The Korean Journal of Nuclear Medicine Technology (핵의학기술)

The Korean Society of Nuclear Medicine Technology (대한핵의학기술학회)
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Consideration of the Usefulness of 18F-FET Brain PET/CT in Brain Tumor Diagnosis

뇌종양진단에 있어 18F-FET Brain PET/CT의 유용성에 대한 고찰

  • Kyu-Ho Yeon (Deparment of Nuclear Medicine, Asan Medical Center) ;
  • Jae-Kwang Ryu (Deparment of Nuclear Medicine, Asan Medical Center)
  • 연규호 (서울아산병원 핵의학과) ;
  • 류재광 (서울아산병원 핵의학과)
  • Received : 2023.11.23
  • Accepted : 2023.12.23
  • Published : 2024.05.30
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Abstract

Purpose: 18F-FET, a radiopharmaceutical based on a Tyrosine amino acid derivative using the Sodium-Potassium Pump-independent Transporter (System L) for non-invasive evaluation of primary, recurrent, and metastatic brain tumors, exhibits distinct characteristics. Unlike the widely absorbed 18F-FDG in both tumor and normal brain tissues, 18F-FET demonstrates specific uptake only in tumor tissue while almost negligible uptake in normal brain tissue. This study aims to compare and evaluate the usefulness of 18F-FDG and 18F-FET Brain PET/CT quantitative analysis in brain tumor diagnosis. Materials and Methods: In 46 patients diagnosed with brain gliomas (High Grade: 34, Low Grade: 12), Brain PET/CT scans were performed at 40 minutes after 18F-FDG injection and at 20 minutes (early) and 80 minutes (delay) after 18F-FET injection. SUVmax and SUVpeak of tumor areas corresponding to MRI images were measured in each scan, and the SUVmax-to-SUVpeak ratio, an indicator of tumor prognosis, was calculated. Differences in SUVmax, SUVpeak, and SUVmax-to-SUVpeak ratio between 18F-FDG and 18F-FET early/delay scans were statistically verified using SPSS (ver.28) package program. Results: SUVmax values were 3.72±1.36 for 18F-FDG, 4.59±1.55 for 18F-FET early, and 4.12±1.36 for 18F-FET delay scans. The highest SUVmax was observed in 18F-FET early scans, particularly in HG tumors (4.85±1.44), showing a slightly more significant difference (P<0.0001). SUVpeak values were 3.33±1.13 for 18F-FDG, 3.04±1.11 for 18F-FET early, and 2.80±0.96 for 18F-FET delay scans. The highest SUVpeak was in 18F-FDG scans, while the lowest was in 18F-FET delay scans, with a more significant difference in HG tumors (P<0.001). SUVmax-to-SUVpeak ratio values were 1.11±0.09 for 18F-FDG, 1.54±0.22 for 18F-FET early, and 1.48±0.17 for 18F-FET delay scans. This ratio was higher in 18F-FET scans for both HG and LG tumors (P<0.0001), but there was no statistically significant difference between 18F-FET early and delay scans. Conclusion: This study confirms the usefulness of early and delay scans in 18F-FET Brain PET/CT examinations, particularly demonstrating the changes in objective quantitative metrics such as SUVmax, SUVpeak, and introducing the SUVmax-to-SUVpeak ratio as a new evaluation metric based on the degree of tumor malignancy. This is expected to further contributions to the quantitative analysis of Brain PET/CT images.

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References

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