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Imaging Findings of 18F-Choline and 18F-DOPA PET/MRI in a Case of Glioblastoma Multiforme Pseudoprogression: Correlation with Clinical Outcome

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Abstract

We describe the case of 74-year-old-male, previously treated with fronto-parietal craniotomy due to primary glioblastoma multiforme (GBM), followed by concurrent radiation therapy (RT) and temozolomide (TMZ) chemotherapy. Magnetic resonance imaging (MRI) of the brain, at 1 month after completing RT + TMZ, depicted partial response. Three months later, the patient was submitted to a further brain MRI, that resulted doubtful for therapy induced changes (i.e., pseudoprogression). The patient, who had been previously treated with prostatectomy for prostate cancer (PC), underwent a positron emission tomography/computed tomography (PET/CT) scan with 18F-choline for PC biochemical recurrence. 18F-choline whole body PET/CT resulted negative for PC relapse, while segmental brain PET, co-registered with MRI, demonstrated increased tracer uptake corresponding to tumor boundaries. In order to solve differential diagnosis between pseudoprogression and GBM recurrence, brain PET/CT with 18F-L-dihydroxy-phenil-alanine (18F-DOPA) was subsequently performed: fused axial PET/MRI images showed increased 18F-DOPA incorporation in the peri-tumoral edema, but not in tumor boundaries, consistent with the suspicion of GBM pseudoprogression, as then confirmed by clinical and radiological follow-up.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Santa Maria Goretti Hospital, Via Canova 3, 04100, Latina, Italy

    Luca Filippi & Oreste Bagni

  2. Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy

    Angela Spanu

  3. Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy

    Orazio Schillaci

  4. IRCCS Neuromed, Pozzilli, Italy

    Orazio Schillaci

  5. Section of Nuclear Medicine and Health Physics, Department of Medicine and Surgery, Università Degli Studi Di Perugia, Piazza Lucio Severi 1, 06132, Perugia, Italy

    Barbara Palumbo

Authors
  1. Luca Filippi
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  2. Angela Spanu
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  3. Oreste Bagni
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  4. Orazio Schillaci
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  5. Barbara Palumbo
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Contributions

LF was responsible for the idea. LF, AS, and BP wrote the manuscript. OB was responsible for PET/CT execution. BP performed PET/MRI co-registration and fusion. OS supervised the paper. All authors read and approved the final manuscript.

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Correspondence to Luca Filippi.

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Conflict of Interest

Luca Filippi, Angela Spanu, Oreste Bagni, Orazio Schillaci, and Barbara Palumbo declare no conflict of interest.

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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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Written consent has been obtained from the participant for the anonymized use of data for research purpose.

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Filippi, L., Spanu, A., Bagni, O. et al. Imaging Findings of 18F-Choline and 18F-DOPA PET/MRI in a Case of Glioblastoma Multiforme Pseudoprogression: Correlation with Clinical Outcome. Nucl Med Mol Imaging 56, 245–251 (2022). https://doi.org/10.1007/s13139-022-00758-2

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  • DOI: https://doi.org/10.1007/s13139-022-00758-2

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