Usefulness of 18 F-FDOPA PET for the management of primary brain tumors: a systematic review of the literature
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REVIEW
Open Access
Usefulness of 18F-FDOPA PET for the management of primary brain tumors: a systematic review of the literature François Somme1* , Laura Bender2, Izzie Jacques Namer1,3, Georges Noël4,5 and Caroline Bund1
Abstract Contrast-enhanced magnetic resonance imaging is currently the standard of care in the management of primary brain tumors, although certain limitations remain. Metabolic imaging has proven useful for an increasing number of indications in oncology over the past few years, most particularly 18F-FDG PET/CT. In neuro-oncology, 18F-FDG was insufficient to clearly evaluate brain tumors. Amino-acid radiotracers such as 18F-FDOPA were then evaluated in the management of brain diseases, notably tumoral diseases. Even though European guidelines on the use of aminoacid PET in gliomas have been published, it is crucial that future studies standardize acquisition and interpretation parameters. The aim of this article was to systematically review the potential effect of this metabolic imaging technique in numerous steps of the disease: primary and recurrence diagnosis, grading, local and systemic treatment assessment, and prognosis. A total of 41 articles were included and analyzed in this review. It appears that 18F-FDOPA PET holds promise as an effective additional tool in the management of gliomas. More consistent prospective studies are still needed. Keywords: F-DOPA, Glioma, Primary brain tumor, Systematic review
Background Management of primary brain tumors is based on contrast-enhanced magnetic resonance imaging (MRI). Despite progress in MRI as a perfusion and diffusion technique, it has a number of limitations (mainly due to the disruption of the blood–brain barrier), most particularly in differentiating recurrence from post-therapeutic effects [1, 2]. Additional magnetic resonance spectroscopy was developed to improve sensitivity and specificity. However, overlap between low-grade tumor values and those obtained for high-grade tumors has made this technique disputable [3, 4]. Its use to differentiate relapse and pseudo-progression remains under study [5]. * Correspondence: [email protected] 1 Nuclear medicine Department, Hautepierre University Hospital, 1, rue Molière, F-67000 Strasbourg, France Full list of author information is available at the end of the article
Differentiating low-grade and high-grade features of a primary brain tumor as well as identifying patients with relapse and those with pseudo-progression are crucial in choosing the best treatment. Positron emission tomography with computed tomography (PET/CT) could be a tool to help reach these goals given the large number of radioisotopes that can be used in various clinical situations. 18 Fluor-fluorodeoxyglucose (18F-FDG) PET/CT is widely used in oncology and can provide relevant information, even in the management of primary brain tumors [6, 7]. Nevertheless, a high rate of glucose metabolism in normal brain tissue (generating a poor signal-to-noise ratio with the tumor), tumors with low glucose metabolism
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