18 F-fluorothymidine PET imaging in gliomas: an update
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18
F-fluorothymidine PET imaging in gliomas: an update
Alexandra Nikaki1,2 • George Angelidis2 • Roxani Efthimiadou3 • Ioannis Tsougos2 Varvara Valotassiou2 • Konstantinos Fountas4 • Vasileios Prasopoulos3,5 • Panagiotis Georgoulias2
•
Received: 21 March 2017 / Accepted: 31 May 2017 Ó The Author(s) 2017. This article is an open access publication
Abstract Brain neoplasms constitute a group of tumors with discrete differentiation grades, and therefore, course of disease and prognosis. Magnetic resonance imaging (MRI) remains the gold standard method for the investigation of central nervous system tumors. However, MRI suffers certain limitations, especially if radiation therapy or chemotherapy has been previously applied. On the other hand, given the development of newer radiopharmaceuticals, positron emission tomography (PET) aims to a better investigation of brain tumors, assisting in the clinical management of the patients. In the present review, the potential contribution of radiolabeled fluorothymidine (FLT) imaging for the evaluation of brain tumors will be discussed. In particular, we will present the role of FLTPET imaging in the depiction of well and poorly differentiated lesions, the assessment of patient prognosis and treatment response, and the recognition of disease recurrence. Moreover, related semi-quantitative and kinetic parameters will be discussed.
& Panagiotis Georgoulias [email protected] 1
Department of Clinical Physiology, KHSHP, 20 Ahvenistontie Str., 13530 Ha¨meenlinna, Finland
2
Department of Nuclear Medicine, University Hospital of Larissa, Mezourlo, 41110 Larissa, Greece
3
PET/CT Department, Hygeia Hospital, 4 Erythrou Stavrou Str., 15123 Athens, Greece
4
Department of Neurosurgery, University Hospital of Larissa, Mezourlo, 41110 Larissa, Greece
5
Department of Nuclear Medicine, Hygeia Hospital, 4 Erythrou Stavrou Str., 15123 Athens, Greece
Keywords Fluorothymidine Glioma MRI PET Prognosis
Introduction Brain neoplasms can be classified into two main groups, primary tumors and metastatic brain lesions which are more common. Gliomas represent the most frequent type of primary brain tumors and mainly consist of malignant neoplasms; more than half of these lesions are glioblastomas [1]. The incidence of malignant gliomas is approximately 3–5/100,000 cases, with slightly higher incidence in males and a peak at the sixth decade of life [1, 2]. They arise from the glial cells and constitute a heterogeneous group of neoplasms characterized by different cell origin and developmental pattern [3]. According to their malignant potential, they are categorized into four grades (I–IV). Grade I and II lesions correspond to non-invasive gliomas, whereas grades III and IV include invasive tumors with worse outcome and poorer prognosis [3, 4]. However, there may be overlaps among the morphological and diagnostic characteristics used for grading purposes. Moreover, genetic/epigenetic evidence is taken into account for the determination of prognosis and in the therap
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