Abstract
These joint practice guidelines, or procedure standards, were developed collaboratively by the European Association of Nuclear Medicine (EANM), the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the European Association of Neurooncology (EANO), and the working group for Response Assessment in Neurooncology with PET (PET-RANO). Brain PET imaging is being increasingly used to supplement MRI in the clinical management of glioma. The aim of these standards/guidelines is to assist nuclear medicine practitioners in recommending, performing, interpreting and reporting the results of brain PET imaging in patients with glioma to achieve a high-quality imaging standard for PET using FDG and the radiolabelled amino acids MET, FET and FDOPA. This will help promote the appropriate use of PET imaging and contribute to evidence-based medicine that may improve the diagnostic impact of this technique in neurooncological practice. The present document replaces a former version of the guidelines published in 2006 (Vander Borght et al. Eur J Nucl Med Mol Imaging. 33:1374–80, 2006), and supplements a recent evidence-based recommendation by the PET-RANO working group and EANO on the clinical use of PET imaging in patients with glioma (Albert et al. Neuro Oncol. 18:1199–208, 2016). The information provided should be taken in the context of local conditions and regulations.
Highlights
Gliomas are the second most common primary brain tumour with an annual incidence rate of around six cases per 100,000individuals worldwide [1]
The most common of all malignant brain and central nervous system (CNS) tumours is glioblastoma (46%) which is associated with a median overall survival of 15 months in patients treated with maximal safe tumour resection, concomitant radiotherapy/chemotherapy and adjuvant chemotherapy [2]
A static image acquired for 10–20 min at least 45 min after injection is used for clinical FDG positron emission tomography (PET) reading, and should be coregistered and fused with recent highresolution contrast-enhanced T1 and T2/fluid-attenuated inversion recovery (FLAIR) Magnetic resonance imaging (MRI) sequences
Summary
Gliomas are the second most common primary brain tumour with an annual incidence rate of around six cases per 100,000. Magnetic resonance imaging (MRI) is the primary clinical imaging modality in patients with glioma at all disease stages including the primary evaluation, presurgical planning, early postsurgical evaluation of residual tumour, radiotherapy planning, surveillance during chemotherapy, and definition of recurrence. There are defined objective and standardized MRI-based criteria for response assessment in neurooncology (RANO) applied to clinical trials in patients with brain tumours. MRI contrast enhancement can be unreliable as a surrogate for tumour size or growth It nonspecifically reflects vascular surface area and the permeability of the contrast agent across a disrupted blood–tumour barrier and may represent tumour biology or a number of other factors including therapy-induced inflammation. To identify infiltrative glioma tissue, the RANO definition of tumour progression was supplemented by inclusion of Bsignificant^ enlarging areas of nonenhancing tumour on MRI T2-weighted and fluid-attenuated inversion recovery (FLAIR) image sequences. The present guidelines/standards focus on the technical aspects of PET image acquisition with the above-mentioned radiotracers, and replace all previously published guidelines on glioma imaging [10]
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