Artikel
Differentiation of tumorous and non-tumorous intracerebral ring-enhancing lesions with positron emission tomography (PET) using the amino acid [18F]-fluoroethyl-l-tyrosine (FET)
Unterscheidung neoplastischer von nicht neoplastischen Läsionen mit Ringenhancement durch ein Aminosäure-PET mit [18F]-fluoroethyl-l-tyrosine (FET)
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Autoren
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F. Floeth
- Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
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K.J. Langen
- Brain Imaging Center West, Institute of Medicine, Research Center Jülich
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D. Pauleit
- Institute of Nuclear Chemistry, Research Center Jülich
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G. Reifenberger
- Neuropathologie, Heinrich-Heine-Universität Düsseldorf
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W. Stummer
- Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
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H.J. Steiger
- Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
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M. Sabel
- Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: The aim of this study was to explore the differential diagnostic value of positron emission tomography (PET) using the amino acid [18F]-fluoroethyl-l-tyrosine (FET) in patients with newly diagnosed solitary intracerebral lesions showing ring-enhancement on contrast-enhanced magnetic resonance imaging (MRI).
Methods: FET-PET analyses were carried out on 15 consecutive patients with intracerebral ring-enhancing lesions. In addition eleven of the patients were studied with 2-[18F]fluoro-2-deoxy-D-glucose (FDG)-PET. In all patients, the main differential diagnosis after MRI was a malignant lesion, in particular glioblastoma multiforme, versus a benign lesion, in particular a brain abscess. Based on FET-PET, a malignant tumor was suspected for lesions showing increased FET-uptake, with a lesion-to-brain ratio ≥1.6 (FET-PET positive). A non-neoplastic lesion was suspected in case of minimal or absent FET-uptake with a lesion-to-brain ratio <1.6 (FET-PET negative). Histologic diagnosis was obtained by serial biopsies in 14 of the 15 patients. One patient refused the biopsy but follow-up indicated an abscess because his lesion regressed under antibiotic therapy.
Results: Histology and clinical follow-up showed high-grade malignant gliomas in 6 patients and non-neoplastic lesions in 9 patients. FET-PET was positive in all 6 glioma patients as well as in 3 out of 9 patients with non-neoplastic lesions, including 2 patients with brain abscesses and 1 patient with a demyelinating lesion. FDG-PET was positive (lesion-to-gray matter ratio ≥0.7) in 4 out of 4 glioma patients and 3 out of 7 patients with non-neoplastic lesions.
Conclusions: Although FET-PET has been shown to be a very valuable method for the diagnostic evaluation of brain tumors, our data indicate a limited specificity of FET-PET, like FDG-PET, for the distinction between neoplastic and non-neoplastic ring-enhancing intracerebral lesions. Thus, histological investigation of biopsy specimens remains mandatory to solve this important differential diagnosis.
