Impact of Automated Hotspot Detection for 18FET PET-Guided Stereotactic Biopsy

  • Thomas ReithmeierEmail author
  • Joacir Cordeiro
  • Michael Mix
  • Michael Trippel
  • Christoph Rottenburger
  • Guido Nikkhah
Conference paper
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 117)


Objective: The aim of this study was to explore the impact of automated hotspot detection on surgical planning of 18FET PET-guided stereotactic serial biopsy.

Method: Imaging of ten patients with brain lesions detected by MRI and showing increased 18FET uptake on PET who were retrospectively and randomly assigned to compose the study. Stereotactic biopsy plans (PET-guided and MR-guided) were performed by two neurosurgeons for each patient, independently and blinded. For PET-guided plans, biopsy target was achieved by means of an automated hotspot detection system. MR-guided plans targeted contrast enhancement areas or hyperintense areas in T2-weighted sequences. FET uptake ratio (UR) was determined in the biopsy trajectory across the lesion. Highest UR (HUR) from both planning techniques was compared.

Results: Each single HUR obtained through PET-guided technique was higher than correspondent values from MR-guided technique. Mean HUR of 2.41 (SE ± 0.23) for PET-guided plans and 1.85 (±0.16) for MR-guided plans were respectively obtained. This difference was statistically significant (p = 0.002).

Conclusion: The use of an automated hotspot detection system was able to provide higher FET HUR along stereotactic biopsy trajectories in comparison to those from MR-guided plans. The use of specially designed computational tools may refine surgical planning by improving biopsy targeting.


Stereotactic brain biopsy Automated hot spot detection FET-PET 



This work was financially supported by a grant from Inomed, Emmendingen, Germany. Authors would like to thank Dr. Graf from the Department of Statistics of the University of Freiburg for the support in the statistical analysis.

Conflict of InterestCordeiro JG was financially supported by Inomed to perform systematic evaluation of computational tools developed for the neurosurgical practice. We confirm that we have read the Journal’s position on issues involved in ethical publication, and affirm that this report is consistent with those guidelines.


