Brain Tumor Res Treat.  2018 Oct;6(2):47-53. 10.14791/btrt.2018.6.e13.

Current Radiopharmaceuticals for Positron Emission Tomography of Brain Tumors

• Jung JH
• Ahn BC

• KMID: 2423973
• DOI: http://doi.org/10.14791/btrt.2018.6.e13

Abstract

Brain tumors represent a diverse spectrum of histology, biology, prognosis, and treatment options. Although MRI remains the gold standard for morphological tumor characterization, positron emission tomography (PET) can play a critical role in evaluating disease status. This article focuses on the use of PET with radiolabeled glucose and amino acid analogs to aid in the diagnosis of tumors and differentiate between recurrent tumors and radiation necrosis. The most widely used tracer is ¹â¸F-fluorodeoxyglucose (FDG). Although the intensity of FDG uptake is clearly associated with tumor grade, the exact role of FDG PET imaging remains debatable. Additionally, high uptake of FDG in normal grey matter limits its use in some low-grade tumors that may not be visualized. Because of their potential to overcome the limitation of FDG PET of brain tumors, 11C-methionine and ¹â¸F-3,4-dihydroxyphenylalanine (FDOPA) have been proposed. Low accumulation of amino acid tracers in normal brains allows the detection of low-grade gliomas and facilitates more precise tumor delineation. These amino acid tracers have higher sensitivity and specificity for detecting brain tumors and differentiating recurrent tumors from post-therapeutic changes. FDG and amino acid tracers may be complementary, and both may be required for assessment of an individual patient. Additional tracers for brain tumor imaging are currently under development. Combinations of different tracers might provide more in-depth information about tumor characteristics, and current limitations may thus be overcome in the near future. PET with various tracers including FDG, ¹¹C-methionine, and FDOPA has improved the management of patients with brain tumors. To evaluate the exact value of PET, however, additional prospective large sample studies are needed.

Keyword

Brain tumors; Positron emission tomography-computed tomography; ¹⁸F-FDG; C-11 methionine; ¹⁸F-FDOPA

MeSH Terms

Biology
Brain Neoplasms*
Brain*
Diagnosis
Electrons*
Glioma
Glucose
Gray Matter
Humans
Magnetic Resonance Imaging
Necrosis
Positron-Emission Tomography*
Prognosis
Prospective Studies
Radiopharmaceuticals*
Sensitivity and Specificity
Glucose
Radiopharmaceuticals

Figure

• 

  Fig. 1 FDG PET/MR for CNS lymphoma. 79-year-old woman diagnosed as CNS lymphoma. T2 fluid attenuated inversion recovery MRI shows multiple lesions with high signal in both hemisphere (A). FDG PET (B) and FDG PET/MR (C) show intense tracer uptake at the lesions. FDG, 18F-fluorodeoxyglucose; PET, positron emission tomography; CNS, central nervous system.

• 

  Fig. 2 FDG PET/MR for high-grade glioma. 18-year-old woman diagnosed as a glioblastoma, WHO grade IV. T2 fluid attenuated inversion recovery MRI shows high signal in pontine lesion (A). FDG PET (B) and FDG PET/MR (C) show increased tracer uptake at the lesion (arrows). FDG, 18F-fluorodeoxyglucose; PET, positron emission tomography.

• 

  Fig. 3 11C-methionine PET/MR. 5-year-old girl diagnosed low-grade glioma in cerebellum. T2 fluid attenuated inversion recovery MRI shows high signal in a cerebellar lesion (A). 11C-methionine PET (B) and 11C-methionine PET/MR (C) show increased tracer uptake at the cerebellar lesion. PET, positron emission tomography.

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