Jansen et al. EJNMMI Research 2014, 4:8http://www.ejnmmires.com/content/4/1/8
18 F-FDG PET standard uptake values of thenormal pons in children: establishing a referencevalue for diffuse intrinsic pontine glioma
Marc H A Jansen1*, Reina W Kloet2, Dannis G van Vuurden1,3, Sophie EM Veldhuijzen van Zanten1, Birgit I Witte4,Serge Goldman5, W Peter Vandertop6, Emile FI Comans2, Otto S Hoekstra2, Ronald Boellaard2and Gert-Jan JL Kaspers1
Background: Positron emission tomography (PET) scanning with [18 F]fluorodeoxyglucose (18 F-FDG) is a usefuldiagnostic and prediction tool in brain tumors, but its value in childhood diffuse intrinsic pontine glioma (DIPG) isstill unclear. For interpretation of 18 F-FDG PET results in DIPG, uptake values of the normal pons of children ofincreasing ages are mandatory. The aim of this study was to determine 18 F-FDG standard uptake value ratios (SUVr)of the normal pons and to compare these to those of DIPG.
Methods: We studied 36 subjects with a normal, non-affected pons (aged 5 to 23 years) and 6 patients with DIPG(aged 4 to 17 years) who underwent 18 F-FDG PET scanning. Magnetic resonance imaging (MRI) was co-registeredto define the regions of interest. SUVr and SUVrmax for the pons/cerebellum (SUVrp/c) and the pons/occipital lobe(SUVrp/o) were calculated. Independent-samples t tests and Mann–Whitney U tests were used to compare the meanSUVr and Pearson's test for correlations.
Results: For the normal pons, mean SUVrp/c and SUVrp/o were 0.65 (±0.054) and 0.51 (±0.056), respectively. Nosignificant correlations were found between the SUVr of the normal pons and sex, age, nor pontine volume. Amodest but statistically significant correlation was found between SUVr and post-injection time acquisition timing.
For DIPG, mean SUVrp/c and SUVrp/o were 0.74 (±0.20) and 0.65 (±0.30), respectively, while mean SUVrp(max)/c andSUVrp(max)/o were 1.95 (±0.48) and 1.81 (±0.20), respectively.
Conclusion: The SUVr of the unaffected pons are strikingly constant between children, irrespective of sex and age,and can therefore be well used as a reference value for 18 F-FDG PET studies in DIPG.
Keywords: Positron emission tomography; [18 F]fluorodeoxyglucose; Pontine glioma; Brain neoplasms;Reference values; Pons
stereotactic brain biopsy In the past few years, 18 F-
Positron emission tomography (PET) scanning with [18 F]
FDG PET studies have been introduced in diffuse intrinsic
fluorodeoxyglucose (18 F-FDG) provides information on
pontine glioma (DIPG) a fatal disease that almost
glucose metabolism. 18 F-FDG PET positively correlates
exclusively occurs in children [Interestingly, 18 F-FDG
with an increasing WHO grade in astrocytomas In
metabolism in the majority of the DIPG was lower than
high-grade glioma (HGG), 18 F-FDG PET is an indicator of
that in the non-affected occipital lobe, but increased 18 F-
response to therapy and is used for PET-guided planning of
FDG uptake correlated with decreased overall survival However, reference values of 18 F-FDG uptake in the nor-mal pons of children of increasing age are mandatory to
* Correspondence: 1
know what increased uptake is in the pons, and these data
Division of Oncology and Hematology, Department of Pediatrics, VU
University Medical Center, De Boelelaan 1118, Amsterdam 1007 MB, the
are lacking. Therefore, the aim of this study was to calculate
the standard uptake value ratios (SUVr) for the pons/
Full list of author information is available at the end of the article
2014 Jansen et al.; licensee Springer. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License which permits unrestricted use, distribution, and reproductionin any medium, provided the original work is properly cited.
Jansen et al. EJNMMI Research 2014, 4:8
cerebellum (SUVrp/c) and for the pons/occipital lobe
Table 1 Baseline and PET characteristics of controls and
patients with DIPG
p/o) in subjects with a normal pons and to investigate
the influence of age, pontine size, and post-injection inter-
val on the SUVr. The SUVr of the normal pons were then
Number of subjects
compared to the SUVr and SUVrmax of DIPG.
