Epileptic Activity Increases Cerebral Amino Acid Transport Assessed by 18F-Fluoroethyl-l-Tyrosine Amino Acid PET: A Potential Brain Tumor Mimic.
- Hutterer M Department of Neurology, University of Regensburg Medical School, Regensburg, Germany markus.hutterer@gmx.at.
- Ebner Y Department of Neurology and Centre for Cognitive Neuroscience, Christian-Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria.
- Riemenschneider MJ Wilhelm Sander-Neurooncology Unit, University of Regensburg Medical School, Regensburg, Germany.
- Willuweit A Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany.
- McCoy M Department of Radiology and Division of Neuroradiology, Christian-Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria.
- Egger B Department of Nuclear Medicine, Landeskrankenhaus Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.
- Schröder M Department of Neurology, University of Regensburg Medical School, Regensburg, Germany.
- Wendl C Department of Radiology and Division of Neuroradiology, University of Regensburg Medical School, Regensburg, Germany.
- Hellwig D Department of Nuclear Medicine, University of Regensburg Medical School, Regensburg, Germany.
- Grosse J Department of Nuclear Medicine, University of Regensburg Medical School, Regensburg, Germany.
- Menhart K Department of Nuclear Medicine, University of Regensburg Medical School, Regensburg, Germany.
- Proescholdt M Wilhelm Sander-Neurooncology Unit, University of Regensburg Medical School, Regensburg, Germany.
- Fritsch B Department of Neurology, University Hospital Freiburg, Freiburg, Germany.
- Urbach H Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany.
- Stockhammer G Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
- Roelcke U Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland.
- Galldiks N Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany.
- Meyer PT Department of Nuclear Medicine, University Hospital Freiburg, Freiburg, Germany; and.
- Langen KJ Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany.
- Hau P Department of Neurology, University of Regensburg Medical School, Regensburg, Germany.
- Trinka E Department of Neurology and Centre for Cognitive Neuroscience, Christian-Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria.
- 2016-07-30
Published in:
- Journal of nuclear medicine : official publication, Society of Nuclear Medicine. - 2017
18F-FET PET
LAT1/2 expression
epileptic seizure
glioma
status epilepticus
Adult
Aged
Amino Acid Transport Systems
Amino Acids
Biological Transport, Active
Brain Neoplasms
Diagnosis, Differential
Diagnostic Errors
Epilepsy
Female
Humans
Male
Middle Aged
Positron-Emission Tomography
Radiopharmaceuticals
Reproducibility of Results
Sensitivity and Specificity
Tyrosine
English
O-(2-18F-fluoroethyl)-l-tyrosine (18F-FET) PET is a well-established method increasingly used for diagnosis, treatment planning, and monitoring in gliomas. Epileptic activity, frequently occurring in glioma patients, can influence MRI findings. Whether seizures also affect 18F-FET PET imaging is currently unknown. The aim of this retrospective analysis was to investigate the brain amino acid metabolism during epileptic seizures by 18F-FET PET and to elucidate the pathophysiologic background.
METHODS
Ten patients with 11 episodes of serial seizures or status epilepticus, who underwent MRI and 18F-FET PET, were studied. The main diagnosis was glioma World Health Organization grade II-IV (n = 8); 2 patients suffered from nonneoplastic diseases. Immunohistochemical assessment of LAT1/LAT2/CD98 amino acid transporters was performed in seizure-affected cortex (n = 2) and compared with glioma tissues (n = 3).
RESULTS
All patients exhibited increased seizure-associated strict gyral 18F-FET uptake, which was reversible in follow-up studies or negative shortly before and without any histologic or clinical signs of tumor recurrence. 18F-FET uptake corresponded to structural MRI changes, compatible with cortical vasogenic and cytotoxic edema, partial contrast enhancement, and hyperperfusion. Patients with prolonged postictal symptoms lasting up to 8 wk displayed intensive and widespread (≥ 1 lobe) cortical 18F-FET uptake. LAT1/LAT2/CD98 was strongly expressed in neurons and endothelium of seizure-affected brains and less in reactive astrocytosis.
CONCLUSION
Seizure activity, in particular status epilepticus, increases cerebral amino acid transport with a strict gyral 18F-FET uptake pattern. Such periictal pseudoprogression represents a potential pitfall of 18F-FET PET and may mimic brain tumor. Our data also indicate a seizure-induced upregulation of neuronal, endothelial, and less astroglial LAT1/LAT2/CD98 amino acid transporter expression.
METHODS
Ten patients with 11 episodes of serial seizures or status epilepticus, who underwent MRI and 18F-FET PET, were studied. The main diagnosis was glioma World Health Organization grade II-IV (n = 8); 2 patients suffered from nonneoplastic diseases. Immunohistochemical assessment of LAT1/LAT2/CD98 amino acid transporters was performed in seizure-affected cortex (n = 2) and compared with glioma tissues (n = 3).
RESULTS
All patients exhibited increased seizure-associated strict gyral 18F-FET uptake, which was reversible in follow-up studies or negative shortly before and without any histologic or clinical signs of tumor recurrence. 18F-FET uptake corresponded to structural MRI changes, compatible with cortical vasogenic and cytotoxic edema, partial contrast enhancement, and hyperperfusion. Patients with prolonged postictal symptoms lasting up to 8 wk displayed intensive and widespread (≥ 1 lobe) cortical 18F-FET uptake. LAT1/LAT2/CD98 was strongly expressed in neurons and endothelium of seizure-affected brains and less in reactive astrocytosis.
CONCLUSION
Seizure activity, in particular status epilepticus, increases cerebral amino acid transport with a strict gyral 18F-FET uptake pattern. Such periictal pseudoprogression represents a potential pitfall of 18F-FET PET and may mimic brain tumor. Our data also indicate a seizure-induced upregulation of neuronal, endothelial, and less astroglial LAT1/LAT2/CD98 amino acid transporter expression.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.2967/jnumed.116.176610
- PMID 27469356
- Persistent URL
- https://sonar.ch/global/documents/125348
Statistics
Document views: 18
File downloads:
- fulltext.pdf: 0