Patients with recurrent enhancing mass on MRI in the side of a diagnosed and treated high
grade glioma or metastatic brain tumor and consenting to study protocol will undergo
18F-Fluciclovine PET/CT imaging once prior to surgery for brain tumor recurrence. Surgery for
recurrent brain tumor will follow standard of care treatment that includes either biopsy of
the region or interest or as complete as possible tumor resection followed by
histopathological analysis. Outcome evaluation will be analysis of tumor histology and
imaging results, comparison of MRI, MRSI, and 18F-Fluciclovine imaging and relationship of
imaging findings with histopathology and anatomical location of recurrent tumor.
Study Objectives. 1. In this study, we will investigate the potential of 18F-fluciclovine to aid the
visualization of residual or recurrent gliomas as depicted by 18F-Fluciclovine PET
imaging compared to standard MRI sequences [T1 weighted imaging (T1WI) with contrast,
diffusion weighted imaging (DWI), perfusion weighted imaging (PWI), T2 weighted fluid
attenuated inversion recovery (T2 FLAIR)] using 3D image fusion.
2. To assess the residual or recurrent of glioma as depicted by 3D short echo time MR
spectroscopic imaging (MRSI) using metabolic tumor markers such as elevated choline,
myo-Inositol and lipids and reduced N-acetyl-aspartate (NAA) compared to standard MRI
sequences (T1WI with contrast, PWI, T2 FLAIR) using 3D image fusion before neurosurgical
3. To spatially register the residual or recurrent glioma as depicted by 18F-Fluciclovine
PET imaging with MR T1WI, DWI, PWI, and 3D MRSI to a) quantitate (SUVmax, SUVmean,
ADCmean, rCBV, Cho, NAA, lipids, Cho/Cr, Cho/NAA) and correlate areas of PET+, T1WI+ and
MRSI+ areas and b) characterize different metabolic profiles measured with MRSI in areas
of glioma infiltration depicted by PET imaging and MRI.
4. Biopsy and pathology confirmation of tumor vs.#46;treatment-induced necrosis in spatially
registered areas of interest will be performed.
Safety analysis Although 18F-Axumin™ is an FDA approved PET imaging agent for biological
recurrent prostate cancer with extensive safety and toxicity data already documented, all
patients will be monitored closely for adverse reactions after administration.