Median age (years)
SubjectsTo study the 18 F-FDG uptake of the normal pons, a retro-
spective cohort was used. Thirty-six children and adoles-
cents aged 6 to 23 years who underwent 18 F-FDG PET
scans for epilepsy surgery planning in the period of 2002
until 2012 were included. All controls had focal epilepsy
and were in a non-ictal state at the moment of scanning.
We inventoried the anti-epileptic agents used at the day
of scanning. We excluded scans that revealed space-
occupying lesions anywhere in the brain or epilepsy-
induced changes in the pons, occipital lobe, and cerebellum
and scans that did not meet the criteria as described under
‘Scanning procedure'. The affected population consisted of
six children with a newly diagnosed DIPG, based on criteria
as described elsewhere from VU University Medical Center(VUmc), Amsterdam, the Netherlands, who underwent an
18 F-FDG PET scan at diagnosis [. The study was ap-
proved by the institutional review board of VUmc.
DIPG histology unknown
Scans of controls and DIPG patients were performed usingan ECAT EXACT HR + PET scanner (Siemens/CTI, Knox-
Mean 18 F-FDG dose (MBq)
ville, TN, USA), as previously described [Patients and
Mean scan duration (min)
controls fasted for at least 4 h before the PET scan. Fifteen
minutes before injection, they were positioned in a quiet,
darkened room, with their eyes closed and no noise. After
18 F-FDG uptake interval time
injection of 185 MBq 18 F-FDG (mean 187.2 MBq ±5.6),
subjects remained in the quiet, darkened room for 35 minfollowed by a 10-min 2D transmission scan, acquired using
PET reconstruction parameters
retractable rotating 68Ge sources, used for attenuation cor-
rection purposes. Approximately 45 min post-injection, a
static 3D emission scan of 15 min was acquired. All emis-
sion scans were reconstructed using ordered subset expect-
OSEM, ordered subset expectation maximization. aThe controls consisted of 6
ation maximization (OSEM, 4 iterations, 16 subsets) with a
subjects with temporal lobe, 1 with parietal lobe, and 2 with frontal lobe
Hanning filter with a cutoff at 0.5 times the Nyquist fre-
epileptogenic foci; 5 with hypometabolism of the hippocampus; 5 with focalcortical dysplasia; 3 with mesial temporal sclerosis; and 14 without structural
or 18F-FDG PET epileptogenic foci.
normalization, decay, dead time, attenuation, scatter, andrandoms During reconstruction, a zoom factor of
Institute, Cologne, Germany) and subsequently used to
2.123 and a matrix of 256 × 256 were used, resulting in
manually define the regions of interest (ROIs) of the pons,
voxel sizes of 1.2 × 1.2 × 2.4 mm3. All subjects underwent
occipital lobe, and cerebellum in normal subjects (Figure
structural magnetic resonance imaging (MRI) T1-T2 for
For DIPG, the ROI was defined as the hypointense pontine
diagnostic purposes. PET characteristics are summarized in
lesion on T1 MRI, independent of contrast enhancement.
The ROIs were projected on the PET, and the mean uptake(becquerel per cubic centimeter) was calculated for the en-
tire defined ROI. Next, the SUV ratios were calculated by
Each patient's T1-weighted MR image was co-registered to
dividing the activity (becquerel per cubic centimeter) of the
their 18 F-FDG PET using VINCI software (Max Planck
pons by the reference regions. Control group reference
Jansen et al. EJNMMI Research 2014, 4:8
Figure 1 Co-registered T1-MR and FDG PET of a control. The ROI was defined on the co-registered T1-MR on sagittal, coronal, and axial slices.
