area under the curve, 0.80 ± 0.09; sensitivity, 79%; specificity, 71%; positive predictive value, 88%; P 5 0.02). For diagnosing tumor progression or recurrence, the highest accuracy (82%) was obtained when curve patterns 2 or 3 were present (area under the curve, 0.80 ± 0.11; sensitivity, 75%; specificity, 90%; positive predictive value, 90%; P 5 0.02). During chemotherapy, a decrease of TBRswas associatedwith a stable clinical course, and in 2 patients PET detected residual tumor after presumably complete tumor resection.

Conclusion: Our findings suggest that ¹⁸F-FET PET can add valuable information for clinical decision making in pediatric brain tumor patients.

Original language	English
Journal	Journal of Nuclear Medicine
Volume	56
Issue number	1
Pages (from-to)	88-92
Number of pages	5
ISSN	0161-5505
DOIs	https://doi.org/10.2967/jnumed.114.148734
Publication status	Published - 1 Jan 2015

Keywords

Adolescent
Brain Neoplasms
Child
Child, Preschool
Disease Progression
Female
Humans
Infant
Male
Neoplasm, Residual
Positron-Emission Tomography
Recurrence
Sensitivity and Specificity
Tyrosine

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Dunkl, V., Cleff, C., Stoffels, G., Judov, N., Sarikaya-Seiwert, S., Law, I., Bøgeskov, L., Nysom, K., Andersen, S. B., Steiger, H-J., Fink, G. R., Reifenberger, G., Shah, N. J., Coenen, H. H., Langen, K-J., & Galldiks, N. (2015). The usefulness of dynamic O-(2-18F-fluoroethyl)-L-tyrosine PET in the clinical evaluation of brain tumors in children and adolescents. Journal of Nuclear Medicine, 56(1), 88-92. https://doi.org/10.2967/jnumed.114.148734

Dunkl, V, Cleff, C, Stoffels, G, Judov, N, Sarikaya-Seiwert, S, Law, I, Bøgeskov, L, Nysom, K, Andersen, SB, Steiger, H-J, Fink, GR, Reifenberger, G, Shah, NJ, Coenen, HH, Langen, K-J & Galldiks, N 2015, 'The usefulness of dynamic O-(2-18F-fluoroethyl)-L-tyrosine PET in the clinical evaluation of brain tumors in children and adolescents', Journal of Nuclear Medicine, vol. 56, no. 1, pp. 88-92. https://doi.org/10.2967/jnumed.114.148734

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title = "The usefulness of dynamic O-(2-18F-fluoroethyl)-L-tyrosine PET in the clinical evaluation of brain tumors in children and adolescents",

abstract = "Experience regarding O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) PET in children and adolescents with brain tumors is limited.Methods: Sixty-nine 18F-FET PET scans of 48 children and adolescents (median age, 13 y; range, 1-18 y) were analyzed retrospectively. Twenty-six scans to assess newly diagnosed cerebral lesions, 24 scans for diagnosing tumor progression or recurrence, 8 scans for monitoring of chemotherapy effects, and 11 scans for the detection of residual tumor after resection were obtained. Maximum and mean tumor-tobrain ratios (TBRs) were determined at 20-40 min after injection, and time-activity curves of 18F-FET uptake were assigned to 3 different patterns: constant increase; peak at greater than 20-40 min after injection, followed by a plateau; and early peak (≤20 min), followed by a constant descent. The diagnostic accuracy of 18F-FET PET was assessed by receiver-operating-characteristic curve analyses using histology or clinical course as a reference.Results: In patients with newly diagnosed cerebral lesions, the highest accuracy (77%) to detect neoplastic tissue (19/26 patients) was obtained when the maximum TBR was 1.7 or greater (area under the curve, 0.80 ± 0.09; sensitivity, 79%; specificity, 71%; positive predictive value, 88%; P 5 0.02). For diagnosing tumor progression or recurrence, the highest accuracy (82%) was obtained when curve patterns 2 or 3 were present (area under the curve, 0.80 ± 0.11; sensitivity, 75%; specificity, 90%; positive predictive value, 90%; P 5 0.02). During chemotherapy, a decrease of TBRswas associatedwith a stable clinical course, and in 2 patients PET detected residual tumor after presumably complete tumor resection.Conclusion: Our findings suggest that 18F-FET PET can add valuable information for clinical decision making in pediatric brain tumor patients.",

keywords = "Adolescent, Brain Neoplasms, Child, Child, Preschool, Disease Progression, Female, Humans, Infant, Male, Neoplasm, Residual, Positron-Emission Tomography, Recurrence, Sensitivity and Specificity, Tyrosine",

author = "Veronika Dunkl and Corvin Cleff and Gabriele Stoffels and Natalie Judov and Sevgi Sarikaya-Seiwert and Ian Law and Lars B{\o}geskov and Karsten Nysom and Andersen, {Sofie B} and Hans-Jakob Steiger and Fink, {Gereon R} and Guido Reifenberger and Shah, {Nadim J} and Coenen, {Heinz H} and Karl-Josef Langen and Norbert Galldiks",

