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Unexpected [ 18 F] Fluciclovine Uptake in Pilocytic Astrocytoma: A Pediatric Case Report

Hiroto Koga1, Shiro Watanabe1,2, Kenji Hirata1,2

  • 1Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.

Clinical Nuclear Medicine
|December 9, 2025
PubMed

Insights

High [18F]Fluciclovine PET uptake in pediatric pilocytic astrocytoma can mimic high-grade glioma, potentially leading to misdiagnosis. This finding highlights the importance of considering amino acid metabolism in pediatric neuro-oncology imaging.

Area of Science:

  • Neuro-oncology
  • Pediatric Radiology
  • Molecular Imaging

Background:

  • Brain tumors are a significant concern in pediatric oncology.
  • Accurate grading of brain tumors is crucial for treatment planning.
  • Positron Emission Tomography (PET) is increasingly used in neuro-oncology.

Purpose of the Study:

  • To evaluate the utility of [18F]Fluciclovine PET in differentiating pediatric pilocytic astrocytoma from higher-grade gliomas.
  • To investigate the potential for [18F]Fluciclovine PET to overestimate tumor grade.

Main Methods:

  • A 5-year-old boy with a septum pellucidum mass underwent MRI and both [18F]Fluciclovine and [18F]Fluorodeoxyglucose PET scans.
  • Histopathology and genetic analysis (KIAA1549-BRAF fusion) were used for definitive diagnosis.
  • Quantitative analysis of PET uptake (SUVmax, TBR) was performed.

Main Results:

  • MRI revealed a mass lesion suspicious for glioma.
  • [18F]Fluciclovine PET showed high uptake (SUVmax, 2.37; TBR, 3.56), suggestive of high-grade glioma.
  • [18F]Fluorodeoxyglucose PET showed low uptake (SUV max: 2.2; TBR: 0.29).
  • Histopathology confirmed WHO grade 1 pilocytic astrocytoma with KIAA1549-BRAF fusion.

Conclusions:

  • High [18F]Fluciclovine uptake can be observed in pilocytic astrocytoma, potentially due to increased amino acid transporter expression.
  • This can lead to an overestimation of the WHO tumor grade.
  • Radiologists and oncologists must be aware of this imaging pitfall in pediatric neuro-oncology.

Keywords:
KIAA1549-BRAF fusionamino acid transporterpediatric brain tumorpilocytic astrocytomatumor grading

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