[124I]CLR1404 PET/CT in High-Grade Primary and Metastatic Brain Tumors

Lance T. Hall, Benjamin Titz, Nishanta Baidya, Anja G. van der Kolk, H. Ian Robins, Mario Otto, Scott B. Perlman, Jamey P. Weichert, John Kuo

Research output: Contribution to journalArticle

Abstract

Purpose: There is a continuous search for imaging techniques with high sensitivity and specificity for brain tumors. Positron emission tomography (PET) imaging has shown promise, though many PET agents either have a low tumor specificity or impractical physical half-lives. [124I]CLR1404 is a small molecule alkylphosphocholine analogue that is thought to bind to plasma membrane lipid rafts and has shown high tumor-to-background ratios (TBR) in a previous pilot study in brain tumor patients. This study attempts to define the clinical value of [124I]CLR1404 PET/CT (aka CLR124). Procedures: Adult patients with new or suspected recurrence of high-grade primary or metastatic brain tumors (N = 27) were injected with [124I]CLR1404 followed by PET/CT at 6, 24, and 48 h. Standard uptake values (SUV) and TBR values were calculated for all time points. Uptake of [124I]CLR1404 was qualitatively assessed, compared with magnetic resonance imaging (MRI), and correlated with clinical outcome. Final diagnosis (N = 25) was established based on surgically resected tissue or long-term follow-up. Results: Positive uptake with high TBR was detected in all but one patient with a final diagnosis of primary/recurrent brain tumor (12/13) and in less than half of patients with treatment-related changes (5/12). Concordance between [124I]CLR1404 uptake and contrast enhancement on MRI was seen in < 40 %, with no concordance between T2-hyperintensities and uptake. No significant difference in overall outcome was found between patients with and without [124I]CLR1404 uptake. Conclusions: The uptake pattern in these patients suggests a very high sensitivity of [124I]CLR1404 PET/CT for diagnosing tumor tissue; however, tumor specificity needs to be further defined. Relative lack of concordance with standard MRI characteristics suggests that [124I]CLR1404 PET/CT provides additional information about brain tumors compared to MRI alone, potentially improving clinical decision-making.

Original languageEnglish (US)
JournalMolecular Imaging and Biology
DOIs
StatePublished - Jan 1 2019

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Brain Neoplasms
Positron-Emission Tomography
Magnetic Resonance Imaging
Neoplasms
CLR1404
Membrane Lipids
Cell Membrane
Recurrence
Sensitivity and Specificity

Keywords

  • Alkyl phosphocholine analogue
  • Brain tumor
  • CLR124
  • CLR1404
  • Molecular imaging
  • PET

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

[124I]CLR1404 PET/CT in High-Grade Primary and Metastatic Brain Tumors. / Hall, Lance T.; Titz, Benjamin; Baidya, Nishanta; van der Kolk, Anja G.; Robins, H. Ian; Otto, Mario; Perlman, Scott B.; Weichert, Jamey P.; Kuo, John.

In: Molecular Imaging and Biology, 01.01.2019.

Research output: Contribution to journalArticle

Hall, LT, Titz, B, Baidya, N, van der Kolk, AG, Robins, HI, Otto, M, Perlman, SB, Weichert, JP & Kuo, J 2019, '[124I]CLR1404 PET/CT in High-Grade Primary and Metastatic Brain Tumors', Molecular Imaging and Biology. https://doi.org/10.1007/s11307-019-01362-1
Hall, Lance T. ; Titz, Benjamin ; Baidya, Nishanta ; van der Kolk, Anja G. ; Robins, H. Ian ; Otto, Mario ; Perlman, Scott B. ; Weichert, Jamey P. ; Kuo, John. / [124I]CLR1404 PET/CT in High-Grade Primary and Metastatic Brain Tumors. In: Molecular Imaging and Biology. 2019.
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abstract = "Purpose: There is a continuous search for imaging techniques with high sensitivity and specificity for brain tumors. Positron emission tomography (PET) imaging has shown promise, though many PET agents either have a low tumor specificity or impractical physical half-lives. [124I]CLR1404 is a small molecule alkylphosphocholine analogue that is thought to bind to plasma membrane lipid rafts and has shown high tumor-to-background ratios (TBR) in a previous pilot study in brain tumor patients. This study attempts to define the clinical value of [124I]CLR1404 PET/CT (aka CLR124). Procedures: Adult patients with new or suspected recurrence of high-grade primary or metastatic brain tumors (N = 27) were injected with [124I]CLR1404 followed by PET/CT at 6, 24, and 48 h. Standard uptake values (SUV) and TBR values were calculated for all time points. Uptake of [124I]CLR1404 was qualitatively assessed, compared with magnetic resonance imaging (MRI), and correlated with clinical outcome. Final diagnosis (N = 25) was established based on surgically resected tissue or long-term follow-up. Results: Positive uptake with high TBR was detected in all but one patient with a final diagnosis of primary/recurrent brain tumor (12/13) and in less than half of patients with treatment-related changes (5/12). Concordance between [124I]CLR1404 uptake and contrast enhancement on MRI was seen in < 40 {\%}, with no concordance between T2-hyperintensities and uptake. No significant difference in overall outcome was found between patients with and without [124I]CLR1404 uptake. Conclusions: The uptake pattern in these patients suggests a very high sensitivity of [124I]CLR1404 PET/CT for diagnosing tumor tissue; however, tumor specificity needs to be further defined. Relative lack of concordance with standard MRI characteristics suggests that [124I]CLR1404 PET/CT provides additional information about brain tumors compared to MRI alone, potentially improving clinical decision-making.",
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AU - Titz, Benjamin

AU - Baidya, Nishanta

AU - van der Kolk, Anja G.

AU - Robins, H. Ian

AU - Otto, Mario

AU - Perlman, Scott B.

AU - Weichert, Jamey P.

AU - Kuo, John

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