The upper row shows the ROI of the pons, the second row of the occipital lobe, and the third row of the cerebellum. For the occipital lobe, fiveslices were taken as the ROI from the coronal angle. The lower row shows the PET scan after T1-MRI fusion.
regions were the occipital lobe (SUVrpons/occipital = SUVrp/o)
are illustrated in histograms and boxplots. To determine
and cerebellum (SUVrpons/cerebellum = SUVrp/c). Temporo-
whether the observations followed a normal (Gaussian)
parietal lobe was excluded as a reference region in this con-
distribution, histograms and QQ plots were established.
trol group as FDG uptake may have been affected by
The mean, standard deviation, and corresponding confi-
epilepsy-induced changes in this region. For DIPG, the
dence intervals were calculated accordingly. Based on a
maximal SUV ratios (SUVrp(max)/c and SUVrp(max)/o) were
Gaussian distribution in both groups, independent-
calculated by dividing the hottest pixel of the pons (bec-
samples t tests were used to compare the mean SUV ra-
querel per cubic centimeter) by the mean uptake of the ref-
tios of male versus female subjects. Non-parametric tests
erence region (becquerel per cubic centimeter). Finally,
(Mann–Whitney U tests) were used to compare the
SUV ratios were correlated to post-injection time, age, sex,
SUVr of DIPG versus the SUVr of controls. Pearson's
and pontine volume (calculated on MRI) in the control
correlation test was used to correlate parameters with
SPSS 18.0 for Windows was used for statistical analyses.
The range and distribution of the SUVrp/c and SUVrp/c
Baseline characteristics are summarized in Table
Jansen et al. EJNMMI Research 2014, 4:8
Figure 2 Boxplots of SUVrp/c (a) and SUVrp/o (b) for the normal pons versus DIPG. The SUVr deviation between controls is limitedcompared to that between patients with DIPG. The mean SUVrp/c and SUVrp/o are both not significantly higher in DIPG compared to controls. Inthe majority of the DIPG patients, the SUVrp/c and SUVrp/o are less than 1.0. Some patients with DIPG even show SUVr at the lower end of theSUVr of controls.
SUV ratios of the normal pons
Pontine SUV ratios in relation to pontine volume, sex,
Controls showed consistent SUV ratios of the normal
pons: a mean SUVrp/c of 0.65 (±0.054) and a mean
The average volume of the normal pons was 10 cm3
SUVrp/o of 0.51 (±0.056). SUVrp/c and SUVrp/o showed
(±1.4). The pontine volume linearly increased with age
normal Gaussian distributions as confirmed by histo-
(regression coefficient 0.17, r = 0.51, p = 0.001; Figure
grams and QQ plots (Additional file Figure S1).
There was no significant correlation between SUVrp/o
Figure shows the SUV ratios of the normal pons.
(r = 0.18, p = 0.28; Figure and pontine volume nor
Pontine volume (ml) controls
Figure 3 Correlation between SUVr and pontine volume, sex, and age. Age is significantly correlated with the pontine volume of controls asmeasured on MRI (a). The line shown is the regression curve. The SUVrp/o of controls and DIPG is plotted against pontine volume (b) and age(c). No correlation was found between SUVrp/o and these parameters. This also applies to SUVrp/c (figures not shown).
Jansen et al. EJNMMI Research 2014, 4:8
p/c (r = −0.13, p = 0.45) and pontine volume. Fur-
F-FDG uptake in the normal pons versus DIPG
thermore, SUV ratios were found to be age independent,
The average DIPG volume on MRI was 27 cm3 (±4.1).
with r values of −0.17 (p = 0.324) and 0.18 (p = 0.305) for
The mean SUVrp/c in DIPG patients was 0.74 (±0.20),
SUVrp/c and SUVrp/o (Figure respectively. We also
whereas in controls a SUVrp/c of 0.65 (±0.054) was
found no significant difference between male and female
found (p = 0.64) (Figure The mean SUVrp/o in DIPG
subjects for SUVrp/c (p = 0.86) nor SUVrp/o (p = 0.98).
