Comparison of F-18 Fluorodeoxyglucose and F-18 Fluorothymidine Positron Emission Tomography in Differentiating Radiation Necrosis from Recurrent Glioma

Purpose of the Report—The objective was to compare F-18 fluorodeoxyglucose (FDG) and F-18 fluorothymidine (FLT) positron emission tomography (PET) in differentiating radiation necrosis from recurrent glioma. Materials and methods—Visual and quantitative analyses were derived from static FDG PET and static and dynamic FLT PET in 15 patients with suspected recurrence of treated ≥ grade II glioma with a new focus of Gd-contrast enhancement on MRI. For FDG PET, SUVmax and the ratio of lesion SUVmax to the SUVmean of contralateral white matter were measured. For FLT PET, SUVmax and Patlak-derived metabolic flux parameter Kimax were measured for the same locus. A 5-point visual confidence scale was applied to FDG PET and FLT PET. ROC analysis was applied to visual and quantitative results. Differences between recurrent tumor and radiation necrosis were tested by Kruskal-Wallis analysis. Based on follow-up Gd-MRI imaging, lesionspecific recurrent tumor was defined as a definitive increase in size of the lesion, and radiation necrosis as stability or regression. Results—For FDG SUVmax, FDG ratio lesion:white matter and FLT Kimax, there was a significant difference between mean values for recurrent tumor and radiation necrosis. Recurrent tumor was best identified by FDG ratio of lesion:contralateral normal white matter (AUC 0.98, CI 0.91–1.00, sens. 100%, spec. 75% for an optimized cut-off value of 1.82). Conclusion—Both quantitative and visual determinations allow accurate differentiation between recurrent glioma and radiation necrosis by both FDG and FLT PET. In this small series, FLT PET offers no advantage over FDG PET.