Clinical applications of PET in brain tumors

Malignant gliomas and metastatic tumors are the most common brain tumors. Neuroimaging plays a significant role clinically. In low-grade tumors, neuroimaging is needed to evaluate recurrent disease and to monitor anaplastic transformation into high-grade tumors. In high-grade and metastatic tumors, the imaging challenge is to distinguish between recurrent tumor and treatment-induced changes such as radiation necrosis. The current clinical gold standard, MRI, provides superior structural detail but poor specificity in identifying viable tumors in brain treated with surgery, radiation, or chemotherapy. (18)F-FDG PET identifies anaplastic transformation and has prognostic value. The sensitivity and specificity of (18)F-FDG in evaluating recurrent tumor and treatment-induced changes can be improved significantly by co-registration with MRI and potentially by delayed imaging 3-8 h after injection. Amino acid PET tracers are more sensitive than (18)F-FDG in imaging recurrent tumors and in particular recurrent low-grade tumors. They are also promising in differentiating between recurrent tumors and treatment-induced changes.