Response Assessment in Neuro-Oncology working group and European Association for Neuro-Oncology recommendations for the clinical use of PET imaging in gliomas.
This guideline provides recommendations for the use of PET imaging in gliomas. The review examines established clinical benefit in glioma patients of PET using glucose ((18)F-FDG) and amino acid tracers ((11)C-MET, (18)F-FET, and (18)F-FDOPA). An increasing number of studies have been published on PET imaging in the setting of diagnosis, biopsy, and resection as well radiotherapy planning, treatment monitoring, and response assessment. Recommendations are based on evidence generated from studies which validated PET findings by histology or clinical course. This guideline emphasizes the clinical value of PET imaging with superiority of amino acid PET over glucose PET and provides a framework for the use of PET to assist in the management of patients with gliomas.
Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.).
Nathalie L
NL
Albert
Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.).
Michael
M
Weller
Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.).
Bogdana
B
Suchorska
Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.).
Norbert
N
Galldiks
Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.).
Riccardo
R
Soffietti
Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.).
Michelle M
MM
Kim
Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.).
Christian
C
la Fougère
Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.).
Whitney
W
Pope
Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.).
Ian
I
Law
Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.).
Javier
J
Arbizu
Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.).
Marc C
MC
Chamberlain
Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.).
Michael
M
Vogelbaum
Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.).
Ben M
BM
Ellingson
Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.) joerg.christian.tonn@med.uni-muenchen.de.
Joerg C
JC
Tonn
D000818:Animals; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000628:therapy; D005910:Glioma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000628:therapy; D006801:Humans; D057054:Molecular Imaging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals / Q000378:metabolism*
D019275:Radiopharmaceuticals
PET imaging; amino acid PET; glioma; guideline; recommendations