Background: Amino acid PET imaging is an increasingly recognized modality for characterizing brain tumors, complementing conventional MRI. While primarily used to differentiate tumor recurrence from treatment-related changes, it also offers valuable insights at initial diagnosis, particularly when surgical/biopsy intervention is not feasible. Case Presentation: We report the case of a 47-year-old woman presenting with seizures, aphasia, and right-hand paresis. MRI revealed a left postcentral gyrus lesion with atypical imaging characteristics, leading to uncertainty between tumor and encephalitic origin. A dynamic [18F]FDOPA PET scan showed intense tracer uptake (TBR = 4.1) with a wash-in/wash-out kinetic pattern (TTP < 15 min, slope = −1.8 SUV/h), suggesting an aggressive glial tumor. Subsequent biopsy confirmed an IDH-wildtype glioblastoma. Discussion: This case illustrates the added value of dynamic amino acid PET imaging for identifying aggressive gliomas, especially when MRI findings are inconclusive. Dynamic metrics such as time-to-peak and uptake kinetics offer prognostic insight and may guide early therapeutic decisions, particularly in lesions not amenable to surgery or biopsy. Conclusion: Dynamic amino acid PET imaging serves as a powerful adjunct to MRI for the initial characterization of brain lesions, providing whole-tumor functional assessment and aiding in the early identification of aggressive gliomas.

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Case 48: Initial Characterization of a Newly Diagnosed Brain Tumor with Dynamic Amino Acid PET Imaging

  • Laura Rozenblum,
  • Timothée Zaragori,
  • Antoine Verger

摘要

Background: Amino acid PET imaging is an increasingly recognized modality for characterizing brain tumors, complementing conventional MRI. While primarily used to differentiate tumor recurrence from treatment-related changes, it also offers valuable insights at initial diagnosis, particularly when surgical/biopsy intervention is not feasible. Case Presentation: We report the case of a 47-year-old woman presenting with seizures, aphasia, and right-hand paresis. MRI revealed a left postcentral gyrus lesion with atypical imaging characteristics, leading to uncertainty between tumor and encephalitic origin. A dynamic [18F]FDOPA PET scan showed intense tracer uptake (TBR = 4.1) with a wash-in/wash-out kinetic pattern (TTP < 15 min, slope = −1.8 SUV/h), suggesting an aggressive glial tumor. Subsequent biopsy confirmed an IDH-wildtype glioblastoma. Discussion: This case illustrates the added value of dynamic amino acid PET imaging for identifying aggressive gliomas, especially when MRI findings are inconclusive. Dynamic metrics such as time-to-peak and uptake kinetics offer prognostic insight and may guide early therapeutic decisions, particularly in lesions not amenable to surgery or biopsy. Conclusion: Dynamic amino acid PET imaging serves as a powerful adjunct to MRI for the initial characterization of brain lesions, providing whole-tumor functional assessment and aiding in the early identification of aggressive gliomas.