Evaluation of 18F-FDG PET and MRI associations in pediatric diffuse intrinsic brain stem glioma: A report from the pediatric brain tumor consortium

Katherine A. Zukotynski, Frederic H. Fahey, Mehmet Kocak, Abass Alavi, Terence Z. Wong, S. Ted Treves, Barry L. Shulkin, Daphne A. Haas-Kogan, Jeffrey R. Geyer, Sridhar Vajapeyam, James M. Boyett, Larry E. Kun, Tina Young Poussaint

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Abstract

The purpose of this study was to assess 18F-FDG uptake in children with a newly diagnosed diffuse intrinsic brain stem glioma (BSG) and to investigate associations with progression-free survival (PFS), overall survival (OS), and MRI indices. Methods: Two Pediatric Brain Tumor Consortium (PBTC) therapeutic trials in children with newly diagnosed BSG were designed to test radiation therapy combined with molecularly targeted agents (PBTC-007: phase I/II study of gefitinib; PBTC-014: phase I/II study of tipifarnib). Baseline brain 18F-FDG PET scans were obtained in 40 children in these trials. Images were evaluated by consensus between 2 PET experts for intensity and uniformity of tracer uptake. Associations of 18F-FDG uptake intensity and uniformity with both PFS and OS, as well as associations with tumor MRI indices at baseline (tumor volume on fluid-attenuated inversion recovery, baseline intratumoral enhancement, diffusion and perfusion values), were evaluated. Results: In most of the children, BSG 18F-FDG uptake was less than gray-matter uptake. Survival was poor, irrespective of intensity of 18F-FDG uptake, with no association between intensity of 18F-FDG uptake and PFS or OS. However, hyperintense 18F-FDG uptake in the tumor, compared with gray matter, suggested poorer survival rates. Patients with 18F-FDG uptake in 50% or more of the tumor had shorter PFS and OS than did patients with 18F-FDG uptake in less than 50% of the tumor. There was some evidence that tumors with higher 18F-FDG uptake were more likely to show enhancement, and when the diffusion ratio was lower, the uniformity of 18F-FDG uptake appeared higher. Conclusion: Children with BSG for which 18F-FDG uptake involves at least half the tumor appear to have poorer survival than children with uptake in less than 50% of the tumor. A larger independent study is needed to verify this hypothesis. Intense tracer uptake in the tumors, compared with gray matter, suggests decreased survival. Higher 18F-FDG uptake within the tumor was associated with enhancement on MR images. Increased tumor cellularity as reflected by restricted MRI diffusion may be associated with increased 18F-FDG uniformity throughout the tumor.

Original languageEnglish (US)
Pages (from-to)188-195
Number of pages8
JournalJournal of Nuclear Medicine
Volume52
Issue number2
DOIs
StatePublished - Feb 1 2011
Externally publishedYes

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Fluorodeoxyglucose F18
Brain Neoplasms
Glioma
Brain Stem
Pediatrics
Neoplasms
Survival
Disease-Free Survival
tipifarnib
Diffusion Magnetic Resonance Imaging
Tumor Burden
Positron-Emission Tomography
Radiotherapy
Survival Rate

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Evaluation of 18F-FDG PET and MRI associations in pediatric diffuse intrinsic brain stem glioma : A report from the pediatric brain tumor consortium. / Zukotynski, Katherine A.; Fahey, Frederic H.; Kocak, Mehmet; Alavi, Abass; Wong, Terence Z.; Treves, S. Ted; Shulkin, Barry L.; Haas-Kogan, Daphne A.; Geyer, Jeffrey R.; Vajapeyam, Sridhar; Boyett, James M.; Kun, Larry E.; Poussaint, Tina Young.

In: Journal of Nuclear Medicine, Vol. 52, No. 2, 01.02.2011, p. 188-195.

