title: ¹⁸F-Fluorocholine PET/CT as a complementary tool in the follow-up of low-grade glioma: diagnostic accuracy and clinical utility.
abstract: OBJECTIVE
  The follow-up of treated low-grade glioma (LGG) requires the evaluation of subtle clinical changes and MRI results. When the result is inconclusive, additional procedures are required to assist decision-making, such as the use of advanced MRI (aMRI) sequences and nuclear medicine scans (SPECT and PET). The aim of this study was to determine whether incorporating (18)F-fluorocholine PET/CT in the follow-up protocol for treated LGG improves diagnostic accuracy and clinical utility.
  
  
  METHODS
  This was a prospective case-series study in patients with treated LGG during standard follow-up with indeterminate clinical and/or radiological findings of tumour activity. All patients underwent clinical evaluation, aMRI, (201)Tl-SPECT and (18)F-fluorocholine PET/CT. Images were interpreted by visual evaluation complemented with semiquantitative analysis.
  
  
  RESULTS
  Between January 2012 and December 2013, 18 patients were included in this study. The final diagnosis was established by histology (five surgical specimens, one biopsy specimen) or by consensus of the Neuro-Oncology Group (11 patients) after a follow-up of >6 months (mean 14.9 ± 2.72 months). The global diagnostic accuracies were 90.9% for aMRI (38.8% inconclusive), 69.2 % for (201)Tl-SPECT (11.1% inconclusive), and 100% for (18)F-fluorocholine PET/CT. (201)Tl-SPECT led correctly to a change in the initial approach in 38.9% of patients but might have led to error in 27.8%. The use of (18)F-fluorocholine PET/CT alone rather than (201)Tl-SPECT led correctly to a change in the approach suggested by routine follow-up in 72.2% of patients and endorsed the approach in the remaining 27.8%.
  
  
  CONCLUSIONS
  Our results support the need to complement structural MRI with aMRI and nuclear medicine procedures in selected patients. (18)F-Fluorocholine PET/CT can be useful in the individualized management of patients with treated LGG with uncertain clinical and/or radiological evidence of tumour activity.
authors: Instituto de Investigación Biosanitaria de Granada, Granada, Spain, manuel.gomez.rio.sspa@juntadeandalucia.es.
authors: Manuel
authors: M
authors: Gómez-Río
authors: Nathalie
authors: N
authors: Testart Dardel
authors: Alicia
authors: A
authors: Santiago Chinchilla
authors: Antonio
authors: A
authors: Rodríguez-Fernández
authors: Gonzalo
authors: G
authors: Olivares Granados
authors: Raquel
authors: R
authors: Luque Caro
authors: Mercedes
authors: M
authors: Zurita Herrera
authors: Clara E
authors: CE
authors: Chamorro Santos
authors: Pablo
authors: P
authors: Lardelli-Claret
authors: José M
authors: JM
authors: Llamas-Elvira
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000000981:diagnostic imaging*; D002794:Choline / Q000031:analogs & derivatives*; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D013793:Thallium; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; C027549:thallium chloride; C514960:fluorocholine; D013793:Thallium; D002794:Choline