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18F-FACBC PET/MRI in the evaluation of human brain metastases: a case report
Knut Johannessen1, Erik Magnus Berntsen1,2, Håkon Johansen2
1Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Postboks 8905, 7491, Trondheim, Norway.
Background:
Patients with metastatic cancer to the brain have a poor prognosis. In clinical practice, MRI is used to delineate, diagnose and plan treatment of brain metastases. However, MRI alone is limited in detecting micro-metastases, delineating lesions and discriminating progression from pseudo-progression. Combined PET/MRI utilises superior soft tissue images from MRI and metabolic data from PET to evaluate tumour structure and function. The amino acid PET tracer 18F-FACBC has shown promising results in discriminating high- and low-grade gliomas, but there are currently no reports on its use on brain metastases. This is the first study to evaluate the use of 18F-FACBC on brain metastases.
Case Presentation:
A middle-aged female patient with brain metastases was evaluated using hybrid PET/MRI with 18F-FACBC before and after stereotactic radiotherapy, and at suspicion of recurrence. Static/dynamic PET and contrast-enhanced T1 MRI data were acquired and analysed. This case report includes the analysis of four 18F-FACBC PET/MRI examinations, investigating their utility in evaluating functional and structural metastasis properties.
Conclusion:
Analysis showed high tumour-to-background ratios in brain metastases compared to other amino acid PET tracers, including high uptake in a very small cerebellar metastasis, suggesting that 18F-FACBC PET can provide early detection of otherwise overlooked metastases. Further studies to determine a threshold for 18F-FACBC brain tumour boundaries and explore its utility in clinical practice should be performed.
Insights
The novel amino acid PET tracer 18F-FACBC shows promise for early detection of brain metastases using PET/MRI. This technique may identify small, otherwise overlooked metastases, improving patient prognosis.
Area of Science:
- Neuro-oncology
- Medical imaging
- Radiochemistry
Background:
- Brain metastases significantly worsen patient prognosis.
- MRI is standard for brain metastasis management but struggles with micro-metastases and progression assessment.
- Combined PET/MRI offers enhanced tumor evaluation by integrating structural and metabolic data.
Purpose of the Study:
- To evaluate the utility of the amino acid PET tracer 18F-FACBC in conjunction with PET/MRI for assessing brain metastases.
- This is the first study to investigate 18F-FACBC for brain metastases.
Main Methods:
- A case report involving a patient with brain metastases.
- Hybrid PET/MRI scans with 18F-FACBC were performed before and after radiotherapy, and upon suspicion of recurrence.
- Analysis included static/dynamic PET and contrast-enhanced T1 MRI data from four examinations.
Main Results:
- 18F-FACBC PET/MRI demonstrated high tumor-to-background ratios in brain metastases.
- High tracer uptake was observed even in a very small cerebellar metastasis.
- The findings suggest potential for early detection of small, otherwise undetected metastases.
Conclusions:
- 18F-FACBC PET/MRI is a promising tool for the early detection of brain metastases.
- Further research is needed to establish 18F-FACBC thresholds for tumor boundaries and its clinical utility.
- This technique could improve the management of patients with metastatic brain cancer.