Research output: Contribution to journalArticle

Zukotynski, KA, Fahey, FH, Kocak, M, Alavi, A, Wong, TZ, Treves, ST, Shulkin, BL, Haas-Kogan, DA, Geyer, JR, Vajapeyam, S, Boyett, JM, Kun, LE & Poussaint, TY 2011, 'Evaluation of 18F-FDG PET and MRI associations in pediatric diffuse intrinsic brain stem glioma: A report from the pediatric brain tumor consortium', Journal of Nuclear Medicine, vol. 52, no. 2, pp. 188-195. https://doi.org/10.2967/jnumed.110.081463
Zukotynski, Katherine A. ; Fahey, Frederic H. ; Kocak, Mehmet ; Alavi, Abass ; Wong, Terence Z. ; Treves, S. Ted ; Shulkin, Barry L. ; Haas-Kogan, Daphne A. ; Geyer, Jeffrey R. ; Vajapeyam, Sridhar ; Boyett, James M. ; Kun, Larry E. ; Poussaint, Tina Young. / Evaluation of 18F-FDG PET and MRI associations in pediatric diffuse intrinsic brain stem glioma : A report from the pediatric brain tumor consortium. In: Journal of Nuclear Medicine. 2011 ; Vol. 52, No. 2. pp. 188-195.
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abstract = "The purpose of this study was to assess 18F-FDG uptake in children with a newly diagnosed diffuse intrinsic brain stem glioma (BSG) and to investigate associations with progression-free survival (PFS), overall survival (OS), and MRI indices. Methods: Two Pediatric Brain Tumor Consortium (PBTC) therapeutic trials in children with newly diagnosed BSG were designed to test radiation therapy combined with molecularly targeted agents (PBTC-007: phase I/II study of gefitinib; PBTC-014: phase I/II study of tipifarnib). Baseline brain 18F-FDG PET scans were obtained in 40 children in these trials. Images were evaluated by consensus between 2 PET experts for intensity and uniformity of tracer uptake. Associations of 18F-FDG uptake intensity and uniformity with both PFS and OS, as well as associations with tumor MRI indices at baseline (tumor volume on fluid-attenuated inversion recovery, baseline intratumoral enhancement, diffusion and perfusion values), were evaluated. Results: In most of the children, BSG 18F-FDG uptake was less than gray-matter uptake. Survival was poor, irrespective of intensity of 18F-FDG uptake, with no association between intensity of 18F-FDG uptake and PFS or OS. However, hyperintense 18F-FDG uptake in the tumor, compared with gray matter, suggested poorer survival rates. Patients with 18F-FDG uptake in 50{\%} or more of the tumor had shorter PFS and OS than did patients with 18F-FDG uptake in less than 50{\%} of the tumor. There was some evidence that tumors with higher 18F-FDG uptake were more likely to show enhancement, and when the diffusion ratio was lower, the uniformity of 18F-FDG uptake appeared higher. Conclusion: Children with BSG for which 18F-FDG uptake involves at least half the tumor appear to have poorer survival than children with uptake in less than 50{\%} of the tumor. A larger independent study is needed to verify this hypothesis. Intense tracer uptake in the tumors, compared with gray matter, suggests decreased survival. Higher 18F-FDG uptake within the tumor was associated with enhancement on MR images. Increased tumor cellularity as reflected by restricted MRI diffusion may be associated with increased 18F-FDG uniformity throughout the tumor.",
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AU - Fahey, Frederic H.

AU - Kocak, Mehmet

AU - Alavi, Abass

AU - Wong, Terence Z.

AU - Treves, S. Ted

AU - Shulkin, Barry L.

AU - Haas-Kogan, Daphne A.

AU - Geyer, Jeffrey R.

AU - Vajapeyam, Sridhar

AU - Boyett, James M.

AU - Kun, Larry E.