patients was 0.65 (±0.30), which was 0.51 (±0.056) incontrols (p = 0.37). In only one out of six DIPGs, aSUVrp/o and SUVrp/c ≥1.0 was found. In three patients
Pontine FDG SUV ratios as a function of post-injection
with increased local 18 F-FDG tumor uptake, the SUVr-
max was calculated. The mean SUVrp(max)/o was 1.81
To determine whether uptake time influenced the 18 F-
(±0.20) and SUVrp(max)/c was 1.95 (±0.48) which was sig-
FDG uptake, we investigated the correlation between the
nificantly higher than the mean SUVr of the normal
SUV ratios and the post-injection uptake time in the
pons (p = 0.042 and p = 0.005).
control group (Figure A modest positive correlationwas found with both SUVrp/c (r = 0.37, p = 0.034) and
SUVrp/o (r = 0.43, p = 0.012) and increasing post-
In an era where numerous drug trials in DIPG are on-
injection time. The regression coefficients were small
going or will be initiated shortly, it is essential to develop
(0.0011/min and 0.0015/min, respectively).
tools to predict disease evolution and to monitor re-sponse to therapy ]. 18 F-FDG PET has the potentialto be such a tool. However, the interpretation of 18 F-FDG PET results in DIPG is hampered by a lack of dataon normal pontine glucose metabolism in children. Weshow in this study that 18 F-FDG SUV ratios of the nor-mal pons versus those of the cerebellum and occipitallobe are very consistent in between controls, independ-ent of sex, age, and pontine volume, and are thereforesuitable as a reference value for 18 F-FDG PET studies inDIPG. Not only the pons of controls but also the ponsinfiltrated by tumor often showed lower 18 F-FDGuptake than the cerebellum and occipital lobe, aphenomenon that has been reported before More-over, the mean SUVr of DIPG were not significantlyhigher than those of the normal pons, but this is prob-ably due to the small DIPG sample size as the standarddeviations were high. One may therefore question therole of 18 F-FDG PET in DIPG; however, the meanSUVrmax clearly increased in DIPG compared to thenormal pons. Indeed, a recent study showed a significantcorrelation between increased 18 F-FDG tumor uptakeand decreased survival in patients with this disease This correlation might be even stronger when consider-ing that a SUVrp/o in DIPG between 0.5 and 1.0 alreadyreflects increased 18 F-FDG uptake in comparison withthe normal pons. This consideration is not taken into ac-count in studies using semi-quantitative measurementsthat lead to classification as ‘hypo/iso/hypermetabolic'compared to other brain areas [
An explanation for the limited 18 F-FDG uptake in DIPG
compared to supratentorial HGG is that DIPGs are hetero-
Figure 4 Correlation between SUVr and post-injection (PI) time.
geneous tumors with a mixed histologic tumor grade, as
The SUVrp/o (a) and SUVrp/c (b) are plotted against the PI time. Both
local uptake of the tracer is related to the presence of ana-
SUV ratios slightly increase over time; in other words, the pons
plastic features . Calculating the SUVrmax,
shows a delayed uptake of 18 F-FDG compared to the cerebellum
reflecting the highest local uptake in the tumor, is helpful in
and occipital lobe. The line shown is the regression curve.
those tumors with heterogeneous 18 F-FDG uptake. Other
Jansen et al. EJNMMI Research 2014, 4:8
explanations of the limited uptake are the frequently ob-
way, the sensitivity and applicability of 18 F-FDG PET as a
served integrity of the blood–brain barrier in DIPG and the
predictive and response monitoring tool for patients with
presence of white matter in the pontine region, which has
DIPG can be increased.
low glucose metabolism
We further investigated whether the time between injec-
tion and PET scanning had an influence on the 18 F-FDG
We established a reference SUVr for 18 F-FDG uptake in
uptake in the pons of controls compared to other brain
the normal pons. SUV ratios are very consistent in between
areas. Indeed, SUVrp/c and SUVrp/o were positively corre-
controls and independent of pontine volume, sex, or age.
lated with increasing post-injection time. This suggests a
Not only was the 18 F-FDG uptake in the normal pons low
delayed uptake of this tracer in the pons compared to the
compared to that in the reference brain areas, but also the
cerebellum and occipital lobe. However, the SUVr regres-
uptake in DIPG was often lower than that in the occipital
sion coefficients were small, and therefore, the influence of
and cerebellar tissues. We encourage a study in controls to
the uptake interval in clinical practice is negligible.
