• Philipp Lohmann, Marc D Piroth, Bernd Sellhaus, Joachim Weis, Stefanie Geisler, Ana-Maria Oros-Peusquens, Hartmut Mohlberg, Katrin Amunts, Nadim J Shah, Norbert Galldiks, and Karl-Josef Langen.
• Institute of Neuroscience and Medicine (INM-1, -3, -4, -11), Forschungszentrum Juelich, Juelich, Germany. Electronic address: p.lohmann@fz-juelich.de.
• World Neurosurg. 2018 Nov 1; 119: e653-e660.

ObjectiveAmino acid positron emission tomography (PET) using O-(2-[18F]fluoroethyl)-L-tyrosine (FET) provides important additional information on the extent of viable tumor tissue of glioblastoma compared with magnetic resonance imaging (MRI). Especially after radiochemotherapy, progression of contrast enhancement in MRI is equivocal and may represent either tumor progression or treatment-related changes. Here, the first case comparing postmortem whole-brain histology of a patient with pretreated glioblastoma with dynamic in vivo FET PET and MRI is presented.MethodsA 61-year-old patient with glioblastoma initially underwent partial tumor resection and died 11 weeks after completion of chemoradiation with concurrent temozolomide. Three days before the patient died, a follow-up FET PET and MRI scan indicated tumor progression. Autopsy was performed 48 hours after death. After formalin fixation, a 7-cm bihemispherical segment of the brain containing the entire tumor mass was cut into 3500 consecutive 20μm coronal sections. Representative sections were stained with hematoxylin and eosin stain, cresyl violet, and glial fibrillary acidic protein immunohistochemistry. An experienced neuropathologist identified areas of dense and diffuse neoplastic infiltration, astrogliosis, and necrosis. In vivo FET PET, MRI datasets, and postmortem histology were co-registered and compared by 3 experienced physicians.ResultsIncreased uptake of FET in the area of equivocal contrast enhancement on MRI correlated very well with dense infiltration by vital tumor cells and showed tracer kinetics typical for malignant gliomas. An area of predominantly reactive astrogliosis showed only moderate uptake of FET and tracer kinetics usually observed in benign lesions.ConclusionsThis case report impressively documents the correct imaging of a progressive glioblastoma by FET PET.Copyright © 2018 Elsevier Inc. All rights reserved.

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