Diagnostic accuracy and clinical impact of [18F]FET PET in childhood CNS tumors

Background. Central nervous system (CNS) tumors cause the highest death rates among childhood cancers, and survivors frequently have severe late effects. Magnetic resonance imaging (MRI) is the imaging modality of choice, but its specificity can be challenged by treatment-induced signal changes. In adults, O-(2-[F-18]fluoroethyl)-l-tyrosine ([F-18]FET) PET can assist in interpreting MRI findings. We assessed the clinical impact and diagnostic accuracy of adding [F-18]FET PET to MRI in children with CNS tumors. Methods. A total of 169 [F-18]FET PET scans were performed in 97 prospectively and consecutively included patients with known or suspected childhood CNS tumors. Scans were performed at primary diagnosis, before or after treatment, or at relapse. Results. Adding [F-18]FET PET to MRI impacted clinical management in 8% [95% confidence interval (CI): 4%-13%] of all scans (n = 151) and in 33% [CI: 17%-53%] of scans deemed clinically indicated due to difficult decision making on MRI alone (n = 30). Using pathology or follow-up as reference standard, the addition of [F-18]FET PET increased specificity (1.00 [0.82-1.00] vs 0.48 [0.30-0.70], P =.0001) and accuracy (0.91 [CI: 0.87-0.96] vs 0.81 [CI: 0.75-0.89], P =.04) in 83 treated lesions and accuracy in 58 untreated lesions (0.96 [CI: 0.91-1.00] vs 0.90 [CI: 0.82-0.92], P <.001). Further, in a subset of patients (n = 15) [F-18]FET uptake correlated positively with genomic proliferation index. Conclusions. The addition of [F-18]FET PET to MRI helped discriminate tumor from non-tumor lesions in the largest consecutive cohort of pediatric CNS tumor patients presented to date.