Contribution of [18F]FET PET in the Management of Gliomas, from Diagnosis to Follow-Up: A Review

Abstract

Gliomas, the most common type of primary malignant brain tumors in adults, pose significant challenges in diagnosis and management due to their heterogeneity and potential aggressiveness. This review evaluates the utility of O-(2-[¹⁸F]fluoroethyl)-L-tyrosine ([¹⁸F]FET) positron emission tomography (PET), a promising imaging modality, to enhance the clinical management of gliomas. We reviewed 82 studies involving 4657 patients, focusing on the application of [¹⁸F]FET in several key areas: diagnosis, grading, identification of IDH status and presence of oligodendroglial component, guided resection or biopsy, detection of residual tumor, guided radiotherapy, detection of malignant transformation in low-grade glioma, differentiation of recurrence versus treatment-related changes and prognostic factors, and treatment response evaluation. Our findings confirm that [¹⁸F]FET helps delineate tumor tissue, improves diagnostic accuracy, and aids in therapeutic decision-making by providing crucial insights into tumor metabolism. This review underscores the need for standardized parameters and further multicentric studies to solidify the role of [¹⁸F]FET PET in routine clinical practice. By offering a comprehensive overview of current research and practical implications, this paper highlights the added value of [¹⁸F]FET PET in improving management of glioma patients from diagnosis to follow-up.

Keywords: PET; fluoroethyltyrosine (FET); glioma; neuro-oncology; nuclear medicine.

Figure 1

Radiolabeled amino acids O-(2-[¹⁸F]fluoroethyl)-L-tyrosine ([¹⁸F]FET), [¹¹C-methyl]-methionine ([¹¹C]MET), and L-3,4-dihydroxy-6-[¹⁸F]fluoro-phenyl-alanine ([¹⁸F]FDOPA) metabolic pathways. Molecular structures (A) and associated uptake mechanism (B) of each radiolabeled amino acid. Created with BioRender.com.

Figure 2

Flowchart of the literature selection.