FDG PET imaging in brain tumours: the WA PET/Cyclotron experience
2006
Purpose: To determine the accuracy of FDG PET imaging in the assessment
of brain tumours at our institution. Methods: The first 49 FDG-PET scans in patients with either possible brain
tumour or possible brain tumour recurrence, performed since the WA PET
and Cyclotron Service became operational in 2002, were reviewed. There
were 18 males and 31 females. FDG PET imaging was reported with reference
to and in some instances coregistration and fusion with, the anatomic
imaging. Based on the report the FDG study was classified as either positive
or negative for the presence of tumour. 38 cases were included in the analysis,
21 having pathologic data and 17 with diagnostic clinical follow-up. 11
patients were excluded as they had no or inadequate follow-up data. Results: Of the 21 cases with pathology, 18 were shown to have tumour. In
the other three cases, the pathology was described as demyelinating in one,
ischaemic with lymphocytic vasculitis in another and the last with white
mater gliosis. Two of the three cases which where called positive on FDG
imaging, the case of demyelination being a true negative. Of the 18 tumour
cases there were 5 false negatives which included, one oligodendroglioma a
ganglioglioma, a WHO 2 or 3 glioma and a highgrade astrocytoma and a
glioblastoma. Thus of the false negatives only 2 cases can be explained by
low grade pathology 17 cases were assessed by clinical follow-up. Of these cases 9 were considered
positive, 8 being negative. There was one false positive in the clinical
follow up group however the follow up duration was relatively short being
only 4 months. There were 2 false negatives one being positive at 1 month
and the second at 14 months following FDG. Sensitivity and specificity were
calculated at Sens 74% and Spec 73%, PPV 87% and NPV 53%. Conclusion: This study shows that the utility of FDG PET imaging in our
hands is similar to the published literature. With a PPV of 87%, a positive
FDG study indicates a high likelihood that there is brain tumour present and
that it will progress.A negative study does not exclude the presence of tumour.
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