Targeting Imaging Brain Lesions with PET/CT: F18-CH and F-18-FLT

Passing to the era of molecular imaging and precision oncology, the

radiopharmaceuticals may play an incremental role in further revealing the nature of

the evaluated lesion. FLT, a radiolabeled thymidine analogue, and FCH, a radiolabeled

substance of the cell membrane phospholipids, have been more or less investigated in

the imaging, identification, and evaluation of brain tumor lesions. In our study, using a

Siemens Biograph LSO PET/CT 16 slices device, a Siemens multimodality workplace

(MMWP) system for brain analysis, and qualitative and semiquantitative analysis

(SUVmax, SUVpeak, T/B ratio), we investigated the role of these two

radiopharmaceuticals in primary and metastatic brain lesions, lymphomas as well as in

investigating neurological symptoms with inconclusive/indefinite evidence in the

conducted MRI. Using F-18-CH for PET/CT imaging, we found that there was FCH

uptake by active tumor sites, with no statistical significance in SUVmax, SUVpeak and

T/B ratio for the discrimination of the lesions between primary, metastatic and

lymphomas, (p > 0.05). However, recurrent primary lesions exhibited lower T/B and

SUVmax compared to the respective mean values of the metastatic ones. With the

utilization of F-18-FLT we concluded that it could discriminate between active from

non-active foci, while mean values of T/B and SUVmax were statistically significantly

higher for NHL compared to primary and metastatic tumors (p<0,001). There was a

tendency for significance for SUVmax and T/B between low and high-grade recurrent

primary tumors (p=0.08 and p=0.06, respectively) when excluding the outliers.

However, further investigation is required for definite conclusions.

Keywords: Brain Lesion, Brain Tumor, FCH, FLT, PET/CT.

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