validate our results and propose that future 18 F-FDG PET
The main advantage of SUV ratios is that the possible er-
trials in DIPG calculate SUV and SUV(max) ratios in order
rors in the measurement of weight or transcription and
to relate these to the here reported mean SUV ratios of the
dose administered are minimized by the ratio between the
normal pons. Smaller changes in the tumor's glucose me-
two SUV measurements [. This applies especially for
tabolism can be detected in this way, which may have prog-
pediatric cancer, with low patient numbers and therefore
nostic relevance for the patient.
often multi-national multi-center trials. In this study, weshowed that SUV ratios of the normal pons are independ-
ent of sex, pontine volume, and age, although we had anunder-representation of the youngest children (<5 years) in
SUVrp/c and SUVrp/o distributions in
the control group. Although SUV ratios may give useful in-
normal controls. Normal Gaussian distributions of both SUVrs are
formation in serial measurements, they have their limita-
presented in histograms (a, d) and boxplots (b, e). The Gaussiandistribution was confirmed by QQ plots (c, f).
tions. In situations in which the 18 F-FDG uptake of thereference tissue varies, changes in SUV ratios can be mis-
leading. For example, this may be the case when patients
The authors declare that they have no competing interests.
use steroids, which influence the glucose metabolism of thebrain A methodological issue in this study was the use
of epilepsy patients as controls, as 18 F-FDG PET data of
MJ, RK, OH, RB, DV, GK, and WV contributed to the concept and studydesign. MJ, RK, OH, EC, SG, and SV collected the data. MJ and BW performed
healthy children could not be obtained due to ethical rea-
the statistical analysis. MJ, RK, OH, RB, GK, and BW were involved in the
sons regarding radiation exposure. We, however, do not ex-
interpretation of the data. All authors were involved in the writing process
pect significant changes in glucose metabolism of the pons
and all approved the manuscript before submission.
due to epilepsy as all our subjects were in an inter-ictal
state, which is not associated with changed glucose
DIPG research is funded by the Semmy and Egbers foundations. The
metabolism Furthermore, several anti-epileptic drugs
sponsors had no role in the preparation and execution of the study and/or
including phenobarbital, phenytoin, benzodiazepines, and
valproic acid have been associated with hypometabolism of
the brain and especially the cerebellum and may therefore
1Division of Oncology and Hematology, Department of Pediatrics, VU
overestimate the SUVr
University Medical Center, De Boelelaan 1118, Amsterdam 1007 MB, the
p/c. Of these drugs, only valproic acid
Netherlands. 2Department of Radiology and Nuclear Medicine, VU University
and clobazam were used in this study by, respectively, 3
Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, the Netherlands.
and 4 out of 37 controls The lack of variance in be-
3Neuro-oncology Research Group, Cancer Center Amsterdam, De Boelelaan
tween controls of both SUVr
1117, Amsterdam 1081 HV, the Netherlands. 4Department of Epidemiology
p/c and SUVrp/o presumes that
and Biostatistics, VU University Medical Center, De Boelelaan 1118,
the use of anti-epileptic drugs has not influenced our re-
Amsterdam 1081 HV, the Netherlands. 5Department of Nuclear Medicine, U.L.
sults significantly. In addition, the use of the cerebellum as
B.-Hôpital Erasme Brussels, 808 route de Lennik, Brussels 1070, Belgium.
a reference in epileptic patients in 18 F-FDG PET studies is
Neurosurgical Center Amsterdam, VU University Medical Center, De
Boelelaan 1117, Amsterdam 1081 HV, the Netherlands.
