Germ cell tumor: Differentiation of viable tumor, mature teratoma, and necrotic tissue with FDG PET and kinetic modeling

Yoshifumi Sugawara, Kenneth R. Zasadny, H. Barton Grossman, Isaac R. Francis, Michael F. Clarke, Richard L. Wahl

Research output: Contribution to journalArticlepeer-review


PURPOSE: To evaluate the feasibility of positron emission tomography (PET) with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) in patients with germ cell tumor (CT) to monitor treatment and differentiate residual masses after chemotherapy. MATERIALS AND METHODS: Twenty-six FDG PET studies were performed in 21 patients with GCT. FDG uptake of tumors was interpreted visually, and the lean standardized uptake value (SUV(lean)) was determined. Tumor kinetic rate constants (K1, k2, k3) and net rate of FDG phosphorylation (K = [K1 · k3]/[k2 + k3]) in tumors were calculated from the dynamic data by means of a three-compartment model, assuming k4 = 0. RESULTS: Viable tumors (n = 10) showed intense FDG uptake and could easily be differentiated visually from mature teratoma (n = 6) and necrosis or scar (n = 10). The SUV(lean) of residual viable tumors (4.51 ± 1.34 [mean ± SD]) was higher than that of mature teratoma (1.38 ± 0.71) and necrosis or scar (1.05 ± 0.29) (P < .05). Although neither the visual interpretation nor SUV(lean) differentiated mature teratoma from necrosis or scar, there were statistically significant differences in the kinetic rate constants K1 and K between mature teratoma and necrosis or scar as follows: K1, 0.113 mL/min/g ± 0.026 versus 0.036 mL/min/g ± 0.005 (P < .05); K, 0.005 mL[min/g ± 0.003 versus 0.0008 mL/min/g ± 0.0001 (P < .05). CONCLUSION: FDG PET with kinetic analysis appears to be a promising method for management of disease in patients with GCT after treatment.

Original languageEnglish (US)
Pages (from-to)249-256
Number of pages8
Issue number1
StatePublished - Apr 1999
Externally publishedYes


  • Emission CT (ECT)
  • Fluorine
  • Germ cell neoplasm
  • Glucose

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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