(18)F-Fluorocholine PET uptake correlates with pathologic evidence of recurrent tumor after stereotactic radiosurgery for brain metastases Journal Article


Authors: Grkovski, M.; Kohutek, Z. A.; Schöder, H.; Brennan, C. W.; Tabar, V. S.; Gutin, P. H.; Zhang, Z.; Young, R. J.; Beattie, B. J.; Zanzonico, P. B.; Huse, J. T.; Rosenblum, M. K.; Blasberg, R. G.; Humm, J. L.; Beal, K.
Article Title: (18)F-Fluorocholine PET uptake correlates with pathologic evidence of recurrent tumor after stereotactic radiosurgery for brain metastases
Abstract: Purpose: Radiographic changes of brain metastases after stereotactic radiosurgery (SRS) can signify tumor recurrence and/or radiation necrosis (RN); however, standard imaging modalities cannot easily distinguish between these two entities. We investigated whether 18F-Fluorocholine uptake in surgical samples of the resected lesions correlates with pathologic evidence of recurrent tumor and PET imaging. Methods: About 14 patients previously treated with SRS that developed radiographic changes were included. All patients underwent a preoperative 40-min dynamic PET/CT concurrent with 392 ± 11 MBq bolus injection of 18F-Fluorocholine. 18F-Fluorocholine pharmacokinetics were evaluated by standardized uptake value (SUV), graphical analysis (Patlak plot; Ki P) and an irreversible two-compartment model (K1, k2, k3, and Ki). 12 out of 14 patients were administered an additional 72 ± 14 MBq injection of 18F-Fluorocholine 95 ± 26 minutes prior to surgical resection. About 113 resected samples from 12 patients were blindly reviewed by a neuropathologist to assess the viable tumor and necrotic content, microvascular proliferation, reactive gliosis, and mono- and polymorphonuclear inflammatory infiltrates. Correlation between these metrics 18F-Fluorocholine SUV was investigated with a linear mixed model. Comparison of survival distributions of two groups of patients (population median split of PET SUVmax) was performed with the log-rank test. Results: Exactly 10 out of 12 patients for which surgical samples were acquired exhibited pathologic recurrence. Strong correlation was observed between SUVmax as measured from a surgically removed sample with highest uptake and by PET (Pearson’s r = 0.66). Patients with 18F-Fluorocholine PET SUVmax > 6 experienced poor survival. Surgical samples with viable tumor had higher 18F-fluorocholine uptake (SUV) than those without tumor (4.5 ± 3.7 and 2.6 ± 3.0; p = 0.01). 18F-fluorocholine count data from surgical samples is driven not only by the percentage viable tumor but also by the degree of inflammation and reactive gliosis (p ≤ 0.02; multivariate regression). Conclusions: 18F-Fluorocholine accumulation is increased in viable tumor; however, inflammation and gliosis may also lead to elevated uptake. Higher 18F-Fluorocholine PET uptake portends worse prognosis. Kinetic analysis of dynamic 18F-Fluorocholine PET imaging supports the adequacy of the simpler static SUV metric. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
Keywords: adult; cancer survival; clinical article; human tissue; aged; middle aged; unclassified drug; clinical trial; histopathology; neuroimaging; prospective study; bolus injection; gliosis; pathology; necrosis; tumor recurrence; radioactivity; brain metastasis; radiopharmaceutical agent; stereotactic radiosurgery; inflammatory infiltrate; compartment model; standardized uptake value; kinetic modeling; tumor necrosis; 18f-fluorocholine; human; male; female; article; positron emission tomography-computed tomography; fluorocholine f 18
Journal Title: European Journal of Nuclear Medicine and Molecular Imaging
Volume: 47
Issue: 6
ISSN: 1619-7070
Publisher: Springer  
Date Published: 2020-06-01
Start Page: 1446
End Page: 1457
Language: English
DOI: 10.1007/s00259-019-04628-6
PUBMED: 31865407
PROVIDER: scopus
DOI/URL:
Notes: Article -- Source: Scopus
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MSK Authors
  1. Zhigang Zhang
    273 Zhang
  2. Ronald G Blasberg
    257 Blasberg
  3. Robert J Young
    138 Young
  4. Viviane S Tabar
    140 Tabar
  5. Philip H Gutin
    161 Gutin
  6. Cameron Brennan
    165 Brennan
  7. Marc Rosenblum
    329 Rosenblum
  8. Kathryn Beal
    170 Beal
  9. Heiko Schoder
    332 Schoder
  10. Jason T Huse
    132 Huse
  11. John Laurence Humm
    364 Humm
  12. Pat B Zanzonico
    280 Zanzonico
  13. Zachary Adam Kohutek
    23 Kohutek
  14. Bradley Beattie
    117 Beattie