ArticleJournal of neurosurgery. Case lessons2026
Utility and limitations of 18F-fluciclovine PET for biopsy targeting in a nonenhancing diffuse glioma with a gliomatosis cerebri-like growth pattern: illustrative case.
Article in Journal of neurosurgery. Case lessons, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundContrast-enhanced MRI reflects blood-brain barrier (BBB) disruption rather than tumor biological activity, whereas 18F-fluciclovine (18F-FACBC) PET reflects amino acid metabolism independent of BBB integrity. The authors compared regional 18F-FACBC uptake with histopathological and molecular findings in a diffuse astrocytoma, IDH-wildtype, not elsewhere classified, with a gliomatosis cerebri (GC)-like infiltrative growth pattern. OBSERVATIONS: A woman in her 50s presented with headache. MRI revealed a nonenhancing, diffusely infiltrating right parietal white matter lesion. 18F-FACBC PET showed focal uptake that guided stereotactic biopsy. Six weeks later, progression caused left uncal herniation requiring emergency decompression, during which PET-negative left temporal tissue was resected. The PET-positive region showed a high Ki-67 index, high-level PDGFRA amplification, and CDKN2A/B homozygous deletion, with a methylation profile matching pediatric-type diffuse high-grade glioma, RTK1 subclass. The PET-negative region was predominantly gliotic, with only low-level PDGFRA amplification. Thus, uptake marked a more proliferative, molecularly altered component. However, both the fatal mass effect and out-of-field recurrence following chemoradiotherapy occurred in regions without corresponding uptake. LESSONS: 18F-FACBC PET identified an aggressive, high-risk tumor component, supporting its use for biopsy targeting in nonenhancing gliomas. However, because life-threatening progression occurred without corresponding uptake, 18F-FACBC uptake reflects proliferative burden rather than the full infiltrative extent. https://thejns.org/doi/10.3171/CASE26761.
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