FDG PET/MRI Coregistration Helps Predict Response to Gamma Knife Radiosurgery in Patients With Brain Metastases

AJR Am J Roentgenol. 2019 Feb;212(2):425-430. doi: 10.2214/AJR.18.20006. Epub 2018 Nov 13.


Objective: The purpose of this study was to determine whether relative standardized uptake value (SUV) measurements at FDG PET/MRI coregistration are predictive of local tumor control in patients with brain metastases treated with stereotactic radiosurgery (SRS).

Materials and methods: A retrospective review was conducted of the images and clinical characteristics of a cohort of patients with brain metastases from non-CNS neoplasms treated with gamma knife radiosurgery (GKRS) who underwent posttherapy FDG PET because of MRI findings concerning for progression. The PET and contrast-enhanced MR images were fused. Relative SUV measurements were calculated from ROIs placed in the area of highest FDG uptake within the enhancing lesion and in the contralateral normal-appearing white matter. Relative SUV was defined as the ratio of maximum SUV in the tumor to maximum SUV in healthy white matter. Two independent readers evaluated response to GKRS using serial posttherapy MRI performed at least 3 months after GKRS completion. The relation between relative SUV and local tumor progression was evaluated with respect to treatment effect.

Results: Eighty-five patients (48 [56.5%] women, 37 [43.5%] men; mean age at diagnosis, 60.5 ± 11.3 years) met the inclusion criteria. Thirty-three (38.8%) lesions progressed after SRS. There was a significant association between relative SUV and local tumor control (p = 0.035). Relative SUV provided a diagnostic ROC AUC of 0.67 (95% CI, 0.55-0.79).

Conclusion: Quantitative relative SUV at posttherapy FDG PET serves as a biomarker of response to SRS in patients with brain metastases in cases in which lesion growth is identified at follow-up MRI. This prognostic data may affect management, supporting the need for further therapeutic actions for selected patients.

Keywords: FDG PET; MRI; gamma knife radiosurgery; progression; radiation necrosis.

MeSH terms

  • Brain Neoplasms / diagnostic imaging*
  • Brain Neoplasms / secondary
  • Brain Neoplasms / surgery*
  • Female
  • Fluorodeoxyglucose F18*
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Neuroimaging
  • Positron-Emission Tomography*
  • Predictive Value of Tests
  • Radiopharmaceuticals*
  • Radiosurgery*
  • Retrospective Studies
  • Treatment Outcome


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18