Volumetric assessment of recurrent or progressive gliomas: comparison between F-DOPA PET and perfusion-weighted MRI

  • Francesco CiconeEmail author
  • Christian P. Filss
  • Giuseppe Minniti
  • Camilla Rossi-Espagnet
  • Annalisa Papa
  • Claudia Scaringi
  • Norbert Galldiks
  • Alessandro Bozzao
  • N. Jon Shah
  • Francesco Scopinaro
  • Karl-Josef Langen
Original Article



To compare the diagnostic information obtained with 6-[18F]-fluoro-l-3,4-dihydroxyphenylalanine (F-DOPA) PET and relative cerebral blood volume (rCBV) maps in recurrent or progressive glioma.


All patients with recurrent or progressive glioma referred for F-DOPA imaging at our institution between May 2010 and May 2014 were retrospectively included, provided that macroscopic disease was visible on conventional MRI images and that rCBV maps were available for comparison. The final analysis included 50 paired studies (44 patients). After image registration, automatic tumour segmentation of both sets of images was performed using the average signal in a large reference VOI including grey and white matter multiplied by 1.6. Tumour volumes identified by both modalities were compared and their spatial congruence calculated. The distances between F-DOPA uptake and rCBV hot spots, tumour-to-brain ratios (TBRs) and normalized histograms were also computed.


On visual inspection, 49 of the 50 F-DOPA and 45 of the 50 rCBV studies were classified as positive. The tumour volume delineated using F-DOPA (F-DOPAvol 1.6) greatly exceeded that of rCBV maps (rCBVvol 1.6). The median F-DOPAvol 1.6 and rCBVvol 1.6 were 11.44 ml (range 0 – 220.95 ml) and 1.04 ml (range 0 – 26.30 ml), respectively (p < 0.00001). Overall, the median overlapping volume was 0.27 ml, resulting in a spatial congruence of 1.38 % (range 0 – 39.22 %). The mean hot spot distance was 27.17 mm (±16.92 mm). F-DOPA uptake TBR was significantly higher than rCBV TBR (1.76 ± 0.60 vs. 1.15 ± 0.52, respectively; p < 0.0001). The histogram analysis showed that F-DOPA provided better separation of tumour from background. In 6 of the 50 studies (12 %), however, physiological uptake in the striatum interfered with tumour delineation.


The information provided by F-DOPA PET and rCBV maps are substantially different. Image interpretation is easier and a larger tumour extent is identified on F-DOPA PET images than on rCBV maps. The clinical impact of such differences needs to be explored in future studies.


Glioma Amino acid brain PET DOPA Tumour volume rCBV maps Perfusion-weighted magnetic resonance 


Compliance with Ethical Standards

Conflicts of interest


Ethical approval

All procedures performed in the study were in accordance with the standards of the institutional ethical committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

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


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Francesco Cicone
    • 1
    • 2
    • 3
    Email author
  • Christian P. Filss
    • 3
    • 4
  • Giuseppe Minniti
    • 2
    • 5
  • Camilla Rossi-Espagnet
    • 6
    • 7
  • Annalisa Papa
    • 1
    • 2
  • Claudia Scaringi
    • 2
    • 5
  • Norbert Galldiks
    • 3
    • 8
  • Alessandro Bozzao
    • 6
    • 7
  • N. Jon Shah
    • 3
  • Francesco Scopinaro
    • 1
    • 2
  • Karl-Josef Langen
    • 3
    • 4
  1. 1.Unit of Nuclear MedicineSant’Andrea HospitalRomeItaly
  2. 2.Department of Surgical and Medical Sciences and translational Medicine, Faculty of Medicine and Psychology“Sapienza” University of RomeRomeItaly
  3. 3.Institute of Neuroscience and MedicineResearch Centre JuelichJuelichGermany
  4. 4.Department of Nuclear MedicineRWTH Aachen University HospitalAachenGermany
  5. 5.Unit of RadiotherapySant’Andrea HospitalRomeItaly
  6. 6.Unit of NeuroradiologySant’Andrea HospitalRomeItaly
  7. 7.Department of Neurosciences, Mental Health and Sensory Organs (Ne.S.M.O.S.), Faculty of Medicine and Psychology“Sapienza” University of RomeRomeItaly
  8. 8.Department of NeurologyUniversity of CologneCologneGermany

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