Case Study: Simultaneous PET/MRI in Brain Tumors

Primary and recurrent Brain Tumors are best evaluated with MRI.

PET Tracers like FET have been widely used to differentiate enhancing lesions, in follow up cases of gliomas, as been due to radiation necrosis, or tumor recurrence. Besides overlaying the PET information on MR for accurate anatomical correlate, the special MR parameters like MR spectroscopy DWI and Perfusion further add specificity to the diagnosis.

PET MRI For Follow Up Case of Right parietal Grade II Oligoastrocytoma.

Case History:

33 years old male, operated Right parietal Grade II astrocytoma ( 2007). Post op/RT. Recurrence on MRI has done in July 2014 Recent MRI 31/7/14 revealed recurrent disease.

Contrast MRI done in July 2014 reveals a complex cystic lesion with small enhancing nodular component on Axial FLAIR (top left) Axial T2W (top right ) Post contrast MPRAGE sagittal (bottom left ) and T1 post contrast (bottom right ).

The patient underwent surgery in August 2014. HPE was grade II oligoastrocytoma.

Prior to re-radiation planning an 18-F FET PET MRI was done, which revealed post op changes and residual non enhancing bulkiness along the margins in FLAIR axial( top left) and post-contrast MPRAGE ( top right ) a discrete area of increased FET uptake along the posterior margin of post op cavity on PET axial (bottom right )and PET MR fused (bottom left) suggesting residual disease . This modified radiation therapy planning due to the additional boost that needed to be given to the PET-positive area.

Credits for Contribution

We thank Director INMAS, Delhi and Dr. Anil Mishra, Head Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi for contributing their support in the preparation of quality grade F18-FET in their lab for procurement and use in our cases under academic understanding.

Case Study Prepared by :

Dr Amarnath Jena (Senior Consultant – Nuclear Medicine, Indraprastha Apollo PET-Suite)
MBBS, DRM, DNB (Nuclear Medicine)

Read More about PET-MRI Scan at House Of Diagnostics in Delhi and NCR.

The Simultaneous PET-MRI Scan is currently offered at PET-Suite at Apollo Hospital, Sarita Vihar.