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Review
. 2022 Feb 22;14(5):1103.
doi: 10.3390/cancers14051103.

PET Imaging in Neuro-Oncology: An Update and Overview of a Rapidly Growing Area

Antoine Verger  1   2 , Aurélie Kas  3   4 , Jacques Darcourt  5   6 , Eric Guedj  7   8   9
Affiliations
Review

PET Imaging in Neuro-Oncology: An Update and Overview of a Rapidly Growing Area

Antoine Verger et al. Cancers (Basel). .

Abstract

PET plays an increasingly important role in the management of brain tumors. This review outlines currently available PET radiotracers and their respective indications. It specifically focuses on 18F-FDG, amino acid and somatostatin receptor radiotracers, for imaging gliomas, meningiomas, primary central nervous system lymphomas as well as brain metastases. Recent advances in radiopharmaceuticals, image analyses and translational applications to therapy are also discussed. The objective of this review is to provide a comprehensive overview of PET imaging's potential in neuro-oncology as an adjunct to brain MRI for all medical professionals implicated in brain tumor diagnosis and care.

Keywords: FDG; PET; amino acid; brain metastases; glioma; meningioma; neuro-oncology; peptide radionuclide therapy; primary central nervous system lymphoma; somatostatin.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Decision flowchart and main indications for PET imaging radiotracer use according to the type of brain tumor and the corresponding levels of 1–3 evidence according to the Oxford Centre for Evidence-based Medicine (OCEBM Levels of Evidence Working Group: “The Oxford 2011 Levels of Evidence”).
Figure 2
Figure 2
Representative PET imaging of brain tumors. On the left, 18F-FDOPA PET at initial diagnosis in a 62-year-old man who presented with a glioblastoma. Note the typical decreasing time–activity curve observed in this lesion with only slight contrast enhancement on MRI. In the middle left, 68GA-DOTATOC PET at initial diagnosis in a 70-year-old woman with grade II meningioma. The meningioma is observed in two locations: within the sphenoid bone with an intra-orbital extension on the contrast-enhanced MRI and a transosseous lesion within the temporal bone, not visible on MRI. In the middle right, 18F-FDG PET in a 78-year-old woman with a primary central nervous system lymphoma at initial diagnosis. 18F-FDG PET exhibits a good contrast ratio between normal brain and the left precuneus lesion. On the right, 18F-FDOPA PET identifies the recurrence of a pulmonary adenocarcinoma metastasis in the right occipital brain of a 72-year-old man referred for a differential diagnosis between treatment-related changes and progression related to a lesion, which could not be differentiated on the contrast-enhanced MRI.
Figure 3
Figure 3
Whole-body maximal intensity projections of 68GA-DOTATOC PET and axial slices of contrast-enhanced MRI and 68GA-DOTATOC/MRI fused images in a 60-year-old woman patient with a refractory grade I meningioma progressing at a high tumor growth rate, before (A) and after 2 courses of 177Lu-DOTA-octreotate (B). The two PET scans show stable disease.
See this image and copyright information in PMC

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