Positron emission tomography for intracranial metastases

Anatomic imaging modalities including standard MRI have limitations in accurately characterizing post-therapeutic reactive changes and treatment response. Molecular imaging techniques such as positron emission tomography (PET) characterize specific metabolic and cellular features of metastases, potentially providing clinically relevant information supplementing anatomic MRI. The RANO working group provides recommendations for the use of PET imaging in the clinical management of patients with BM based on evidence from studies validated by histology and/or clinical outcome 1).


The use of PET with radiolabeled amino acids, in particular, has been validated as an important diagnostic tool in brain cancer 2). 3) 4) 5).

The overexpression of LAT1 transports in BM make intracranial metastases a compelling target for amino acid PET imaging 6).


Fink in 2013 stated that nuclear medicine studies including FDG PET and other molecular imaging may play a larger role in the future. 7).


1)
Galldiks N, Langen KJ, Albert NL, Chamberlain M, Soffietti R, Kim MM, Law I, Le Rhun E, Chang S, Schwarting J, Combs SE, Preusser M, Forsyth P, Pope W, Weller M, Tonn JC. PET Imaging in Patients with Brain Metastasis - Report of the RANO/PET Group. Neuro Oncol. 2019 Jan 5. doi: 10.1093/neuonc/noz003. [Epub ahead of print] PubMed PMID: 30615138.
2)
Langen KJ, Galldiks N, Hattingen E, Shah NJ. Advances in neuro-oncology imaging. Nat Rev Neurol. 2017; 13(5):279-289
3)
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.
4)
Galldiks N, Albert NL, Sommerauer M, et al. PET imaging in patients with meningioma-report of the RANO/PET Group. Neuro Oncol. 2017; 19(12):1576-1587.
5)
Langen KJ, Watts C. Neuro-oncology: Amino acid PET for brain tumours - ready for the clinic? Nat Rev Neurol. 2016; 12(7):375-376.
6)
Papin-Michault C, Bonnetaud C, Dufour M, et al. Study of LAT1 Expression in Brain Metastases: Towards a Better Understanding of the Results of Positron Emission Tomography Using Amino Acid Tracers. PloS one. 2016; 11(6):e0157139.
7)
Fink KR, Fink JR. Imaging of brain metastases. Surg Neurol Int. 2013 May 2;4(Suppl 4):S209-19. doi: 10.4103/2152-7806.111298. Print 2013. PubMed PMID: 23717792; PubMed Central PMCID: PMC3656556.
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