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Distinguishing Pseudoprogression From Progression in High-Grade Gliomas: A Brief Review of Current Clinical Practice and Demonstration of the Potential Value of 18F-FDG PET

Oborski, Matthew J. MS*; Laymon, Charles M. PhD*; Lieberman, Frank S. MD; Mountz, James M. MD, PhD*

doi: 10.1097/RLU.0b013e318286c148
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We report a case in which 18F-FDG PET was able to discriminate pseudoprogression from progression observed on contrast-enhanced (CE) MRI (CE-MRI). A 56-year-old male patient with anaplastic oligodendroglioma demonstrated markedly increased tumor enhancement on CE-MRI 1 month after completing radiation therapy (RT), suggesting radiological progression. However, the patient was clinically improved and therefore received an early-therapy response assessment PET to assess for pseudoprogression. PET showed low tumor uptake indicating stable disease. Follow-up CE-MRI at 3 and 4 months post-RT confirmed stable disease. This case emphasizes the value of 18F-FDG PET when pseudoprogression is clinically suspected.

From the *Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and †Department of Neurology and Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Received for publication August 10, 2012; and revision accepted January 4, 2013.

Institution where work was performed: Department of Radiology, University of Pittsburgh, Pittsburgh, PA.

Conflicts of interest and sources of funding: This work was supported by the US National Institutes of Health research grant U01 CA140230 and UPCI shared resources award P30CA047904.

Reprints: James M. Mountz, MD, PhD, Department of Radiology, Division of Nuclear Medicine, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213. E-mail:

© 2013 by Lippincott Williams & Wilkins