18F-Fluciclovine (18F-FACBC) PET/CT or PET/MRI in gliomas/glioblastomas

  • Domenico AlbanoEmail author
  • Davide Tomasini
  • Marco Bonù
  • Raffaele Giubbini
  • Francesco Bertagna
Review Article


18F-fluciclovine (18F-FACBC) is a radiotracer already studied for prostate cancer, and its potential role in brain tumors (such as glioma) is not yet well investigated despite promising results. The aim of this review is to evaluate the possible diagnostic role of 18F-FACBC PET/CT or PET/MRI in patients with gliomas and glioblastomas. A comprehensive literature search of the PubMed/MEDLINE, Scopus, Embase, and Cochrane library databases was conducted to find the relevant published articles about the diagnostic performance of FACBC PET/CT or PET/MRI in patients affected by glioma and/or glioblastoma. Seven papers were included in the systematic review. From the analyses of the selected studies, the following main findings were obtained: glioma and glioblastoma are FACBC-avid tumors with a detection rate of about 100%; FACBC PET has high-diagnostic accuracy in defining tumor extent, volumes, and satellite lesions better than MR; compared to methionine, FACBC has similar accuracy but better tumor-to-background contrast; FACBC uptake may help to discriminate between low-grade and high-grade glioma. Radiolabelled fluciclovine (18F-FACBC) imaging seems to be useful in analyzing glioma/glioblastoma. Further studies enrolling a wider population are needed to clarify the real clinical and diagnostic role of 18F-FACBC in this setting and its possible position in the diagnostic flowchart.


Fluciclovine FACBC Glioma Glioblastoma Positron emission tomography PET/CT PET/MRI 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


