title: Glioblastoma Multiforme Recurrence: An Exploratory Study of (18)F FPPRGD2 PET/CT.
abstract: OBJECTIVE
  To prospectively evaluate fluorine 18 ((18)F) 2-fluoropropionyl-labeled PEGylated dimeric arginine-glycine-aspartic acid (RGD) peptide (PEG3-E[c{RGDyk}]2) (FPPRGD2) positron emission tomography (PET) in patients with glioblastoma multiforme (GBM).
  
  
  METHODS
  The institutional review board approved this HIPAA-compliant protocol. Written informed consent was obtained from each patient. (18)F FPPRGD2 uptake was measured semiquantitatively in the form of maximum standardized uptake values (SUV(max)) and uptake volumes before and after treatment with bevacizumab. Vital signs and laboratory results were collected before, during, and after the examinations. A nonparametric version of multivariate analysis of variance was used to assess safety outcome measures simultaneously across time points. A paired two-sample t test was performed to compare SUV(max).
  
  
  RESULTS
  A total of 17 participants (eight men, nine women; age range, 25-65 years) were enrolled prospectively. (18)F FPPRGD2 PET/computed tomography (CT), (18)F fluorodeoxyglucose (FDG) PET/CT, and brain magnetic resonance (MR) imaging were performed within 3 weeks, prior to the start of bevacizumab therapy. In eight of the 17 patients (47%), (18)F FPPRGD2 PET/CT was repeated 1 week after the start of bevacizumab therapy; six patients (35%) underwent (18)F FPPRGD2 PET/CT a third time 6 weeks after starting bevacizumab therapy. There were no changes in vital signs, electrocardiographic findings, or laboratory values that qualified as adverse events. One patient (6%) had recurrent GBM identified only on (18)F FPPRGD2 PET images, and subsequent MR images enabled confirmation of recurrence. Of the 17 patients, 14 (82%) had recurrent GBM identified on (18)F FPPRGD2 PET and brain MR images, while (18)F FDG PET enabled identification of recurrence in 13 (76%) patients. Two patients (12%) had no recurrent GBM.
  
  
  CONCLUSIONS
  (18)F FPPRGD2 is a safe PET radiopharmaceutical that has increased uptake in GBM lesions. Larger cohorts are required to confirm these preliminary findings.
authors.affiliation: From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.).
authors.forename: Andrei
authors.initials: A
authors.lastname: Iagaru
authors.affiliation: From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.).
authors.forename: Camila
authors.initials: C
authors.lastname: Mosci
authors.affiliation: From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.).
authors.forename: Erik
authors.initials: E
authors.lastname: Mittra
authors.affiliation: From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.).
authors.forename: Greg
authors.initials: G
authors.lastname: Zaharchuk
authors.affiliation: From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.).
authors.forename: Nancy
authors.initials: N
authors.lastname: Fischbein
authors.affiliation: From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.).
authors.forename: Griffith
authors.initials: G
authors.lastname: Harsh
authors.affiliation: From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.).
authors.forename: Gordon
authors.initials: G
authors.lastname: Li
authors.affiliation: From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.).
authors.forename: Seema
authors.initials: S
authors.lastname: Nagpal
authors.affiliation: From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.).
authors.forename: Lawrence
authors.initials: L
authors.lastname: Recht
authors.affiliation: From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.).
authors.forename: Sanjiv Sam
authors.initials: SS
authors.lastname: Gambhir
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005462:Fluorine Radioisotopes / Q000737:chemistry; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology; D010456:Peptides, Cyclic / Q000138:chemical synthesis*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals / Q000138:chemical synthesis*; D014057:Tomography, X-Ray Computed
chemical_list: C574086:FPP(RGD)2; D005462:Fluorine Radioisotopes; D010456:Peptides, Cyclic; D019275:Radiopharmaceuticals