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Increased Fluorine-18 2-Fluoro-2-Deoxy-D-Glucose (FDG) Uptake in Childhood CNS Tumors Is Correlated With Malignancy Grade: A Study With FDG Positron Emission Tomography/Magnetic Resonance Imaging Coregistration and Image Fusion

From the Department of Clinical Physiology, Nuclear Medicine, and Positron Emission Tomography; Pediatric Clinic II; Neuroteam, Department of Pathology; and Department of Radiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark

Address reprint requests to Lise Borgwardt, MD, Positron Emission Tomography and Cyclotron Unit, Department of Clinical Physiology, Nuclear Medicine and Positron Emission Tomography, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; e-mail: borgwardtpet{at}rh.dk

PURPOSE: Positron emission tomography (PET) has been used in grading of CNS tumors in adults, whereas studies of children have been limited.

PATIENTS AND METHODS: Nineteen boys and 19 girls (median age, 8 years) with primary CNS tumors were studied prospectively by fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG) PET with (n = 16) or without (n = 22) H₂¹⁵O-PET before therapy. Image processing included coregistration to magnetic resonance imaging (MRI) in all patients. The FDG uptake in tumors was semiquantitatively calculated by a region-of-interest–based tumor hotspot/brain index. Eight tumors without histologic confirmation were classified as WHO grade 1 based on location, MRI, and clinical course (22 to 42 months).

RESULTS: Four grade 4 tumors had a mean index of 4.27 ± 0.5, four grade 3 tumors had a mean index of 2.47 ± 1.07, 10 grade 2 tumors had a mean index of 1.34 ± 0.73, and eight of 12 grade 1 tumors had a mean index of –0.31 ± 0.59. Eight patients with no histologic confirmation had a mean index of 1.04. For these 34 tumors, FDG uptake was positively correlated with malignancy grading (n = 34; r = 0.72; P < .01), as for the 26 histologically classified tumors (n = 26; r = 0.89; P < .01). The choroid plexus papilloma (n = 1) and the pilocytic astrocytomas (n = 3) had a mean index of 3.26 (n = 38; r = 0.57; P < .01). H₂¹⁵O-uptake showed no correlation with malignancy. Digitally performed PET/MRI coregistration increased information on tumor characterization in 90% of cases.

CONCLUSION: FDG PET of the brain with MRI coregistration can be used to obtain a more specific diagnosis with respect to malignancy grading. Improved PET/MRI imaging of the benign hypermetabolic tumors is needed to optimize clinical use.

Supported by Female Researchers in Joint Action (FREJA; Copenhagen, Denmark) research grant, the Danish National Research Council, and the John and Birthe Meyer Foundation, Copenhagen, Denmark.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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