Metabolic imaging of malignant brain tumors

Imaging of malignant brain tumors following treatment often presents a diagnostic dilemma even with available MR imaging tools. PET imaging provides critical complementary information regarding tumor metabolic properties and can be performed at the same time as advanced MRI. In general, amino acid PET imaging and more specifically 18F-fluoroethyltyrosine (FET) PET imaging allows for unique properties for both static and dynamic tumor imaging not found with any other imaging agent. FET PET can be performed simultaneously with CT or MRI, although the MRI is preferred given its higher tissue resolution FET enters cells with higher amino acid and protein demand through the L-amino acid type 1 receptor, which is typically expressed in cells of high proliferation and metabolic demand. The relative lack of these receptors on normal mature neurons allows a high tumor to normal brain ratio. When combining all available MRI and FET PET tools, the neuroradiologist has the highest chance of establishing the accurate diagnosis in the most difficult cases. One limitation of FET PET imaging is that it is not yet available, or FDA approved in the United States despite wider availability in European countries. 
  • Publications

    Overcast WB, Davis KM, Ho CY, Hutchins GD, Green MA, Graner BD, Veronesi MC. Advanced imaging techniques for neuro-oncologic tumor diagnosis, with an emphasis on PET-MRI imaging of malignant brain tumors. Curr Oncol Rep. 2021 Feb 18;23(3):34. doi: 10.1007/s11912-021-01020-2. PMID: 33599882; PMCID: PMC7892735.

    Scales W, Territo W, Sims J, Tann M, Aaron V, Kamer A, Green MA, Hutchins GD, Graner BD, MC Veronesi. Imaging of malignant brain tumors using hybrid 18F-Fluoro-Ethy-Tyrosine PET MRI, integration into standard clinical care at a single US institution. 59th Annual Meeting the American Society of Neuroradiology, May 22-27, 2021.

Broadening research

To date the lab has helped a multidisciplinary team of neuro-oncologists, radiation oncologists and neurosurgeons help over sixty patients in the past year. In the second year of the program, the lab is broadening the indications of FET PET MRI to include initial diagnosis of a suspected malignant brain tumor, surgical resection and biopsy planning, radiation planning and additional maintenance treatment intervals. Through the success of the program, the use of FET PET MRI has become one of the highest objectives of both the Department of Radiology and Imaging Sciences and the neuroradiology division with the recent hire of a clinical coordinator and addition of three research staff dedicated to the program. Through this process, Michael Veronesi, MD, PhD serves as co-mentor for an MD/ PhD student in the application of more advanced kinetic modeling.