AU - Poussaint, Tina Young

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N2 - The purpose of this study was to assess 18F-FDG uptake in children with a newly diagnosed diffuse intrinsic brain stem glioma (BSG) and to investigate associations with progression-free survival (PFS), overall survival (OS), and MRI indices. Methods: Two Pediatric Brain Tumor Consortium (PBTC) therapeutic trials in children with newly diagnosed BSG were designed to test radiation therapy combined with molecularly targeted agents (PBTC-007: phase I/II study of gefitinib; PBTC-014: phase I/II study of tipifarnib). Baseline brain 18F-FDG PET scans were obtained in 40 children in these trials. Images were evaluated by consensus between 2 PET experts for intensity and uniformity of tracer uptake. Associations of 18F-FDG uptake intensity and uniformity with both PFS and OS, as well as associations with tumor MRI indices at baseline (tumor volume on fluid-attenuated inversion recovery, baseline intratumoral enhancement, diffusion and perfusion values), were evaluated. Results: In most of the children, BSG 18F-FDG uptake was less than gray-matter uptake. Survival was poor, irrespective of intensity of 18F-FDG uptake, with no association between intensity of 18F-FDG uptake and PFS or OS. However, hyperintense 18F-FDG uptake in the tumor, compared with gray matter, suggested poorer survival rates. Patients with 18F-FDG uptake in 50% or more of the tumor had shorter PFS and OS than did patients with 18F-FDG uptake in less than 50% of the tumor. There was some evidence that tumors with higher 18F-FDG uptake were more likely to show enhancement, and when the diffusion ratio was lower, the uniformity of 18F-FDG uptake appeared higher. Conclusion: Children with BSG for which 18F-FDG uptake involves at least half the tumor appear to have poorer survival than children with uptake in less than 50% of the tumor. A larger independent study is needed to verify this hypothesis. Intense tracer uptake in the tumors, compared with gray matter, suggests decreased survival. Higher 18F-FDG uptake within the tumor was associated with enhancement on MR images. Increased tumor cellularity as reflected by restricted MRI diffusion may be associated with increased 18F-FDG uniformity throughout the tumor.

AB - The purpose of this study was to assess 18F-FDG uptake in children with a newly diagnosed diffuse intrinsic brain stem glioma (BSG) and to investigate associations with progression-free survival (PFS), overall survival (OS), and MRI indices. Methods: Two Pediatric Brain Tumor Consortium (PBTC) therapeutic trials in children with newly diagnosed BSG were designed to test radiation therapy combined with molecularly targeted agents (PBTC-007: phase I/II study of gefitinib; PBTC-014: phase I/II study of tipifarnib). Baseline brain 18F-FDG PET scans were obtained in 40 children in these trials. Images were evaluated by consensus between 2 PET experts for intensity and uniformity of tracer uptake. Associations of 18F-FDG uptake intensity and uniformity with both PFS and OS, as well as associations with tumor MRI indices at baseline (tumor volume on fluid-attenuated inversion recovery, baseline intratumoral enhancement, diffusion and perfusion values), were evaluated. Results: In most of the children, BSG 18F-FDG uptake was less than gray-matter uptake. Survival was poor, irrespective of intensity of 18F-FDG uptake, with no association between intensity of 18F-FDG uptake and PFS or OS. However, hyperintense 18F-FDG uptake in the tumor, compared with gray matter, suggested poorer survival rates. Patients with 18F-FDG uptake in 50% or more of the tumor had shorter PFS and OS than did patients with 18F-FDG uptake in less than 50% of the tumor. There was some evidence that tumors with higher 18F-FDG uptake were more likely to show enhancement, and when the diffusion ratio was lower, the uniformity of 18F-FDG uptake appeared higher. Conclusion: Children with BSG for which 18F-FDG uptake involves at least half the tumor appear to have poorer survival than children with uptake in less than 50% of the tumor. A larger independent study is needed to verify this hypothesis. Intense tracer uptake in the tumors, compared with gray matter, suggests decreased survival. Higher 18F-FDG uptake within the tumor was associated with enhancement on MR images. Increased tumor cellularity as reflected by restricted MRI diffusion may be associated with increased 18F-FDG uniformity throughout the tumor.

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