Malignant Glioma Clinical Trial
Official title:
A Dual Time Point FDG-PET to Differentiate Between Recurrent Brain Tumor and Radionecrosis
Gliomas are the most common malignant primary central nervous system (CNS) tumours. When high-grade gliomas (HGG) recur, subsequent magnetic resonance (MRI) imaging, with additional sequences is required.The Positron Emission Tomography (PET) radiotracer [18F]-fluorodeoxyglucose (FDG) will be used in this study to distinguish between changes seen on MRI which can be a reflection of pseudoprogression, radiation necrosis, or recurrence.
Molecular imaging has been used to distinguish recurrent tumor from post-treatment changes
through the use of positron emission tomography (PET) as well as other techniques. The
best-studied PET radiotracer for this application is [18F]-fluorodeoxyglucose (FDG). Normal
brain matter is very FDG-avid, making it more difficult to identify lesions and in addition,
inflammation associated with radiation injury has been shown to be FDG avid.
In light of this, variations of the standard FDG protocols have been proposed in order to
increase overall accuracy, including dual time point imaging (DTPI), consisting of injecting
the patient with the standard radiotracer and acquiring two sets of images several hours
apart, typically the normal initial images in addition to a delayed acquisition set.
There is good reason to suspect that DTPI FDG-PET would be useful a technique for
characterizing lesions in the brain. It's been shown that FDG uptake by normal brain
parenchyma initially increases then decreases with time, while tumor uptake typically
increases and then plateaus. This pattern of increasing and then decreasing FDG activity has
also been seen in inflammatory tissue. The difference in FDG uptake at different times is
what allows for a better distinction between malignant and benign tissue.
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