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[124I]CLR1404 PET/CT in High-Grade Primary and Metastatic Brain Tumors

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Abstract

Purpose

There is a continuous search for imaging techniques with high sensitivity and specificity for brain tumors. Positron emission tomography (PET) imaging has shown promise, though many PET agents either have a low tumor specificity or impractical physical half-lives. [124I]CLR1404 is a small molecule alkylphosphocholine analogue that is thought to bind to plasma membrane lipid rafts and has shown high tumor-to-background ratios (TBR) in a previous pilot study in brain tumor patients. This study attempts to define the clinical value of [124I]CLR1404 PET/CT (aka CLR124).

Procedures

Adult patients with new or suspected recurrence of high-grade primary or metastatic brain tumors (N = 27) were injected with [124I]CLR1404 followed by PET/CT at 6, 24, and 48 h. Standard uptake values (SUV) and TBR values were calculated for all time points. Uptake of [124I]CLR1404 was qualitatively assessed, compared with magnetic resonance imaging (MRI), and correlated with clinical outcome. Final diagnosis (N = 25) was established based on surgically resected tissue or long-term follow-up.

Results

Positive uptake with high TBR was detected in all but one patient with a final diagnosis of primary/recurrent brain tumor (12/13) and in less than half of patients with treatment-related changes (5/12). Concordance between [124I]CLR1404 uptake and contrast enhancement on MRI was seen in < 40 %, with no concordance between T2-hyperintensities and uptake. No significant difference in overall outcome was found between patients with and without [124I]CLR1404 uptake.

Conclusions

The uptake pattern in these patients suggests a very high sensitivity of [124I]CLR1404 PET/CT for diagnosing tumor tissue; however, tumor specificity needs to be further defined. Relative lack of concordance with standard MRI characteristics suggests that [124I]CLR1404 PET/CT provides additional information about brain tumors compared to MRI alone, potentially improving clinical decision-making.

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Acknowledgements

We gratefully acknowledge our dedicated clinical study coordinators (Diana Trask, Nick Anger, Lori Hayes, and Belinda Buehl-Soppe), PET study coordinator (Christine Jaskowiak), statistician (Kaitlin Woo), and of course our patient volunteers who selflessly gave their time and trust to participate in our studies.

Funding

This study was funded by grants UL1TR000427, P30CA014520, and R01CA158800.

Author information

Author notes

  1. John S. Kuo

    Present address: Department of Neurosurgery, The University of Texas at Austin, Austin, TX, USA

Authors and Affiliations

  1. Department of Radiology, University of Wisconsin Hospitals and Clinics, MC 3252, 600 Highland Ave, Madison, WI, 53792, USA

    Lance T. Hall, Benjamin Titz, Nishanta Baidya, Anja G. van der Kolk, Scott B. Perlman & Jamey P. Weichert

  2. Carbone Cancer Center, University of Wisconsin, Madison, WI, USA

    Lance T. Hall, H. Ian Robins, Scott B. Perlman, Jamey P. Weichert & John S. Kuo

  3. Department of Human Oncology, University of Wisconsin, Madison, WI, USA

    H. Ian Robins & John S. Kuo

  4. Department of Neurology, University of Wisconsin, Madison, WI, USA

    H. Ian Robins

  5. Department of Medicine, University of Wisconsin, Madison, WI, USA

    H. Ian Robins

  6. Department of Pediatrics, University of Wisconsin, Madison, WI, USA

    Mario Otto

  7. Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA

    John S. Kuo

Authors
  1. Lance T. Hall
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  2. Benjamin Titz
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Corresponding author

Correspondence to Lance T. Hall.

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All authors declare that he/she has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Hall, L.T., Titz, B., Baidya, N. et al. [124I]CLR1404 PET/CT in High-Grade Primary and Metastatic Brain Tumors. Mol Imaging Biol 22, 434–443 (2020). https://doi.org/10.1007/s11307-019-01362-1

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  • DOI: https://doi.org/10.1007/s11307-019-01362-1

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