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T1 - The usefulness of dynamic O-(2-18F-fluoroethyl)-L-tyrosine PET in the clinical evaluation of brain tumors in children and adolescents

AU - Dunkl, Veronika

AU - Cleff, Corvin

AU - Stoffels, Gabriele

AU - Judov, Natalie

AU - Sarikaya-Seiwert, Sevgi

AU - Law, Ian

AU - Bøgeskov, Lars

AU - Nysom, Karsten

AU - Andersen, Sofie B

AU - Steiger, Hans-Jakob

AU - Fink, Gereon R

AU - Reifenberger, Guido

AU - Shah, Nadim J

AU - Coenen, Heinz H

AU - Langen, Karl-Josef

AU - Galldiks, Norbert

PY - 2015/1/1

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N2 - Experience regarding O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) PET in children and adolescents with brain tumors is limited.Methods: Sixty-nine 18F-FET PET scans of 48 children and adolescents (median age, 13 y; range, 1-18 y) were analyzed retrospectively. Twenty-six scans to assess newly diagnosed cerebral lesions, 24 scans for diagnosing tumor progression or recurrence, 8 scans for monitoring of chemotherapy effects, and 11 scans for the detection of residual tumor after resection were obtained. Maximum and mean tumor-tobrain ratios (TBRs) were determined at 20-40 min after injection, and time-activity curves of 18F-FET uptake were assigned to 3 different patterns: constant increase; peak at greater than 20-40 min after injection, followed by a plateau; and early peak (≤20 min), followed by a constant descent. The diagnostic accuracy of 18F-FET PET was assessed by receiver-operating-characteristic curve analyses using histology or clinical course as a reference.Results: In patients with newly diagnosed cerebral lesions, the highest accuracy (77%) to detect neoplastic tissue (19/26 patients) was obtained when the maximum TBR was 1.7 or greater (area under the curve, 0.80 ± 0.09; sensitivity, 79%; specificity, 71%; positive predictive value, 88%; P 5 0.02). For diagnosing tumor progression or recurrence, the highest accuracy (82%) was obtained when curve patterns 2 or 3 were present (area under the curve, 0.80 ± 0.11; sensitivity, 75%; specificity, 90%; positive predictive value, 90%; P 5 0.02). During chemotherapy, a decrease of TBRswas associatedwith a stable clinical course, and in 2 patients PET detected residual tumor after presumably complete tumor resection.Conclusion: Our findings suggest that 18F-FET PET can add valuable information for clinical decision making in pediatric brain tumor patients.

AB - Experience regarding O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) PET in children and adolescents with brain tumors is limited.Methods: Sixty-nine 18F-FET PET scans of 48 children and adolescents (median age, 13 y; range, 1-18 y) were analyzed retrospectively. Twenty-six scans to assess newly diagnosed cerebral lesions, 24 scans for diagnosing tumor progression or recurrence, 8 scans for monitoring of chemotherapy effects, and 11 scans for the detection of residual tumor after resection were obtained. Maximum and mean tumor-tobrain ratios (TBRs) were determined at 20-40 min after injection, and time-activity curves of 18F-FET uptake were assigned to 3 different patterns: constant increase; peak at greater than 20-40 min after injection, followed by a plateau; and early peak (≤20 min), followed by a constant descent. The diagnostic accuracy of 18F-FET PET was assessed by receiver-operating-characteristic curve analyses using histology or clinical course as a reference.Results: In patients with newly diagnosed cerebral lesions, the highest accuracy (77%) to detect neoplastic tissue (19/26 patients) was obtained when the maximum TBR was 1.7 or greater (area under the curve, 0.80 ± 0.09; sensitivity, 79%; specificity, 71%; positive predictive value, 88%; P 5 0.02). For diagnosing tumor progression or recurrence, the highest accuracy (82%) was obtained when curve patterns 2 or 3 were present (area under the curve, 0.80 ± 0.11; sensitivity, 75%; specificity, 90%; positive predictive value, 90%; P 5 0.02). During chemotherapy, a decrease of TBRswas associatedwith a stable clinical course, and in 2 patients PET detected residual tumor after presumably complete tumor resection.Conclusion: Our findings suggest that 18F-FET PET can add valuable information for clinical decision making in pediatric brain tumor patients.

KW - Adolescent

KW - Brain Neoplasms

KW - Child

KW - Child, Preschool

KW - Disease Progression

KW - Female

KW - Humans

KW - Infant

KW - Male

KW - Neoplasm, Residual

KW - Positron-Emission Tomography

KW - Recurrence

KW - Sensitivity and Specificity

KW - Tyrosine

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DO - 10.2967/jnumed.114.148734

M3 - Journal article

C2 - 25525183

SN - 0161-5505

VL - 56

SP - 88

EP - 92

JO - The Journal of Nuclear Medicine

JF - The Journal of Nuclear Medicine

IS - 1

ER -

The usefulness of dynamic O-(2-18F-fluoroethyl)-L-tyrosine PET in the clinical evaluation of brain tumors in children and adolescents

Abstract

Keywords

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