Amino Acid PET Successfully Differentiates Recurrent Brain Metastases, Reducing Invasive Procedures and Overtreatment

May 12, 2023

Reston, VA—A newly published meta-analysis indicates that amino acid PET can accurately differentiate recurrent or progressive brain metastases from treatment-related changes. A specificity of 84 percent suggests that it may reduce the number of invasive procedures and overtreatment in patients who in fact experience treatment-related changes. This research was published in the May issue of The Journal of Nuclear Medicine.

Brain metastases occur in 20 to 40 percent of all cancer patients and are most likely to occur in those with lung, breast and renal cancer, melanoma, and cancers of the gastrointestinal tract. Management of patients with brain metastases usually includes surgery, radiation and chemotherapy. Some patients develop treatment-related changes such as radiation necrosis or pseudoprogression.

“A differentiation between recurrent or progressive brain metastases and treatment-related changes is challenging,” said Igor Yakushev, senior physician in the department of nuclear medicine at Technical University of Munich in Germany. “As the management of patients with recurrent or progressive brain metastases and treatment-related changes is fairly different, accurate and early differential diagnosis is essential.”

The meta-analysis included 12 studies with amino acid PET radiotracers. The studies included a total of 397 patients with 547 lesions. Overall, 269 lesions (49 percent) were found to be recurrent or progressive brain metastases. Using a histologic examination and/or radiological and clinical follow-up as reference, pooled sensitivity and specificity of amino acid PET were found to be 82 and 84 percent respectively.

“This study provides IIa class evidence on diagnostic utility of amino acid PET in the differential diagnosis of recurrent or progressive brain metastases,” stated Yakushev. “These findings are in line with an increasing role of molecular imaging in the management of patients with brain tumors, yet the results also point to potential for further improvement of diagnostic accuracy.”

Graphical Abstract. Does a new or increasing contrast enhancement on T1 MRI represent a consequence of treatment or progressive/recurrent tumor? This common clinical dilemma can be resolved by amino acid PET with good diagnostic accuracy.

The authors of “Diagnostic utility of amino acid PET in the differential diagnosis of recurrent brain metastases and treatment-related changes: a meta-analysis” include Timo Schlürmann, Wolfgang Weber, and Igor Yakushev, Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany; Birgit Waschulzik, Institute of AI and Informatics in Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany; Stephanie Combs, Department of Radiation Oncology, Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Oberschleißheim, Germany, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Sites; Jens Gempt, Department of Neurosurgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany; and Benedikt Wiestler, Department of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany.

Visit the JNM website for the latest research, and follow our new Twitter and Facebook pages @JournalofNucMed or follow us on LinkedIn.

###

Please visit the SNMMI Media Center for more information about molecular imaging and precision imaging. To schedule an interview with the researchers, please contact Rebecca Maxey at (703) 652-6772 or rmaxey@snmmi.org.

About JNM and the Society of Nuclear Medicine and Molecular Imaging

The Journal of Nuclear Medicine (JNM) is the world’s leading nuclear medicine, molecular imaging and theranostics journal, accessed 15 million times each year by practitioners around the globe, providing them with the information they need to advance this rapidly expanding field. Current and past issues of The Journal of Nuclear Medicine can be found online at http://jnm.snmjournals.org.

JNM is published by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), an international scientific and medical organization dedicated to advancing nuclear medicine and molecular imaging—precision medicine that allows diagnosis and treatment to be tailored to individual patients in order to achieve the best possible outcomes. For more information, visit www.snmmi.org.