¹⁸F-choline PET/CT in Cerebral Gliomas

Purpose: To evaluate the diagnostic value of PET with ¹⁸F-choline in patients with glial brain tumors.

Material and methods: The analysis was based on data generated from PET/CT and MRI examinations of 30 patients with intracerebral tumors: glioblastomas – 9 (30 %) cases, anaplastic astrocytomas – 9 (30 %) cases, gliomas GrII – 7 (23.3 %) cases, benign astrocytomas GrI – 5 (16.7 %) cases. All patients with brain neoplasms underwent a selective brain ¹⁸F-choline PET/CT and MRI follow up at minimum two time points: for at least 6 months. All PET/CT studies were performed with Biograph mCT Siemens (multidetector (64) helical CT scanner, 120 kV, 300 mA, slice thick ness 1.2 mm; PET acquisitions occurred at 4 ring positions (48 lutetium orthosilicate based units each), scan slab – 21.6 cm, at the first stage 5 min / slab, the second 10 min / slab). The first registration was performed immediately after intravenous injection of the radiopharmaceutical (RP) using an automatic RP injector Intego 2010. Then patient were scanned again with the same protocol 45–55 min after injection. Administered activity was 300 MBq. Images visually and semiquantitatively assessment, with maximum standardized uptake value registration (maxSUV₁ – on the first stage and maxSUV₂ – on the second), was performed offline on a SyngoVia workstation using Oncology protocol.

Results: The highest average maxSUV₁ were observed in anaplastic astrocytomas and glioblastomas – 5.07 and 4.89, respectively, but the highest average growth (in %) of maxSUV₂ observed in glioblastomas – 15.46 %. The lowest maxSUV₁ 0.76 was registered in low-grade gliomas GrI.

Conclusion: PET using different radiopharmaceuticals, provides unique information on the functional status of tumors for a variety of biological processes. ¹⁸F-choline is a marker of cell membrane lipid metabolism, so it could allow estimating the activity of cell membranes formation. An unaffected brain substance almost does not accumulate ¹⁸F-choline. Two-stage PET technique of brain scanning with ¹⁸F-choline enabled us to assume the gradate of malignancy of intracranial tumors which depends on both the level of accumulation of tracer in the first stage (maxSUV₁) and the degree of uptake increase in the second stage (maxSUV₂). Thus, the increment of maxSUV₂ may be useful in the evaluation of tumor activity.

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