Reduced grey matter metabolism due to white matter edema allows optimal assessment of brain tumors on 18F-FDG-PET.

The main aim of this research was to demonstrate that the cortical and subcortical grey matter hypometabolism as revealed by fluorine-18 fluorodesoxyglucose-positron emission tomography ((18)F-FDG-PET) imaging in brain tumors is related to associated edema as demonstrated by magnetic resonance imaging (MRI). This in turn enhances the ability to assess disease activity in the tumor and the degree of loss of cerebral function in the adjacent and distant structures. We evaluated brain T1 and T2 weighted MRI and (18)F-FDG-PET scans of 29 patients (19 adult, 10 pediatric) with history of brain tumor. Tumor histology types included 21 gliomas, 1 melanoma, 1 primitive neuroectodermal tumor, 3 medulloblastomas and 3 ependymomas. The majority of scans were performed within the same week (94% <1 month. The extent of hypo and hypermetabolism was assessed on the (18)F-FDG-PET scans. A template of 12 regions of interest (ROI) was applied and the laterality indices of the regional counts (signal intensity) were computed. Extent of edema, enhancement, and anatomical change were assessed on the MRI scans. Extent of edema in the same ROI was evaluated by a 6-point semiquantitative scale and laterality indices were generated. Metabolic activity of the grey matter was correlated with the extent of edema using these indices. In all cases where edema was present, significant hypometabolism was observed in the adjacent structures. Overall, there was a strong correlation between the extent of edema and severity of hypometabolism (r=0.92, P=0.01). This was true regardless of the location of edema, whether there was history of radiation treatment (r=0.91, P=0.03), or not (r=0.97, P=0.17). In conclusion, edema independent of underlying variables appeared to contribute significantly to cortical and sub-cortical grey matter hypometabolism observed in patients with brain tumors. This would indicate that brain tumors can be successfully assessed by (18)F-FDG-PET and therefore the efforts for utilizing other tracers may not be justified.