  1. 1.
    Pauleit D, Floeth F, Hamacher K, Riemenschneider MJ, Reifenberger G, Müller HW, et al. O-(2-[18F]fluoroethyl)-l-tyrosine PET combined with MRI improves the diagnostic assessment of cerebral gliomas. Brain. 2005;128:678–87.CrossRefGoogle Scholar
  2. 2.
    Juhász C, Dwivedi S, Kamson DO, Michelhaugh SK, Mittal S. Comparison of amino acid positron emission tomographic radiotracers for molecular imaging of primary and metastatic brain tumors. Mol Imaging. 2014;13:1–16.CrossRefGoogle Scholar
  3. 3.
    Galldiks N, Law I, Pope WB, Arbizu J, Langen KJ. The use of amino acid PET and conventional MRI for monitoring of brain tumor therapy. Neuroimage Clin. 2016;13:386–94.CrossRefGoogle Scholar
  4. 4.
    Filss CP, Cicone F, Shah NJ, Shah NJ, Galldikis N, Lamgen KJ. Amino acid PET and MR perfusion imaging in brain tumours. Clin Transl Imaging. 2017;5:209–23.CrossRefGoogle Scholar
  5. 5.
    Langen KJ, Galldiks N, Hattingen E, Shah NJ. Advances in neuro-oncology imaging. Nat Rev Neurol. 2017;13:279–89.CrossRefGoogle Scholar
  6. 6.
    Verger A, Filss CP, Lohmann P, Stoffels G, Sabel M, Wittsack HJ, et al. Comparison of (18)F-FET PET and perfusion-weighted MRI for glioma grading: a hybrid PET/MR study. Eur J Nucl Med Mol Imaging. 2017;44:2257–65.CrossRefGoogle Scholar
  7. 7.
    Albert NL, Weller M, Suchorska B, Galldikis N, Soffietti R, Kim MM, et al. Response assessment in neuro-oncology working group and European Association for Neuro-Oncology recommendations for the clinical use of PET imaging in gliomas. Neuro Oncol. 2016;18:1199–208.CrossRefGoogle Scholar
  8. 8.
    Eisele SC, Wen PY, Lee EQ. Assessment of brain tumor response: RANO and its offspring. Curr Treat Options Oncol. 2016;17:35.CrossRefGoogle Scholar
  9. 9.
    Jager PL, Vaalburg W, Pruim J, de Vries EG, Langen KJ, Piers DA. Radiolabeled amino acids: basic aspects and clinical applications in oncology. J Nucl Med. 2001;42:432–45.PubMedGoogle Scholar
  10. 10.
    Laudicella R, Albano D, Alongi P, Argiroffi G, Bauckneht M, Baldari S, et al. 18F-Facbc in prostate cancer: a systematic review and meta-analysis. Cancers (Basel). 2019. Scholar
  11. 11.
    Oka S, Hattori R, Kurosaki F, Toyama M, Williams LA, Yu W, et al. A preliminary study of anti-1-amino-3-18F-fluorocyclobutyl-1-carboxylic acid for the detection of prostate cancer. J Nucl Med. 2007;48:46e55.Google Scholar
  12. 12.
    Shoup TM, Olson J, Hoffman JM, Votaw J, Eshima D, Eshima L, et al. Synthesis and evaluation of [18F]1-amino-3-fluorocyclobutane-1-carboxylic acid to image brain tumors. J Nucl Med. 1999;40:331–8.PubMedGoogle Scholar
  13. 13.
    Michaud L, Beattie BJ, Akhurst T, Dunphy M, Zanzonico P, Finn R, et al. 18F-Fluciclovine (18F-FACBC) PET imaging of recurrent brain tumors. Eur J Nucl Med Mol Imaging. 2019. Scholar
  14. 14.
    Bogsrud TV, Londalen A, Brandal P, Leske H, Panagopoulos I, Borghammer P, Bach-Gansmo T. 18F-Fluciclovine PET/CT in suspected residual or recurrent high-grade glioma. Clin Nucl Med. 2019;44(8):605–11.CrossRefGoogle Scholar
  15. 15.
    Karlberg A, Berntsen EM, Johansen H, Skjulsvik AJ, Reinertsen I, Dai HY, et al. 18F-FACBC PET/MRI in diagnostic assessment and neurosurgery of gliomas. Clin Nucl Med. 2019;44(7):550–9.PubMedGoogle Scholar
  16. 16.
    Parent EE, Benayoun M, Ibeanu I, Olson JJ, Hadjipanayis CG, Brat DJ, et al. [18F]Fluciclovine PET discrimination between high- and low-grade gliomas. EJNMMI Res. 2018;8(1):67.CrossRefGoogle Scholar
  17. 17.
    Tsuyuguchi N, Terakawa Y, Uda T, Nakajo K, Kanemura Y. Diagnosis of brain tumors using amino acid transport PET imaging with 18F-fluciclovine: a comparative study with l-methyl-11C-methionine PET imaging. Asia Ocean J Nucl Med Biol. 2017;5(2):85–94.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Wakabayashi T, Iuchi T, Tsuyuguchi N, Nishikawa R, Arakawa Y, Sasayama T, et al. Diagnostic performance and safety of positron emission tomography using 18F-fluciclovine in patients with clinically suspected high- or low-grade gliomas: a multicenter phase IIb trial. Asia Ocean J Nucl Med Biol. 2017;5(1):10–211.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Kondo A, Ishii H, Aoki S, Suzuki M, Nagasawa H, Kubota K, et al. Phase IIa clinical study of [18F]fluciclovine: efficacy and safety of a new PET tracer for brain tumors. Ann Nucl Med. 2016;30(9):608–18.CrossRefGoogle Scholar
  20. 20.
    Schucht P, Beck J, Seidel K, Raabe A. Extending resection and preserving function: modern concepts of glioma surgery. Swiss Med Wkly. 2015;145:w14082.PubMedGoogle Scholar
  21. 21.
    Herholz K. Brain tumors: an update on clinical PET research in gliomas. Semin Nucl Med. 2017;47:5–17.CrossRefGoogle Scholar
  22. 22.
    Bhutia YD, Babu E, Ramachandran S, Ganapathy V. Amino Acid transporters in cancer and their relevance to ‘‘glutamine addiction’’: novel targets for the design of a new class of anticancer drugs. Cancer Res. 2015;75:1782–8.CrossRefGoogle Scholar
  23. 23.
    Nariai T, Tanaka Y, Wakimoto H, Aoyagi M, Tamaki M, Ishiwata K, et al. Usefulness of l-[methyl-11C] methionine-positron emission tomography as a biological monitoring tool in the treatment of glioma. J Neurosurg. 2005;103:498–507.CrossRefGoogle Scholar
  24. 24.
    Akhurst T, Beattie B, Gogiberidze G, Montiel J, Cai S, Lassman A, et al. [18F]FACBC Imaging of recurrent gliomas: a comparison with [11C]methionine and MRI. J Nucl Med. 2006;47(suppl. 1):79.Google Scholar
  25. 25.
    Ono M, Oka S, Okudaira H, Schuster DM, Goodman MM, Kawai K, et al. Comparative evaluation of transport mechanisms of trans-1-amino-3-[18F]fluorocyclobutanecarboxylic acid and l-[methyl-11C]methionine in human glioma cell lines. Brain Res. 2013;1535:24–37.CrossRefGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2019

Authors and Affiliations

  1. 1.Nuclear MedicineUniversity of Brescia and Spedali Civili BresciaBresciaItaly
  2. 2.Department of Radiation OncologyUniversity of Brescia and ASST Spedali Civili Di BresciaBresciaItaly

Personalised recommendations