  1. 1.
    Benouaich-Amiel A, Lubrano V, Tafani M, Uro-coste E, Gantet P, Sol JC et al (2010) Evaluation of O-(2-[18F]-fluoroethyl)-L-tyrosine in the diagnosis of glioblastoma. Arch Neurol 67(3):370–372PubMedCrossRefGoogle Scholar
  2. 2.
    Candrasoma PT, Smith MM, Apuzzo ML et al (1989) Stereotactic biopsy in the diagnosis of brain masses: comparison of results from biopsy and resected surgical specimen. Neurosurgery 24:160–165CrossRefGoogle Scholar
  3. 3.
    Cordeiro JG, Rottenburger C, Pinsker M, Trippel M, Weber W, Nikkhah G, Reithmeier T (2010) Value of 18F-FET PET in comparison to stereotactic serial biopsy to evaluate the follow up of brain gliomas. Presented in the 19th congress of the European Society Stereotaxic and Functional Neurosurgery, AthensGoogle Scholar
  4. 4.
    Del Sole A, Falini A, Ravasi L, Ottobrini L, De Marchis D, Bombardieri E et al (2001) Anatomical and biochemical investigation of primary brain tumours. Eur J Nucl Med 28:1851–1872PubMedCrossRefGoogle Scholar
  5. 5.
    Floeth FW, Pauleit D, Wittsack H et al (2005) Multimodal metabolic imaging of cerebral gliomas: positron emission tomography with [18F]fluoroethyl-L-tyrosine and magnetic resonance spectroscopy. J Neurosurg 102(2):318–327PubMedCrossRefGoogle Scholar
  6. 6.
    Floeth FW, Pauleit D, Sabel M et al (2006) 18F-FET PET differentiation of ring-enhancing brain lesions. J Nucl Med 47(5):776–782PubMedGoogle Scholar
  7. 7.
    Grosu AL, Weber WA, Franz M et al (2005) Reirradiation of recurrent high-grade gliomas using amino acid PET (SPECT)/CT/MRI image fusion to determine gross tumor volume for stereotactic fractionated radiotherapy. Int J Radiat Oncol Biol Phys 63(2):511–519PubMedCrossRefGoogle Scholar
  8. 8.
    Hamacher K, Coenen HH (2002) Efficient routine production of the 18Flabelled amino acid O-(2-[18F]fluoroethyl)-L-tyrosine. Appl Radiat Isot 57:853–856PubMedCrossRefGoogle Scholar
  9. 9.
    Jackson RJ, Fuller GN, Abi-Said D et al (2001) Limitations of stereotactic biopsy in the initial management of gliomas. Neuro Oncol 3:193–200PubMedGoogle Scholar
  10. 10.
    Jacobs A (1995) Amino acid uptake in ischemically compromised brain tissue. Stroke 26:1859–1866PubMedCrossRefGoogle Scholar
  11. 11.
    Langen K, Hamacher K, Weckesser M et al (2006) O-(2-[18F]fluoroethyl)-L-tyrosine: uptake mechanisms and clinical applications. Nucl Med Biol 33(3):287–294PubMedCrossRefGoogle Scholar
  12. 12.
    Mc Girt MJ, Villavicencio AT, Ketan RB, Friedman AH (2003) MRI-guided stereotactic biopsy in the diagnosis of glioma: comparison of biopsy and surgical resection specimen. Surg Neurol 59:277–282Google Scholar
  13. 13.
    Nakagawa M, Kuwabara Y, Sasaki M, Koga H, Chen T, Kaneko O et al (2002) 11C-Methionine uptake in cerebrovascular disease: a comparison with 18F-FDG PET and 99mTc-HMPAO SPECT. Ann Nucl Med 16:207–211PubMedCrossRefGoogle Scholar
  14. 14.
    Pauleit D, Stoffels G, Bachofner A et al (2009) Comparison of (18)F-FET and (18)F-FDG PET in brain tumors. Nucl Med Biol 36(7):779–787PubMedCrossRefGoogle Scholar
  15. 15.
    Pirotte BJM, Lubansu A, Massager N et al (2007) Results of positron emission tomography guidance and reassessment of the utility of and indications for stereotactic biopsy in children with infiltrative brainstem tumors. J Neurosurg 107(5 Suppl):392–399PubMedGoogle Scholar
  16. 16.
    Pöpperl G, Kreth FW, Herms J et al (2006) Analysis of 18F-FET PET for grading of recurrent gliomas: is evaluation of uptake kinetics superior to standard methods? J Nucl Med 47(3):393–403PubMedGoogle Scholar
  17. 17.
    Pöpperl G, Kreth FW, Mehrkens JH et al (2007) FET PET for the evaluation of untreated gliomas: correlation of FET uptake and uptake kinetics with tumour grading. Eur J Nucl Med Mol Imaging 34(12):1933–1942PubMedCrossRefGoogle Scholar
  18. 18.
    Rottenburger C, Doostkam S, Prinz M, Meckel S, Nikkhah G, Meyer P, Reithmeier T (2010) Interesting image. Amino acid PET tracer accumulation in cortical ischemia: an interesting case. Clin Nucl Med 35(11):907–908PubMedCrossRefGoogle Scholar
  19. 19.
    Rottenburger C, Hentschel M, Kelly T, Trippel M, Brink I, Reithmeier T, Meyer PT, Nikkhah G (2011) Comparison of C-11 methionine and C-11 choline for PET imaging of brain metastases: a prospective pilot study. Clin Nucl Med 36(8):639–642PubMedCrossRefGoogle Scholar
  20. 20.
    Stadlbauer A, Prante O, Nimsky C et al (2008) Metabolic imaging of cerebral gliomas: spatial correlation of changes in O-(2-18F-fluoroethyl)-L-tyrosine PET and proton magnetic resonance spectroscopic imaging. J Nucl Med 49(5):721–729PubMedCrossRefGoogle Scholar
  21. 21.
    Weber WA, Wester HJ, Grosu AL et al (2000) O-(2-[18F]fluoroethyl)-L-tyrosine and L-[methyl-11C] methionine uptake in brain tumours: initial results of a comparative study. Eur J Nucl Med 27(5):542–549PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Thomas Reithmeier
    • 1
    Email author
  • Joacir Cordeiro
    • 1
  • Michael Mix
    • 2
  • Michael Trippel
    • 1
  • Christoph Rottenburger
    • 2
  • Guido Nikkhah
    • 3
    • 4
  1. 1.Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, Neurosurgical ClinicUniversity Medical Center FreiburgFreiburgGermany
  2. 2.Department of Nuclear MedicineUniversity Medical Center FreiburgFreiburgGermany
  3. 3.Division of Stereotactic and Functional Neurosurgery, Department of General Neurosurgery, Neurosurgical ClinicUniversity Medical Center FreiburgFreiburgGermany
  4. 4.Neurosurgical ClinicUniversity Hospital ErlangenErlangenGermany

Personalised recommendations