Elsevier

World Neurosurgery

Volume 108, December 2017, Pages 989.e1-989.e8
World Neurosurgery

Case Report
Multimodal 18F-Fluciclovine PET/MRI and Ultrasound-Guided Neurosurgery of an Anaplastic Oligodendroglioma

https://doi.org/10.1016/j.wneu.2017.08.085Get rights and content
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Background

Structural magnetic resonance imaging (MRI) and histopathologic tissue sampling are routinely performed as part of the diagnostic workup for patients with glioma. Because of the heterogeneous nature of gliomas, there is a risk of undergrading caused by histopathologic sampling errors. MRI has limitations in identifying tumor grade and type, detecting diffuse invasive growth, and separating recurrences from treatment induced changes. Positron emission tomography (PET) can provide quantitative information of cellular activity and metabolism, and may therefore complement MRI. In this report, we present the first patient with brain glioma examined with simultaneous PET/MRI using the amino acid tracer 18F-fluciclovine (18F-FACBC) for intraoperative image-guided surgery.

Case Description

A previously healthy 60-year old woman was admitted to the emergency care with speech difficulties and a mild left-sided hemiparesis. MRI revealed a tumor that was suggestive of glioma. Before surgery, the patient underwent a simultaneous PET/MRI examination. Fused PET/MRI, T1, FLAIR, and intraoperative three-dimensional ultrasound images were used to guide histopathologic tissue sampling and surgical resection. Navigated, image-guided histopathologic samples were compared with PET/MRI image data to assess the additional value of the PET acquisition. Histopathologic analysis showed anaplastic oligodendroglioma in the most malignant parts of the tumor, while several regions were World Health Organization (WHO) grade II.

Conclusions

18F-Fluciclovine uptake was found in parts of the tumor where regional WHO grade, cell proliferation, and cell densities were highest. This finding suggests that PET/MRI with this tracer could be used to improve accuracy in histopathologic tissue sampling and grading, and possibly for guiding treatments targeting the most malignant part of extensive and eloquent gliomas.

Key words

18F-fluciclovine
18F-FACBC
PET/MRI
Glioma

Abbreviations and Acronyms

3D
Three-dimensional
11C-MET
L-[methyl-11C]Methionine
18F-FACBC
Anti-1-amino-3-[18F]fluorocyclobutane-1-carboxylic acid
18F-FDG
[18F]Fluoro-2-deoxy-2-D-glucose
18F-FDOPA
L-3,4-Dihydroxy-6-[18F]fluorophenylalanine
18F-FET
O-(2-[18F]Fluoroethyl)-L-tyrosine
ADC
Apparent diffusion coefficient
Cho
Choline
Cre
Creatine
CSI
Chemical shift imaging
DWI
Diffusion weighted image
FLAIR
Fluid attenuated inversion recovery
MRI
Magnetic resonance imaging
NAA
N-acetyl-aspartate
OSEM
Ordered subset expectation maximization
PET
Positron emission tomography
p.i.
postinjection
rCBV
Relative cerebral blood volume
ROI
Region of interest
SUV
Standardized uptake value
TAC
Time-activity curve
TBR
Tumor-to-background ratio
WHO
World Health Organization

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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Supplementary digital content available online.