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I recently learned about the utility of AA-PET for brain to help distinguish between radiation necrosis and tumor recurrence. Just curious if any of you use this, and if so, who is the vendor.
Here is a case example from a patient I treated a while back
Grade 2 glioma on the right side, treated with resection and adjuvant RT
View attachment 404146
During follow up, possible progression on the left side in the MRI around the posterior ventricle.
View attachment 404147
FET-PET confirms it
View attachment 404148
One month later (patient did not undergo tratment yet), MRI finding becomes clearer
View attachment 404149
Did you use D32? If you use the xx.9 codes, they usually get rejected.Very intriguing. On a related note, I’ve tried to order a dotatate PET for meningioma treatment planning, and it was flat out denied by Medicare because the diagnosis code is not in the list of approved codes. I imagine there would be a similar issue with AA PET. Anyone have some advice?
I recently learned about the utility of AA-PET for brain to help distinguish between radiation necrosis and tumor recurrence. Just curious if any of you use this, and if so, who is the vendor.
Very intriguing. On a related note, I’ve tried to order a dotatate PET for meningioma treatment planning, and it was flat out denied by Medicare because the diagnosis code is not in the list of approved codes. I imagine there would be a similar issue with AA PET. Anyone have some advice?
I’m happy to pick whatever will get paid for. Problem is, these tracers are expensive. Facbc is at least 4k a dose. If insurance (or CMS) aren’t paying, we either bill the patient (freestanding/idtf) or the hospital eats the cost (which means they won’t schedule the patient)![]()
Utility of Amino Acid PET in the Differential Diagnosis of Recurrent Brain Metastases and Treatment-Related Changes: A Meta-analysis
Amino acid PET is an established method to assist differential diagnosis of therapy-related changes versus recurrence in gliomas. However, its diagnostic value in brain metastases is yet to be determined. The goal of this study was to summarize evidence on the diagnostic utility of amino acid...jnm.snmjournals.org
Will have to see if local rads willing to pick a tracer. 84% PPV is pretty good. Enough to hedge on re-treatment in many cases (now just a clinical decision making disaster).
Interestingly, Axumin trial excluded from this analysis.
Diagnostic Value of 18F-FACBC PET/MRI in Brain Metastases - PMC
The study aims to evaluate whether combined 18F-FACBC PET/MRI could provide additional diagnostic information compared with MRI alone in brain metastases. Eighteen patients with newly diagnosed or suspected recurrence of brain metastases received ...pmc.ncbi.nlm.nih.gov
It’s not that they stock it. It’s available from the commercial radiopharmacy they order from still carries it. If someone wants it and the payer will pay it, we’ll order and scan it.So, one can actually use almost all the available amino acid PETs for this. I most commonly send for fluciclovine (Axumin) cause most PET centers still stock it pretty frequently (despite it being inferior to PSMA), but have also successfully used F-DOPA and C-methionine. Gamechangers!