(82)Rubidium chloride positron emission tomography discrimination of recurrent intracranial malignancy from radiation necrosis

• Type of Material: Article
• Authors: Ephraim Parent, Emory University; Ila Sethi, Emory University; Jonathon Nye, Emory University; Chad Holder, Emory University; Jeffrey Olson, Emory University; Jeffrey Switchenko, Emory University; Funmilayo Tade, Emory University; Oladunni Akin-Akintayo, Emory University; Olayinka A Abiodun-Ojo, Emory University; Akinyemi Akintayo, Emory University; David Schuster, Emory University
• Language: English
• Date: 2022-03-01
• Publisher: EDIZIONI MINERVA MEDICA
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 EDIZIONI MINERVA MEDICA
• Final Published Version (URL): http://dx.doi.org/10.23736/S1824-4785.19.03173-X
• Title of Journal or Parent Work: QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
• Volume: 66
• Issue: 1
• Start Page: 74
• End Page: 81
• Grant/Funding Information: Internal departmental funds and the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/ NCI under award number P30CA138292 supported this research.
• Keywords: RB-82; TUMOR RECURRENCE; CHALLENGES; Radiology, Nuclear Medicine & Medical Imaging; DIAGNOSIS; Glioma; PET; BRAIN-TUMOR; Life Sciences & Biomedicine; Science & Technology; Necrosis; Positron emission tomography; FDG

Abstract

BACKGROUND: Accurate identification and discrimination of post treatment changes from recurrent disease remains a challenge for patients with intracranial malignancies despite advances in molecular and magnetic resonance imaging. We have explored the ability of readily available Rubidium-82 chloride (82 RbCl) positron emission tomography (PET) to identify and distinguish progressive intracranial disease from radiation necrosis in patients previously treated with radiation therapy. METHODS: Six patients with a total of 9 lesions of either primary (N.=3) or metastatic (N.=6) intracranial malignancies previously treated with stereotactic radiation surgery (SRS) and persistent contrast enhancement on MRIunderwent brain 82 RbCl PET imaging. Two patients with arteriovenous malformations previously treated with SRS, also had brain 82 RbCl PET imaging for a total of 11 lesions studied. Histological confirmation via stereotactic biopsy/excisional resection was obtained for 9 lesions with the remaining 2 classified as either recurrent tumor or radiation necrosis based on subsequent MRIexaminations. 82 RbCl PET time activity curve analysis was performed which comprised lesion SUVmax, contralateral normal brain SUVmax, and tumor to background ratios (TBmax). RESULTS: 82RbCl demonstrates uptake greater than normal brain parenchyma in all lesions studied. Time activity curves demonstrated progressive uptake of 82RbCl in all lesions without evidence of washout. While recurrent disease demonstrated a greater mean SUVmax compared to radiation necrosis, no statistically significant difference between lesion SUVmax nor TBmax was found (P>0.05). CONCLUSIONS: 82 RbCl PET produces high-contrast uptake of both recurrent disease and radiation necrosis compared to normal brain. However, no statistically significant difference was found between recurrent tumor and radiation necrosis.