title: The use of dynamic O-(2-18F-fluoroethyl)-l-tyrosine PET in the diagnosis of patients with progressive and recurrent glioma.
abstract: BACKGROUND
  We evaluated the diagnostic value of static and dynamic O-(2-[(18)F]fluoroethyl)-L-tyrosine ((18)F-FET) PET parameters in patients with progressive or recurrent glioma.
  
  
  METHODS
  We retrospectively analyzed 132 dynamic (18)F-FET PET and conventional MRI scans of 124 glioma patients (primary World Health Organization grade II, n = 55; grade III, n = 19; grade IV, n = 50; mean age, 52 ± 14 y). Patients had been referred for PET assessment with clinical signs and/or MRI findings suggestive of tumor progression or recurrence based on Response Assessment in Neuro-Oncology criteria. Maximum and mean tumor/brain ratios of (18)F-FET uptake were determined (20-40 min post-injection) as well as tracer uptake kinetics (ie, time to peak and patterns of the time-activity curves). Diagnoses were confirmed histologically (95%) or by clinical follow-up (5%). Diagnostic accuracies of PET and MR parameters for the detection of tumor progression or recurrence were evaluated by receiver operating characteristic analyses/chi-square test.
  
  
  RESULTS
  Tumor progression or recurrence could be diagnosed in 121 of 132 cases (92%). MRI and (18)F-FET PET findings were concordant in 84% and discordant in 16%. Compared with the diagnostic accuracy of conventional MRI to diagnose tumor progression or recurrence (85%), a higher accuracy (93%) was achieved by (18)F-FET PET when a mean tumor/brain ratio ≥2.0 or time to peak <45 min was present (sensitivity, 93%; specificity, 100%; accuracy, 93%; positive predictive value, 100%; P < .001).
  
  
  CONCLUSIONS
  Static and dynamic (18)F-FET PET parameters differentiate progressive or recurrent glioma from treatment-related nonneoplastic changes with higher accuracy than conventional MRI.
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.).
authors.forename: Norbert
authors.initials: N
authors.lastname: Galldiks
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.).
authors.forename: Gabriele
authors.initials: G
authors.lastname: Stoffels
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.).
authors.forename: Christian
authors.initials: C
authors.lastname: Filss
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.).
authors.forename: Marion
authors.initials: M
authors.lastname: Rapp
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.).
authors.forename: Tobias
authors.initials: T
authors.lastname: Blau
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.).
authors.forename: Caroline
authors.initials: C
authors.lastname: Tscherpel
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.).
authors.forename: Garry
authors.initials: G
authors.lastname: Ceccon
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.).
authors.forename: Veronika
authors.initials: V
authors.lastname: Dunkl
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.).
authors.forename: Martin
authors.initials: M
authors.lastname: Weinzierl
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.).
authors.forename: Michael
authors.initials: M
authors.lastname: Stoffel
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.).
authors.forename: Michael
authors.initials: M
authors.lastname: Sabel
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.).
authors.forename: Gereon R
authors.initials: GR
authors.lastname: Fink
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.).
authors.forename: Nadim J
authors.initials: NJ
authors.lastname: Shah
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany (N.G., C.T., G.C., V.D., G.R.F.); Department of Neuropathology, University of Cologne, Cologne, Germany (T.B.); Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany (N.G., G.S., C.F., V.D., G.R.F., N.J.S., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany (M.R., M.Sa.); Department of Neurosurgery, Helios Kliniken, Krefeld, Germany (M.W., M.St.); Department of Neurology, University of Aachen, Aachen, Germany (N.J.S.); Department of Nuclear Medicine, University of Aachen, Aachen, Germany (K.-J.L.); Jülich-Aachen Research Alliance (JARA)-Section JARA-Brain (N.J.S., K.-J.L.).
authors.forename: Karl-Josef
authors.initials: KJ
authors.lastname: Langen
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000378:metabolism
chemical_list: C117289:O-(2-fluoroethyl)tyrosine; D014443:Tyrosine
keywords: FET PET; malignant glioma; progressive disease; tumor recurrence