Comparison of 18F-FET PET and 5-ALA fluorescence in cerebral gliomas

  • Frank Willi Floeth
  • Michael Sabel
  • Christian Ewelt
  • Walter Stummer
  • Jörg Felsberg
  • Guido Reifenberger
  • Hans Jakob Steiger
  • Gabriele Stoffels
  • Heinz Hubert Coenen
  • Karl-Josef Langen
Original Article
First Online:
Received:
Accepted:

Abstract

Purpose

The aim of the study was to compare presurgical 18F-fluoroethyl-L-tyrosine (18F-FET) uptake and Gd-diethylenetriaminepentaacetic acid (DTPA) enhancement on MRI (Gd) with intraoperative 5-aminolevulinic acid (5-ALA) fluorescence in cerebral gliomas.

Methods

18F-FET positron emission tomography (PET) was performed in 30 patients with brain lesions suggestive of diffuse WHO grade II or III gliomas on MRI. PET and MRI data were coregistered to guide neuronavigated biopsies before resection. After oral application of 5-ALA, 38 neuronavigated biopsies were taken from predefined tumour areas that were positive or negative for 18F-FET or Gd and checked for 5-ALA fluorescence. 18F-FET uptake with a mean tumour to brain ratio ≥1.6 was rated as positive.

Results

Of 38 biopsies, 21 corresponded to high-grade glioma tissue (HGG) of WHO grade III (n = 19) or IV (n = 2) and 17 biopsies to low-grade glioma tissue (LGG) of WHO grade II. In biopsies corresponding to HGG, 18F-FET PET was positive in 86% (18/21), but 5-ALA and Gd in only 57% (12/21). A mismatch between Gd and 5-ALA was observed in 6 of 21 cases of HGG biopsy samples (3 Gd-positive/5-ALA-negative and 3 Gd-negative/5-ALA-positive). In biopsies corresponding to LGG, 18F-FET was positive in 41% (7/17), while 5-ALA and Gd were negative in all but one instance. All tumour areas with 5-ALA fluorescence were positive on 18F-FET PET.

Conclusion

There are differences between 18F-FET and 5-ALA uptake in cerebral gliomas owing to a limited sensitivity of 5-ALA to detect tumour tissue especially in LGG. 18F-FET PET is more sensitive to detect glioma tissue than 5-ALA fluorescence and should be considered as an additional tool in resection planning.

Keywords

Cerebral glioma Amino acid PET [18F]Fluoroethyl-L-tyrosine (18F-FET) 5-Aminolevulinic acid (5-ALA) Fluorescence-guided resection Gd-DTPA enhancement 
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Notes

Acknowledgement

The authors wish to thank Suzanne Schaden and Elisabeth Theelen for assistance in the PET studies; Silke Grafmüller, Erika Wabbals and Sascha Rehbein for radiosynthesis of 18F-FET. This work was supported by the Brain Imaging Center West (BICW).

Conflicts of interest

None.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Frank Willi Floeth
    • 1
  • Michael Sabel
    • 1
  • Christian Ewelt
    • 2
  • Walter Stummer
    • 2
  • Jörg Felsberg
    • 3
  • Guido Reifenberger
    • 3
  • Hans Jakob Steiger
    • 1
  • Gabriele Stoffels
    • 4
  • Heinz Hubert Coenen
    • 5
  • Karl-Josef Langen
    • 4
  1. 1.Department of NeurosurgeryHeinrich Heine UniversityDüsseldorfGermany
  2. 2.Department of NeurosurgeryWestfälische Wilhelms UniversityMünsterGermany
  3. 3.Department of NeuropathologyHeinrich Heine UniversityDüsseldorfGermany
  4. 4.Institute of Neuroscience and Medicine 4Medical Imaging Physics, Forschungszentrum JülichJülichGermany
  5. 5.Institute of Neuroscience and Medicine 5Nuclear Chemistry, Forschungszentrum JülichJülichGermany

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