DOI: 10.1007/s00259-017-3812-3Pages: 2257-2265

Comparison of 18F-FET PET and perfusion-weighted MRI for glioma grading: a hybrid PET/MR study

1. Forschungszentrum Jülich, Institute of Neuroscience and Medicine (INM-3, -4)

2. Lorraine University, Department of Nuclear Medicine & Nancyclotep Imaging Platform, CHRU Nancy

3. Lorraine University, IADI, INSERM, UMR 947

4. RWTH Aachen University Hospital, Department of Nuclear Medicine

5. University of Düsseldorf, Department of Neurosurgery

6. University Düsseldorf, Department of Diagnostic and Interventional Radiology, Medical Faculty

7. University of Cologne, Department of Neurology

8. University of Cologne and Bonn, Center of Integrated Oncology (CIO)

9. RWTH Aachen University Hospital, Department of Neurology

10. Jülich-Aachen Research Alliance (JARA), Section JARA-Brain

Correspondence to:
Karl-Josef Langen
Tel: 0049-2461-61-5900




Both perfusion-weighted MR imaging (PWI) and O-(2-18F-fluoroethyl)-L-tyrosine PET (18F–FET) provide grading information in cerebral gliomas. The aim of this study was to compare the diagnostic value of 18F–FET PET and PWI for tumor grading in a series of patients with newly diagnosed, untreated gliomas using an integrated PET/MR scanner.


Seventy-two patients with untreated gliomas [22 low-grade gliomas (LGG), and 50 high-grade gliomas (HGG)] were investigated with 18F–FET PET and PWI using a hybrid PET/MR scanner. After visual inspection of PET and PWI maps (rCBV, rCBF, MTT), volumes of interest (VOIs) with a diameter of 16 mm were centered upon the maximum of abnormality in the tumor area in each modality and the contralateral unaffected hemisphere. Mean and maximum tumor-to-brain ratios (TBRmean, TBRmax) were calculated. In addition, Time-to-Peak (TTP) and slopes of time–activity curves were calculated for 18F–FET PET. Diagnostic accuracies of 18F–FET PET and PWI for differentiating low-grade glioma (LGG) from high-grade glioma (HGG) were evaluated by receiver operating characteristic analyses (area under the curve; AUC).


The diagnostic accuracy of 18F–FET PET and PWI to discriminate LGG from HGG was similar with highest AUC values for TBRmean and TBRmax of 18F–FET PET uptake (0.80, 0.83) and for TBRmean and TBRmax of rCBV (0.80, 0.81). In case of increased signal in the tumor area with both methods (n = 32), local hot-spots were incongruent in 25 patients (78%) with a mean distance of 10.6 ± 9.5 mm. Dynamic FET PET and combination of different parameters did not further improve diagnostic accuracy.


Both 18F–FET PET and PWI discriminate LGG from HGG with similar diagnostic performance. Regional abnormalities in the tumor area are usually not congruent indicating that tumor grading by 18F–FET PET and PWI is based on different pathophysiological phenomena.

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  • Accepted: Aug 15, 2017
  • Online: Aug 22, 2017

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