18F-FDOPA PET/CT for detection of recurrence in patients with glioma: prospective comparison with 18F-FDG PET/CT

Purpose Differentiation between recurrence and radiation necrosis in patients with glioma is crucial, since the two entities have completely different management and prognosis. The purpose of the present study was to compare the efficacies of F-18-FDG PET/CT and 3,4-dihydroxy-6-[F-18] fluoro-phenylalanine (F-18-FDOPA) PET/CT in detection of recurrent gliomas. Methods A total of 28 patients (age 38.82 +/- 1.25 years; 85. 7 % men) with histopathologically proven glioma with clinical/imaging suspicion of recurrence were evaluated using F-18-FDG PET/CT and F-18-FDOPA PET/CT. F-18-FDG PET/CT and F-18-FDOPA PET/CT images were evaluated qualitatively and semiquantitatively. The combination of clinical follow-up, repeat imaging and/or biopsy (when available) was taken as the reference standard. Results Based on the reference standard, 21 patients were positive and 7 were negative for tumour recurrence. The sensitivity, specificity and accuracy of (18)FFDG PET/CT were 47.6 %, 100 % and 60.7 %, respectively, and those of F-18-FDOPA PET/CT were 100 %, 85.7 % and 96.4 %, respectively. The results of (18)FFDG PET/CT and F-18-FDOPA PET/CT were concordant in 57.1 % of patients (16 of 28) and discordant in 42. 9 % (12 of 28). The difference in the findings between F-18-FDG PET/CT and F-18-FDOPA PET/CT was significant (P=0.0005, McNemar's test). The difference was significant for low-grade tumours (P=0.0039) but not for high-grade tumours (P=0.250). Conclusion F-18-FDOPA PET/CT is highly sensitive and specific for detection of recurrence in glioma patients. It is superior to F-18-FDG PET/CT for this purpose and is especially advantageous in patients with low-grade gliomas.