FDG-PET/CT [Neurosurgery Wiki]

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====== FDG-PET/CT ======

[[18F]]-2-[[fluoro]]-2-[[deoxy]]-[[D-glucose]] ([[FDG]]) represents the most widely used [[tracer]] in oncologic [[PET]] imaging and has evolved over the last several decades into the paramount clinical PET modality for cancer detection
((Herholz K, Langen KJ, Schiepers C, Mountz JM. Brain tumors. Semin Nucl Med.
2012; 42(6):356-370.)).

Due to the long half-life of the fluorine-18 isotope (110 minutes), in-house production of this tracer is not necessary, overcoming logistic problems that occur with isotopes of shorter half-life. Thus, FDG can be transported to all PET centers, alleviating the need for an on-site cyclotron-based manufacturing. Increased FDG uptake is commonly seen in highly proliferating cancer cells because of increased expression of glucose transporters and hexokinase, the enzyme that converts glucose (and FDG) to a phosphorylated product. Related to increased glycolysis, the uptake of FDG in neoplastic tissue is generally higher than in non-neoplastic tissue. However, the high and regionally variable FDG uptake in normal brain parenchyma often makes the delineation of tumors in the brain difficult
((Albert NL, Weller M, Suchorska B, et al. Response Assessment in Neuro-Oncology
working group and European Association for Neuro-Oncology recommendations for the
clinical use of PET imaging in gliomas. Neuro Oncol. 2016; 18(9):1199-1208.))

Furthermore, inflammatory tissue can exhibit high FDG tracer uptake, also diminishing diagnostic specificity
((Langen KJ, Galldiks N, Hattingen E, Shah NJ. Advances in neuro-oncology imaging.
Nat Rev Neurol. 2017; 13(5):279-289.)).
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see [[18F positron emission tomography]].

Fluorine-18 ([[18F]]) is a [[fluorine]] [[radioisotope]] which is an important source of positrons. It has a mass of 18.0009380 u and its half-life is 109.771 minutes. It decays by positron emission 97% of the time and electron capture 3% of the time. Both modes of decay yield stable oxygen-18.

Fludeoxyglucose (18F) (INN), or [[fludeoxyglucose]] F 18 (USAN and USP), also commonly called [[fluorodeoxyglucose]] and abbreviated [18F]FDG, 18F-FDG or [[FDG]].
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[[Fludeoxyglucose]] (18F) (INN), or fludeoxyglucose F 18 (USAN and USP), also commonly called fluorodeoxyglucose and abbreviated [18F]FDG, 18F-FDG or FDG, is a radiopharmaceutical used in the medical imaging modality [[positron emission tomography]] (PET). Chemically, it is 2-deoxy-2-(18F)fluoro-D-glucose, a glucose analog, with the positron-emitting radioactive isotope fluorine-18 substituted for the normal hydroxyl group at the 2' position in the glucose molecule.

The uptake of 18F-FDG by tissues is a marker for the tissue uptake of glucose, which in turn is closely correlated with certain types of tissue metabolism. After 18F-FDG is injected into a patient, a PET scanner can form two-dimensional or three-dimensional images of the distribution of 18F-FDG within the body.

Since its development in 1976, 18F-FDG had a profound influence on research in the neurosciences.