Brain Tumor NM

Question 1

Amino acid transport and protein synthesis

Answer 1

Need fasting, no uptake in normal cortex
C11-methionine - more accurate than FDG in DD tumor recurrence vs radiation necrosis, the best!!!
6 MBq/kg, 20-30 min, 15% incorporated into protein
F-FET is not incorporated into proteins - - uptake reflects primarily transport across BBB
200 MBq, 20 min - 2 h

Question 2

Amino acid transport and dopamine metabolism

Answer 2

F-DOPA
Better than FDG in detection of glioma recurrence
For low grade glioma
Uptake less sensitive to transport across BBB
Accumulates in striatum late–early acquisition 20 min postinjection vs 70 min for PD
Tumor recurrence vs radiation necrosis > MRI

Question 3

DNA synthesis

Answer 3

C11-thymidine
F-FLT - -
Superior to amino acid tracers for grading
DD tumor recurrence vs radiation necrosis
Uptake heavily affected by BBB integrity
1 h postinjection

Question 4

Lipid metabolism
Choline - phospholipid precursor

Answer 4

C11-choline
F-fluorocholine
Uptake reflects membrane proliferation in brain tumor
No physiologic uptake - - high sensitivity
False positive - meningioma, brain MTS, inflammation
Static 2 min postinjection
Also for prostate cancer

Question 5

Hypoxia

Answer 5

F-MISO–easy cross BBB - - uptake in periphery of GBM (photopenic necrotic centre) - - predict tumor grade
F-FAZA
Cu64-ATSM
Hypoxia - - resistant to radio and some chemo
Tissue binding depends on tissue oxygen concentration
Physiological uptake

Question 6

Low grade glioma

Answer 6

Grade I and II
FDG - areas of activity lower than white matter

Question 7

High grade glioma

Answer 7

Grade III and IV
Poor prognosis

Question 8

Factors for grade

Answer 8

Degree of mitosis
Nuclear atypia
Necrosis
Microvascular proliferation

Question 9

Poor prognosis

Answer 9

Older age
Extent of tumor resection
Anatomic location
Karnofsky performance status

Question 10

Grade III glioma

Answer 10

Anaplastic Astrocytoma

Question 11

Grade IV glioma

Answer 11

Glioblastoma
Most common
Aggressive
Resistant to treatment
FDG - areas of activity higher than gray matter

Question 12

Glioma treatment

Answer 12

Surgery
Radio
no chemo - not cross BBB
Bevacizumab = anti VEGF - - for recurrent high grade glioma
Reactive changes of BBB permeability - - pseudo progression - - over treatment

Question 13

Radioimmunotherapy

Answer 13

Monoclonal AB conjugated with high energy beta emitter - - Y90 or Lu177

Question 14

Answer 14

FDG - cold
C-Methionine - hot

Question 15

Answer 15

Amino acid tracer
Very low uptake in normal cortex

Question 16

Answer 16

MRI - - FDG - - FLT

Question 17

Answer 17

F-DOPA

Question 18

No physiologic uptake

Answer 18

Choline
FET

Question 19

Tumor grading

Answer 19

FDG
FLT
MISO
Not amino acid tracers