Comparison of the effectiveness of MRI perfusion and fluorine-18 FDG PET-CT for differentiating radiation injury from viable brain tumor: A preliminary retrospective analysis with pathologic correlation in all patients Journal Article


Authors: Hatzoglou, V.; Ulaner, G. A.; Zhang, Z.; Beal, K.; Holodny, A. I.; Young, R. J.
Article Title: Comparison of the effectiveness of MRI perfusion and fluorine-18 FDG PET-CT for differentiating radiation injury from viable brain tumor: A preliminary retrospective analysis with pathologic correlation in all patients
Abstract: Objectives: Differentiating radiation injury from viable tumor is important for optimizing patient care. Our aim was to directly compare the effectiveness of fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) and dynamic susceptibility-weighted contrast-enhanced (DSC) magnetic resonance (MR) perfusion in differentiating radiation effects from tumor growth in patients with increased enhancement following radiotherapy for primary or secondary brain tumors. Materials and methods: We retrospectively identified 12 consecutive patients with primary and secondary brain tumors over a 1-year period that demonstrated indeterminate enhancing lesions after radiotherapy and that had undergone DSC MR perfusion, FDG PET-CT, and subsequent histopathologic diagnosis. The maximum standardized uptake value (SUV) of the lesion (SUVlesion max), SUVratio (SUVlesion max/SUVnormal brain), maximum relative cerebral blood volume, percentage of signal intensity recovery, and relative peak height were calculated from the positron emission tomography and MR perfusion studies. A prediction of tumor or radiation injury was made based on these variables while being blinded to the results of the surgical pathology. Results: SUVratio had the highest predictive value (area under the curve=0.943) for tumor progression, although this was not statistically better than any MR perfusion metric (area under the curve=0.757-0.829). Conclusions: This preliminary study suggests that FDG PET-CT and DSC MR perfusion may demonstrate similar effectiveness for distinguishing tumor growth from radiation injury. Assessment of the SUVratio may increase the sensitivity and specificity of FDG PET-CT for differentiating tumor and radiation injury. Further analysis is needed to help define which modality has greater predictive capabilities. © 2013 Elsevier Inc.
Keywords: adult; clinical article; treatment outcome; middle aged; retrospective studies; histopathology; cancer radiotherapy; neuroimaging; nuclear magnetic resonance imaging; positron emission tomography; brain tumor; brain neoplasms; sensitivity and specificity; radiopharmaceuticals; reproducibility of results; computer assisted tomography; diagnosis, differential; radiotherapy; brain injuries; radiation injury; retrospective study; brain; neoplasm, residual; computerized tomography; tumors; pilot projects; contrast enhancement; diagnosis; fluorodeoxyglucose f 18; fluorodeoxyglucose f18; radiation injuries; magnetic resonance; intermethod comparison; brain blood volume; magnetic resonance angiography; brain perfusion; fluorine; positron-emission tomography and computed tomography; differentiating radiation injury and tumor; mri perfusion versus fdg pet-ct; psr; rcbvmax; rph; suvratio; rcbv<sub>max</sub>; suv<sub>ratio</sub>; magnetic susceptibility; susceptibility weighted imaging
Journal Title: Clinical Imaging
Volume: 37
Issue: 3
ISSN: 0899-7071
Publisher: Elsevier Inc.  
Date Published: 2013-05-01
Start Page: 451
End Page: 457
Language: English
DOI: 10.1016/j.clinimag.2012.08.008
PROVIDER: scopus
PUBMED: 23068052
PMCID: PMC3789370
DOI/URL:
Notes: --- - "Export Date: 3 June 2013" - "CODEN: CLIME" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Zhigang Zhang
    240 Zhang
  2. Gary Ulaner
    84 Ulaner
  3. Robert J Young
    108 Young
  4. Kathryn Beal
    157 Beal
  5. Andrei Holodny
    136 Holodny