This chapter reviews nuclear imaging of gliomas, both high- and low-grade, with emphasis on results from positron emission tomography (PET) with [F-18]-2-fluoro-2-deoxyglucose (FDG) for assessing energy metabolism. There are many additional advances beyond FDG-PET that are very exciting and potentially applicable in the management of gliomas. Biosynthesis in tumors occurs along several important broad fronts for DNA, proteins, and membrane lipids. Molecular imaging of these pathways is coming to the foreground. Hypoxia, a significant resistance mechanism that compromises the efficacy of radiotherapy and chemotherapy, can now be regionally quantified in vivo with PET. In the near future it is likely that the presence of mutant receptors, apoptosis, and angiogenesis will also be measurable with PET and new tracers.
Key Words: Brain tumor; glioma; PET; FDG; fluoromisonidazole; amino acids; thymidine; FLT; proliferation; acetate.
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Metabolism. There isn’t perhaps a more frequently used word in the weight loss (and weight gain) vocabulary than this. Indeed, it’s not uncommon to overhear people talking about their struggles or triumphs over the holiday bulge or love handles in terms of whether their metabolism is working, or not.