Low-Grade Glioma on FDG and FET PET/MRI

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MRI is the modality of choice for imaging the craniospinal axis including brain and spinal cord diseases.

This section comprises off our sub-sections

• Glioma
• Meningioma
• Neurodegenerative disorders and Encephalitides
• Spinal cord diseases

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Glioma

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Up to 30% of patients with glioblastoma on chemoradiation therapy develop treatment-related effects, which mimic tumor recurrence, and both present as a new enhancing lesion on contrast-enhanced (CE) MR imaging. Differentiation of tumor recurrence from treatment-induced necrosis, which remains a challenge on conventional CE-MR imaging, is important because their management and prognosis are completely different.

Other hands, provides additional information about tumor metabolism. The advent of simultaneous PET/MRI imaging has made it possible to assess all the parameters together in the same physical space in a single examination. We believe that simultaneous acquisition may help in overcoming some of the limitations of individual techniques and bring a synergistic effect in improved differentiation of recurrence from treatment-induced necrosis.

Whereas, tumoral FDG uptake may be undermined/masked by the normal FDG uptake in the brain parenchyma, 18F-fluoroethyl-L- tyrosine (18F-FET) is an amino acid-based tracer which differentiates tumor recurrence vs radiation necrosis with high accuracy. The following pages portray a few representative cases of treated gliomas done with FDG or FET PET/MRI performed on Biograph MMR and highlight the immense potential this modality brings for evaluation of Gliomas.

Case History:

38 year old male with a new onset of seizures.

Findings:

 

FLAIR (A) image showing ill-defined FLAIR hyperintensity in the left frontoparietal lobe (arrow) with no significant enhancement or increased perfusion (B, C). Increased Cho: Creatine ratio was seen on MRS (D) suggesting the possibility of a low-grade Glioma.

FDG PET (E, F) showing physiological uptake in the brain parenchyma with no significant differential uptake within the mass.

(Note: Intense Background FDG uptake in the normal brain parenchyma)

FET PET in the same patient showing focal differential uptake (arrows in G, H, I) in the mass suggesting low-grade glioma.

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Case Study Prepared by:

This short PET-MRI Scan case was compiled by Dr. Sangeeta Taneja and Dr. Amarnath Jena (Nuclear Medicine Physician at PET-Suite @ Indraprastha Apollo Hospital, Sarita Vihar).

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

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

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