European Radiology

, Volume 25, Issue 10, pp 3017–3024 | Cite as

Dual-time-point O-(2-[18F]fluoroethyl)-L-tyrosine PET for grading of cerebral gliomas

  • Philipp Lohmann
  • Hans Herzog
  • Elena Rota Kops
  • Gabriele Stoffels
  • Natalie Judov
  • Christian Filss
  • Norbert Galldiks
  • Lutz Tellmann
  • Carolin Weiss
  • Michael Sabel
  • Heinz Hubert Coenen
  • Nadim Jon Shah
  • Karl-Josef LangenEmail author
Nuclear Medicine



We aimed to evaluate the diagnostic potential of dual-time-point imaging with positron emission tomography (PET) using O-(2-[18F]fluoroethyl)-L-tyrosine (18F-FET) for non-invasive grading of cerebral gliomas compared with a dynamic approach.


Thirty-six patients with histologically confirmed cerebral gliomas (21 primary, 15 recurrent; 24 high-grade, 12 low-grade) underwent dynamic PET from 0 to 50 min post-injection (p.i.) of 18F-FET, and additionally from 70 to 90 min p.i. Mean tumour-to-brain ratios (TBRmean) of 18F-FET uptake were determined in early (20–40 min p.i.) and late (70–90 min p.i.) examinations. Time–activity curves (TAC) of the tumours from 0 to 50 min after injection were assigned to different patterns. The diagnostic accuracy of changes of 18F-FET uptake between early and late examinations for tumour grading was compared to that of curve pattern analysis from 0 to 50 min p.i. of 18F-FET.


The diagnostic accuracy of changes of the TBRmean of 18F-FET PET uptake between early and late examinations for the identification of HGG was 81 % (sensitivity 83 %; specificity 75 %; cutoff - 8 %; p < 0.001), and 83 % for curve pattern analysis (sensitivity 88 %; specificity 75 %; p < 0.001).


Dual-time-point imaging of 18F-FET uptake in gliomas achieves diagnostic accuracy for tumour grading that is similar to the more time-consuming dynamic data acquisition protocol.

Key Points

Dual-time-point imaging is equivalent to dynamic FET PET for grading of gliomas.

Dual-time-point imaging is less time consuming than dynamic FET PET.

Costs can be reduced due to higher patient throughput.

Reduced imaging time increases patient comfort and sedation might be avoided.

Quicker image interpretation is possible, as no curve evaluation is necessary.


Cerebral glioma FET PET Tracer kinetics Dual-time-point imaging Tumour grade 









Area under receiver-operating-characteristic curve


High-grade glioma


Low-grade glioma


Ordinary Poisson ordered subset expectation maximisation


Ordered subset expectation maximisation




Standardised uptake value


Mean standardised uptake value


Time-activity curve


Tumour-to-brain ratio


Mean tumour-to-brain ratio


Time to peak





The authors thank Suzanne Schaden, Elisabeth Theelen and Kornelia Frey for assistance in the patient studies; and Johannes Ermert, Silke Grafmüller, Erika Wabbals and Sascha Rehbein for radiosynthesis of 18F-FET. The scientific guarantor of this publication is Prof. Dr. Karl-Josef Langen. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic study, performed at one institution.

Supplementary material

330_2015_3691_MOESM1_ESM.doc (52 kb)
ESM 1 (DOC 52.5 kb)


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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Philipp Lohmann
    • 1
  • Hans Herzog
    • 1
  • Elena Rota Kops
    • 1
  • Gabriele Stoffels
    • 1
  • Natalie Judov
    • 1
  • Christian Filss
    • 1
  • Norbert Galldiks
    • 1
    • 2
  • Lutz Tellmann
    • 1
  • Carolin Weiss
    • 3
  • Michael Sabel
    • 4
  • Heinz Hubert Coenen
    • 1
    • 6
  • Nadim Jon Shah
    • 1
    • 6
    • 7
  • Karl-Josef Langen
    • 1
    • 5
    • 6
    Email author
  1. 1.Institute of Neuroscience and MedicineForschungszentrum JülichJülichGermany
  2. 2.Department of NeurologyUniversity of CologneCologneGermany
  3. 3.Department of NeurosurgeryUniversity of CologneCologneGermany
  4. 4.Department of NeurosurgeryHeinrich-Heine UniversityDüsseldorfGermany
  5. 5.Department of Nuclear MedicineRWTH Aachen University HospitalAachenGermany
  6. 6.Jülich-Aachen Research Alliance (JARA) – Section JARA-BrainJülichGermany
  7. 7.Department of NeurologyRWTH Aachen University HospitalAachenGermany

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