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18F-fluoroethylcholine (18F-Cho) PET/MRI functional parameters in pediatric astrocytic brain tumors
Francesco Fraioli1, Ananth Shankar, Darren Hargrave
1From the *Department of Nuclear Medicine, and †Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; ‡Department of Paediatric Oncology, Great Ormond Street Hospital, London, UK; §Department of Radiology University, and ¶Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
Purpose:
To examine the feasibility of simultaneous acquisition of F-fluoroethylcholine (F-choline) PET and functional MRI (standardized uptake value [SUV]max/mean and apparent diffusion coefficient [ADC]mean), using a hybrid PET/MRI scanner, for diagnosis and response assessment in a cohort of children with astrocytic brain tumors.
Methods:
F-choline PET/MRI scans were performed in 12 patients with proven astrocytic tumors.Eight patients simultaneously underwent F-choline PET/MR follow-up scans after treatment. Uptake in the lesion above the normal brain activity was considered indicative of a positive scan. Maximum and mean SUVs (SUVmax and SUVmean) and mean ADC (ADCmean) of the whole tumor region of interest were assessed. Lesion size and contrast enhancement were recorded. For all tumors, the association between ADCmean and SUVmean/SUVmax values were assessed using the Spearman correlation coefficient.
Results:
At baseline, the areas of F-choline uptake matched areas of contrast enhancement and restricted diffusion. There was a negative correlation trend between SUVmax and ADCmean and a positive correlation trend between SUVmax and tumor size. There was concordance between reduction in tumor size and reductions in SUVmax and SUVmean in 4 children, in three of whom ADCmean values were increased. In 2 patients, tumor size remained stable whereas SUVmax and SUVmean values were increased with reduction in the ADCmean values. Additionally, in 2 children, cross-sectional MRI showed an increase both in tumor size and SUVmax but a reduction in ADC values.
Conclusions:
Simultaneous F-choline PET/MRI is a promising and reliable imaging tool for children with astrocytic tumors, as it permits monitoring of morphological and metabolic response and changes during therapy.
Insights
Simultaneous F-choline PET/MRI shows promise for diagnosing and monitoring pediatric astrocytic brain tumors. This hybrid imaging approach effectively tracks changes in tumor size, metabolism, and diffusion during therapy.
Area of Science:
- Pediatric oncology
- Neuroimaging
- Radiochemistry
Background:
- Astrocytic brain tumors are a significant concern in pediatric oncology.
- Accurate diagnosis and response assessment are crucial for effective treatment planning.
- Current imaging modalities may have limitations in comprehensively evaluating tumor characteristics.
Purpose of the Study:
- To evaluate the feasibility of simultaneous F-fluoroethylcholine (F-choline) PET and functional MRI acquisition.
- To assess the utility of hybrid PET/MRI for diagnosis and treatment response monitoring in pediatric astrocytic tumors.
- To correlate metabolic (SUV) and diffusion (ADC) parameters with tumor characteristics.
Main Methods:
- 12 pediatric patients with astrocytic tumors underwent simultaneous F-choline PET/MRI scans.
- Follow-up scans were performed in 8 patients post-treatment.
- Tumor regions of interest were analyzed for maximum/mean standardized uptake values (SUVmax/mean) and mean apparent diffusion coefficient (ADCmean).
- Spearman correlation assessed the association between ADCmean and SUV values.
Main Results:
- Baseline F-choline uptake correlated with contrast enhancement and restricted diffusion.
- Negative trend observed between SUVmax and ADCmean; positive trend between SUVmax and tumor size.
- Concordance between reduced tumor size and decreased SUV values was noted in 4 children, with increased ADCmean in three.
- Changes in SUV and ADC values indicated treatment response or progression in other patients.
Conclusions:
- Simultaneous F-choline PET/MRI is a feasible and reliable imaging technique for pediatric astrocytic tumors.
- This hybrid approach enables simultaneous monitoring of morphological and metabolic tumor changes.
- It holds promise for assessing treatment response and guiding therapy in this patient population.
