Biopsy validation of 18F-DOPA PET and biodistribution in gliomas for neurosurgical planning and radiotherapy target delineation: Results of a prospective pilot study

Deanna H. Pafundi, Nadia N. Laack, Ryan S. Youland, Ian F. Parney, Val J. Lowe, Caterina Giannini, Brad J. Kemp, Michael P. Grams, Jonathan M. Morris, Jason M. Hoover, Leland S. Hu, Jann N. Sarkaria, Debra H. Brinkmann

Research output: Contribution to journalReview article

92 Scopus citations

Abstract

BackgroundDelineation of glioma extent for surgical or radiotherapy planning is routinely based on MRI. There is increasing awareness that contrast enhancement on T1-weighted images (T1-CE) may not reflect the entire extent of disease. The amino acid tracer 18F-DOPA (3,4-dihydroxy-6-[18F] fluoro-l-phenylalanine) has a high tumor-to-background signal and high sensitivity for glioma imaging. This study compares 18F-DOPA PET against conventional MRI for neurosurgical biopsy targeting, resection planning, and radiotherapy target volume delineation.MethodsConventional MR and 18F-DOPA PET/CT images were acquired in 10 patients with suspected malignant brain tumors. One to 3 biopsy locations per patient were chosen in regions of concordant and discordant 18F-DOPA uptake and MR contrast enhancement. Histopathology was reviewed on 23 biopsies. 18F-DOPA PET was quantified using standardized uptake values (SUV) and tumor-to-normal hemispheric tissue (T/N) ratios.ResultsPathologic review confirmed glioma in 22 of 23 biopsy specimens. Thirteen of 16 high-grade biopsy specimens were obtained from regions of elevated 18F-DOPA uptake, while T1-CE was present in only 6 of those 16 samples. Optimal 18F-DOPA PET thresholds corresponding to high-grade disease based on histopathology were calculated as T/N > 2.0. In every patient, 18F-DOPA uptake regions with T/N > 2.0 extended beyond T1-CE up to a maximum of 3.5 cm. SUV was found to correlate with grade and cellularity.Conclusions18F-DOPA PET SUVmax may more accurately identify regions of higher-grade/higher-density disease in patients with astrocytomas and will have utility in guiding stereotactic biopsy selection. Using SUV-based thresholds to define high-grade portions of disease may be valuable in delineating radiotherapy boost volumes.

Original languageEnglish (US)
Pages (from-to)1058-1067
Number of pages10
JournalNeuro-oncology
Volume15
Issue number8
DOIs
StatePublished - Aug 1 2013

Keywords

  • F-DOPA PET
  • PET-MRI image registration
  • glioma target delineation
  • image-guided biopsy planning
  • image-guided radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology
  • Cancer Research

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