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Effect of Whole-body [18F]Fluoro-2-deoxy-2-d-glucose Positron Emission Tomography in Patients with Suspected Brain Metastasis
Background and Purpose [18F]Fluoro-2-deoxy-2-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) has a promising role in the workup and management of carcinoma of unknown primary (CUP). We have evaluated the effect of whole-body FDG PET/CT in assessing the patients presented with suspected brain metastasis (CUP-BM) on brain magnetic resonance imaging (MRI) or computed tomography (CT).
Materials and Methods This retrospective study included FDG PET/CT of 50 patients (24 males, mean: 58 ± 12.2 years old) with a CUP-BM diagnosis based on MRI and CT imaging. The final diagnosis of primary brain neoplasm (BP) or brain metastases (BM) was based on FDG PET/CT findings and/or histopathology (HPE).
Results On FDG PET/CT, 52% (26/50) of patients did not have any systemic lesion apart from a brain lesion. Out of these, 50% (13/26) had HPE confirmation of primary brain neoplasm (BP). FDG PET/CT identified multiple systemic lesions apart from brain lesions in the remaining 48% (24/50) of patients. They were categorized as the brain metastases (BM) group. The primary lesions were located in the lungs (n = 20), kidneys (n = 1), prostate (n = 1), esophagus (n = 1), and tongue (n = 1).
Conclusion FDG PET/CT could suggest a diagnosis of BM based on the presence of systemic lesions. It also provides an easily accessible peripheral site for biopsy and systemic disease burden in a single scan. FDG PET/CT's up-front use in suspected CUP-BM on CT and/or MRI could differentiate the BM from BP in most cases and avoid brain biopsy in the BM group.
Availability of Data and Material (Data Transparency)
Data are partially available after a request from the corresponding author. It contains patient no. identification.
Ethical Approval Statement
It was a retrospective study on anonymized data, and all investigations and procedures were done as part of the standard of care. The ethical committee's permission was not required.
M.O. and S.G. contributed to the concept and design of the study. A.H.N., P.M., and A.M. did data collection, data, and statistical analysis. M.O., N.S. wrote the first draft. A.H.N., N.S., A.M., did manuscript preparation and figure preparation. M.O., N.S. and S.G. finalized manuscript.
Article published online:
16 May 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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