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The new era of bio-molecular imaging with O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) in neurosurgery of gliomas

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Abstract

Purpose

The possibility to provide answers from morphological imaging to neurosurgeon needs in patients with high- and low-grade gliomas relies on FLAIR images and percentage increase of contrast enhancement on T1-weighted images. Molecular imaging investigating the functionality of tumor cells has been progressively introduced in surgery planning to overcome limitations of conventional MRI. The purpose is to highlight the potential diagnostic and prognostic role of 18F-FET PET in gliomas.

Methods

We performed a literature review for articles on the topic in PubMed, Google Scholar, and Web of Science until January 2022. Search keywords included “glioma”, “glioblastoma”, “tumor biology” “18F-FET”, “MRI”, “surgery”.

Results

This review provides evidence of the potential of molecular imaging with 18F-FET to address the surgeon diagnostic and prognostic needs, including the knowledge of precise burden of cancer to guide biopsy or maximal safe resection, tumor grade and residual disease. The main cornerstones underlying the capacity of molecular imaging to provide information concerning tumor biology are deeply discussed to make the reader confident with the role of 18F-FET as a reliable imaging bio-marker in gliomas.

Conclusion

Although conventional MRI has been shown to be reliable technique to identify gliomas in terms of morphological concerns, some important limitations depending on the incapacity to reveal the tumor biology have emerged. The 18F-FET PET has been established to provide early information of functional nature including real tumor extension, grade, and metabolic residual disease. Therefore, the use of 18F-FET PET has progressively increased suggesting a potential shift from a morphological to functional plus morphological neurosurgery.

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Acknowledgements

We are grateful to Nuclear Medicine Staff of S. Stefano Hospital of Prato - Azienda USL Toscana Centro (physicians, technicians, nurses and administrative) for the fruitful collaboration, discussion and competence demonstrated in the implementation of 18F-FET PET in the clinical routine.

Funding

This research received no external funding.

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Authors and Affiliations

  1. Nuclear Medicine Unit, Department of Diagnostic Imaging, PO S. Stefano, Azienda USL Toscana Centro, Prato, Italy

    Iashar Laghai, Elisa Tardelli & Anna Lisa Martini

  2. Department of Neurosurgery Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi Hospital, University of Florence, Florence, Italy

    Giovanni Muscas & Alessandro Della Puppa

  3. Medical Physics Unit Pistoia Prato, Azienda USL Toscana Centro, Prato, Italy

    Margherita Betti & Luca Fedeli

  4. Radiation Oncology Unit, Department of Oncology, Ospedale Santa Maria Annunziata, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy

    Silvia Scoccianti

  5. Department of Oncology, Oncology Unit, Ospedale San Giuseppe, Azienda USL Toscana Centro, Empoli, Italy

    Francesca Martella

  6. Neurology Unit, PO S. Stefano, Azienda USL Toscana Centro, Prato, Italy

    Pasquale Palumbo

  7. Nuclear Medicine Unit, Department of Medicine – DIMED, University of Padua, Padua, Italy

    Diego Cecchin

  8. Interuniversity Center for Sustainable Development (CIRPS), Chairman Section Health and Development, Rome, Italy

    Luigi Mansi

  9. Unit of Nuclear Medicine, Department of Diagnostic Imaging, N.O.P. – S. Stefano, U.S.L. Toscana Centro, Prato, Italy

    Stelvio Sestini

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  1. Iashar Laghai
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  2. Giovanni Muscas
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  3. Elisa Tardelli
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  10. Diego Cecchin
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  11. Alessandro Della Puppa
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  13. Stelvio Sestini
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All authors equally contributed to the paper.

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Correspondence to Stelvio Sestini.

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Laghai, I., Muscas, G., Tardelli, E. et al. The new era of bio-molecular imaging with O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) in neurosurgery of gliomas. Clin Transl Imaging 10, 553–565 (2022). https://doi.org/10.1007/s40336-022-00509-5

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