Comparison of 18F-fluorodeoxyglucose and 18F-fluorothymidine PET in differentiating radiation necrosis from recurrent glioma.
OBJECTIVE
The objective was to compare F-fluorodeoxyglucose (FDG) and F-fluorothymidine (FLT) PET in differentiating radiation necrosis from recurrent glioma.


METHODS
Visual and quantitative analyses were derived from static FDG PET and static and dynamic FLT PET in 15 patients with suspected recurrence of treated grade 2 glioma or worse with a new focus of Gd contrast enhancement on MRI. For FDG PET, SUVmax and the ratio of lesion SUVmax to the SUVmean of contralateral white matter were measured. For FLT PET, SUVmax and Patlak-derived metabolic flux parameter Kimax were measured for the same locus. A 5-point visual confidence scale was applied to FDG PET and FLT PET. Receiver operating curve analysis was applied to visual and quantitative results. Differences between recurrent tumor and radiation necrosis were tested by Kruskal-Wallis analysis. On the basis of follow-up Gd-enhanced MRI, lesion-specific recurrent tumor was defined as a definitive increase in size of the lesion, and radiation necrosis was defined as stability or regression.


RESULTS
For FDG SUVmax, the FDG ratio of lesion-white matter, and FLT Kimax, there was a significant difference between mean values for recurrent tumor and radiation necrosis. Recurrent tumor was best identified by the FDG ratio of lesion-contralateral normal white matter (area under the curve of 0.98, confidence interval of 0.91 to 1.00, sensitivity of 100%, and specificity of 75% for an optimized cutoff value of 1.82).


CONCLUSIONS
Both quantitative and visual determinations allow accurate differentiation between recurrent glioma and radiation necrosis by both FDG and FLT PET. In this small series, FLT PET offers no advantage over FDG PET.
Department of Radiology, University of Utah, Salt Lake City, UT 84132, USA.
Michael S
MS
Enslow
Lauren V
LV
Zollinger
Kathryn A
KA
Morton
Regan I
RI
Butterfield
Dan J
DJ
Kadrmas
Paul E
PE
Christian
Kenneth M
KM
Boucher
Marta E
ME
Heilbrun
Randy L
RL
Jensen
John M
JM
Hoffman
D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D015224:Dideoxynucleosides; D005260:Female; D019788:Fluorodeoxyglucose F18; D005910:Glioma / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000000981:diagnostic imaging*; D060787:Neoplasm Grading; D049268:Positron-Emission Tomography / Q000379:methods*; D011832:Radiation Injuries / Q000000981:diagnostic imaging*; D012008:Recurrence; D055815:Young Adult
D015224:Dideoxynucleosides; D019788:Fluorodeoxyglucose F18; C002854:alovudine