Advances in PET imaging of brain tumors: a referring physician's perspective

To highlight the most recent advances in PET imaging of brain tumors, aiming at expanding the referring physician's knowledge in the field, the sine qua non for translating PET into the practice of neuro-oncology.

The role of PET with amino acid tracers in the setting of brain lesions of unknown significance has been better defined, reducing the need for invasive procedures. The impact of PET-guided resection of high-grade glioma using ¹¹C-methionine (¹¹C-MET) has been strongly documented. [¹⁸F]Fluoroethyl-L-tyrosine is currently available for glioma management; advances in targeting glial tumor biopsy and monitoring response to standard chemoradiation of malignant glioma have been remarkable. 2-(2-nitro-1H-imidazol-1-yl)-N-(2,2,3,3,3-penta-fluoropropyl)-acetamide is a rationally designed radiotracer with potential for imaging hypoxia in glioblastoma. New insights regarding the predictive value of 3-deoxy-3-[¹⁸F]fluorothymidine in outcome of recurrent malignant glioma treated with bevacizumab/irinotecan have been provided. First steps are being made toward apoptosis PET imaging for early assessment of radiotherapy response in brain metastases.

The use of ¹¹C-MET and ¹⁸F-labeled PET tracers is getting a more precise position in the management of brain tumors. Advances hold promises in routine decision-making and in the design and conduct of clinical trials.