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18F-FDG PET of Common Enhancing Malignant Brain Tumors

Nobuyuki Kosaka1, Tatsuro Tsuchida1, Hidemasa Uematsu1, Hirohiko Kimura1, Hidehiko Okazawa2 and Harumi Itoh1

1 Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
2 Biomedical Imaging Research Center, University of Fukui, Fukui, Japan.


Figure 1
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  		Fig. 1 —Example of region of interest (ROI) placed on necrotic tumor in 47-year-old man. Apparent low accumulation of 18F-FDG at center of tumor is excluded from ROI, which represents necrotic portion. This patient was revealed as having metastatic brain tumor (squamous cell carcinoma).

 

Figure 2
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  		Fig. 2A —Scatterplots of 18F-FDG uptake in lesions. Scatterplots show average and maximum standard uptake values (SUVavg and SUVmax) (A), average tumor-to-cortex activity ratio (T/Cavg) and ratio of count of maximum pixels in tumor to average count per pixel in cortex (T/Cmax) (B), and average tumor-to-white matter activity ratio (T/WMavg) and ratio of count of maximum pixels in tumor to average count per pixel in white matter (T/WMmax) (C). L denotes CNS lymphoma; G, high-grade glioma; and M, metastatic brain tumor. Mean values and SDs are also shown. Dashed lines indicate lowest values for each CNS lymphoma parameter. When these values are used as cutoff levels to distinguish CNS lymphomas from other tumors, SUVmax is the most accurate parameter. Using SUVmax of 15.0 as cutoff level, only one high-grade glioma was found to be false-positive (SUVmax, 18.8) in our patient group.

 

Figure 3
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  		Fig. 2B —Scatterplots of 18F-FDG uptake in lesions. Scatterplots show average and maximum standard uptake values (SUVavg and SUVmax) (A), average tumor-to-cortex activity ratio (T/Cavg) and ratio of count of maximum pixels in tumor to average count per pixel in cortex (T/Cmax) (B), and average tumor-to-white matter activity ratio (T/WMavg) and ratio of count of maximum pixels in tumor to average count per pixel in white matter (T/WMmax) (C). L denotes CNS lymphoma; G, high-grade glioma; and M, metastatic brain tumor. Mean values and SDs are also shown. Dashed lines indicate lowest values for each CNS lymphoma parameter. When these values are used as cutoff levels to distinguish CNS lymphomas from other tumors, SUVmax is the most accurate parameter. Using SUVmax of 15.0 as cutoff level, only one high-grade glioma was found to be false-positive (SUVmax, 18.8) in our patient group.

 

Figure 4
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  		Fig. 2C —Scatterplots of 18F-FDG uptake in lesions. Scatterplots show average and maximum standard uptake values (SUVavg and SUVmax) (A), average tumor-to-cortex activity ratio (T/Cavg) and ratio of count of maximum pixels in tumor to average count per pixel in cortex (T/Cmax) (B), and average tumor-to-white matter activity ratio (T/WMavg) and ratio of count of maximum pixels in tumor to average count per pixel in white matter (T/WMmax) (C). L denotes CNS lymphoma; G, high-grade glioma; and M, metastatic brain tumor. Mean values and SDs are also shown. Dashed lines indicate lowest values for each CNS lymphoma parameter. When these values are used as cutoff levels to distinguish CNS lymphomas from other tumors, SUVmax is the most accurate parameter. Using SUVmax of 15.0 as cutoff level, only one high-grade glioma was found to be false-positive (SUVmax, 18.8) in our patient group.

 

Figure 5
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  		Fig. 3A —76-year-old woman with CNS lymphoma. Axial contrast-enhanced T1-weighted MR image shows well-enhanced brain tumor (arrow).

 

Figure 6
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  		Fig. 3B —76-year-old woman with CNS lymphoma. Corresponding axial 18F-FDG PET image shows FDG accumulation (arrow) is visually higher than in other tumors (Figs. 4B and 5B). Parameters of this patient were average standard uptake value (SUVavg), 17.51; maximum SUV (SUVmax), 27.20; average tumor-to-cortex activity ratio (T/Cavg), 3.37; ratio of count of maximum pixels in tumor to average count per pixel in cortex (T/Cmax), 5.24; average tumor-to-white matter activity ratio (T/WMavg), 5.43; and ratio of count of maximum pixels in tumor to average count per pixel in white matter (T/WMmax), 8.43.

 

Figure 7
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  		Fig. 4A —17-year-old girl with glioblastoma multiforme. Axial contrast-enhanced T1-weighted MR image shows enhancing brain tumor (arrow).

 

Figure 8
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  		Fig. 4B —17-year-old girl with glioblastoma multiforme. Corresponding axial 18F-FDG PET image shows moderate FDG accumulation (arrow). Parameters of this patient were average standard uptake value (SUVavg), 11.25; maximum SUV (SUVmax), 13.73; average tumor-to-cortex activity ratio (T/Cavg), 1.84; ratio of count of maximum pixels in tumor to average count per pixel in cortex (T/Cmax), 2.25; average tumor-to-white matter activity ratio (T/WMavg), 3.84; and ratio of count of maximum pixels in tumor to average count per pixel in white matter (T/WMmax),4.68.

 

Figure 9
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  		Fig. 5A —69-year-old man with metastatic adenocarcinoma from lung cancer. Axial contrast-enhanced T1-weighted MRI shows enhancing brain tumor (arrow).

 

Figure 10
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  		Fig. 5B —69-year-old man with metastatic adenocarcinoma from lung cancer. Corresponding axial 18F-FDG PET image shows moderate FDG accumulation (arrow). Parameters of this patient were average standard uptake value (SUVavg), 6.17; maximum SUV (SUVmax), 9.17; average tumor-to-cortex activity ratio (T/Cavg), 1.52; ratio of count of maximum pixels in tumor to average count per pixel in cortex (T/Cmax), 2.26; average tumor-to-white matter activity ratio (T/WMavg), 2.28; and ratio of count of maximum pixels in tumor to average count per pixel in white matter (T/WMmax), 3.38.

 

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