(82)Rubidium chloride positron emission tomography discrimination of recurrent intracranial malignancy from radiation necrosis

BACKGROUND: Accurate identification and discrimination of post treatment changes from recurrent disease remains a challenge for patients with intracranial malignancies despite advances in molecular and magnetic resonance imaging. We have explored the ability of readily available Rubidium-82 chloride ((RbCl)-Rb-82) positron emission tomography (PET) to identify and distinguish progressive intracranial disease from radiation necrosis in patients previously treated with radiation therapy. METIIODS: Six patients with a total of 9 lesions of either primary (N.=3) or metastatic (N.=6) intracranial malignancies previously treated with stereotactic radiation surgery (SRS) and persistent contrast enhancement on MRI underwent brain (RbCI)-Rb-82 PET imaging. Two patients with arteriovenous malformations previously treated with SRS, also had brain (RbCl)-Rb-82 PET imaging for a total of 11 lesions studied. Histological confirmation via stereotactic biopsy/excisional resection was obtained for 9 lesions with the remaining 2 classified as either recurrent tumor or radiation necrosis based on subsequent MRI examinations. (RbCl)-Rb-82 PET time activity curve analysis was performed which comprised lesion SUV contralateral normal brain SUVmax, and tumor to background ratios (TBmax). RESULTS: (RbCl)-Rb-82 demonstrates uptake greater than normal brain parenchyma in all lesions studied. Time activity curves demonstrated progressive uptake of (RbCl)-Rb-82 in all lesions without evidence of washout. While recurrent disease demonstrated a greater mean SUVmax compared to radiation necrosis, no statistically significant difference between lesion SUVmax nor TBmax was found (P>0.05). CONCLUSIONS: (RbCl)-Rb-82 PET produces high-contrast uptake of both recurrent disease and radiation necrosis compared to normal brain. However, no statistically significant difference was found between recurrent tumor and radiation necrosis.