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Molecular imaging of pediatric brain tumors: comparison of tumor metabolism using 18F-FDG-PET and MRSI

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Abstract

Magnetic resonance spectroscopic imaging (MRSI) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are non-invasive imaging techniques routinely used to evaluate tumor malignancy in adults with brain tumors. We compared the metabolic activity of pediatric brain tumors using FDG-PET and MRSI. Children (n = 37) diagnosed with a primary brain tumor underwent FDG-PET and MRSI within two weeks of each other. Tumor metabolism was classified as inactive, active or highly active using the maximum choline:N-acetyl-asparate (Cho:NAA) on MRSI and the highest tumor uptake on FDG-PET. A voxel-wise comparison was used to evaluate the area with the greatest abnormal metabolism. Agreement between methods was assessed using the percent agreement and the kappa statistic (κ). Pediatric brain tumors were metabolically heterogeneous on FDG-PET and MRSI studies. Active tumor metabolism was observed more frequently using MRSI compared to FDG-PET, and agreement in tumor classification was weak (κ = 0.16, p = 0.12), with 42 % agreement (95 % CI = 25–61 %). Voxel-wise comparison for identifying the area of greatest metabolic activity showed overlap in the majority (62 %) of studies, though exact agreement between techniques was low (29.4 %, 95 % CI = 15.1–47.5 %). These results indicate that FDG-PET and MRSI detect similar but not always identical regions of tumor activity, and there is little agreement in the degree of tumor metabolic activity between the two techniques.

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Acknowledgments

This work was presented in part at the 2011 ASCO annual meeting in Chicago, IL. The views expressed in this article are those of the authors and do not reflect the official policy of the National Institutes of Health, Department of Army, Department of Defense, or U.S. Government. Research was supported in part by the Intramural Research Program of the National Institutes of Health, National Cancer Institute, Center for Cancer Research.

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Authors and Affiliations

  1. Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA

    Sean J. Hipp, Emilie A. Steffen-Smith & Robyn S. Bent

  2. Department of Pediatrics, San Antonio Military Medical Center, 3551 Roger Brooke Dr., Ft. Sam Houston, TX, 78234, USA

    Sean J. Hipp

  3. Department of Pediatrics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA

    Sean J. Hipp

  4. Department of Pediatrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA

    Sean J. Hipp

  5. Department of Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA

    Nicholas Patronas & Jeffrey M. Solomon

  6. PET Department, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA

    Peter Herscovitch

  7. Expert Image Analysis, LLC, 12609 Orchard Brook Terrace, Potomac, MD, 20854, USA

    Jeffrey M. Solomon

  8. Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA

    Seth M. Steinberg

  9. Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10/Room 1-5750, 9000 Rockville Pike, Bethesda, MD, 20892, USA

    Katherine E. Warren

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  1. Sean J. Hipp
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  2. Emilie A. Steffen-Smith
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  3. Nicholas Patronas
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  4. Peter Herscovitch
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  5. Jeffrey M. Solomon
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  6. Robyn S. Bent
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  7. Seth M. Steinberg
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  8. Katherine E. Warren
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Corresponding author

Correspondence to Katherine E. Warren.

Additional information

Sean J. Hipp and Emilie A. Steffen-Smith contributed equally to this study.

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Hipp, S.J., Steffen-Smith, E.A., Patronas, N. et al. Molecular imaging of pediatric brain tumors: comparison of tumor metabolism using 18F-FDG-PET and MRSI. J Neurooncol 109, 521–527 (2012). https://doi.org/10.1007/s11060-012-0918-0

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  • DOI: https://doi.org/10.1007/s11060-012-0918-0

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