Future 18 F-FDG PET studies in DIPG may now compare
Received: 20 September 2013 Accepted: 14 January 2014
SUVr and SUVrmax in DIPG to the here reported mean
Published: 28 January 2014
SUV ratios of the normal pons. By comparing SUV ratios
to the normal pons, smaller increases in glucose metabol-
Di CG, Oldfield E, Bairamian D, Patronas NJ, Brooks RA, Mansi L, Smith BH,
ism can be detected in comparison with semi-quantitative
Kornblith PL, Margolin R: Metabolic imaging of the brain stem and spinalcord: studies with positron emission tomography using 18 F-2-
measurements, as DIPGs often show lower glucose metab-
deoxyglucose in normal and pathological cases. J Comput Assist Tomogr
olism than the reference brain tissue (occipital lobe). In this
Jansen et al. EJNMMI Research 2014, 4:8
Colavolpe C, Chinot O, Metellus P, Mancini J, Barrie M, Bequet-Boucard C,
Leiderman DB, Balish M, Bromfield EB, Theodore WH: Effect of valproate on
Tabouret E, Mundler O, Figarella-Branger D, Guedj E: FDG-PET predicts
human cerebral glucose metabolism. Epilepsia 1991, 32:417–422.
survival in recurrent high-grade gliomas treated with bevacizumab and
Ferrie CD, Marsden PK, Maisey MN, Robinson RO: Visual and
irinotecan. Neuro Oncol 2012, 14:649–657.
semiquantitative analysis of cortical FDG-PET scans in childhood
Colavolpe C, Metellus P, Mancini J, Barrie M, Bequet-Boucard C, Figarella-
epileptic encephalopathies. J Nucl Med 1997, 38:1891–1894.
Branger D, Mundler O, Chinot O, Guedj E: Independent prognostic value
Ferrie CD, Marsden PK, Maisey MN, Robinson RO: Cortical and subcortical
of pre-treatment 18-FDG-PET in high-grade gliomas. J Neurooncol 2012,
glucose metabolism in childhood epileptic encephalopathies. J Neurol
Neurosurg Psychiatry 1997, 63:181–187.
Goldman S, Levivier M, Pirotte B, Brucher JM, Wikler D, Damhaut P, Dethy S,Brotchi J, Hildebrand J: Regional methionine and glucose uptake in high-
grade gliomas: a comparative study on PET-guided stereotactic biopsy.
Cite this article as: Jansen et al.: 18 F-FDG PET standard uptake values of
J Nucl Med 1997, 38:1459–1462.
the normal pons in children: establishing a reference value for diffuse
Pirotte B, Goldman S, Massager N, David P, Wikler D, Lipszyc M, Salmon I,
intrinsic pontine glioma. EJNMMI Research 2014 4:8.
Brotchi J, Levivier M: Combined use of 18 F-fluorodeoxyglucose and11C-methionine in 45 positron emission tomography-guided stereotacticbrain biopsies. J Neurosurg 2004, 101:476–483.
Bruggers CS, Friedman HS, Fuller GN, Tien RD, Marks LB, Halperin EC,Hockenberger B, Oakes WJ, Hoffman JM: Comparison of serial PET andMRI scans in a pediatric patient with a brainstem glioma. Med PediatrOncol 1993, 21:301–306.
Kwon JW, Kim IO, Cheon JE, Kim WS, Moon SG, Kim TJ, Chi JG, Wang KC,Chung JK, Yeon KM: Paediatric brain-stem gliomas: MRI, FDG-PET andhistological grading correlation. Pediatr Radiol 2006, 36:959–964.
Pirotte BJ, Lubansu A, Massager N, Wikler D, Goldman S, Levivier M: Resultsof positron emission tomography guidance and reassessment of theutility of and indications for stereotactic biopsy in children withinfiltrative brainstem tumors. J Neurosurg 2007, 107:392–399.
Rosenfeld A, Etzl M, Bandy D, Carpenteri D, Gieseking A, Dvorchik I, KaplanA: Use of positron emission tomography in the evaluation of diffuseintrinsic brainstem gliomas in children. J Pediatr Hematol Oncol 2011,33:369–373.
Zukotynski KA, Fahey FH, Kocak M, Alavi A, Wong TZ, Treves ST, Shulkin BL,Haas-Kogan DA, Geyer JR, Vajapeyam S, Boyett JM, Kun LE, Poussaint TY:Evaluation of 18 F-FDG PET and MRI associations in pediatric diffuseintrinsic brain stem glioma: a report from the pediatric brain tumorconsortium. J Nucl Med 2011, 52:188–195.
Jansen MH, van Vuurden DG, Vandertop WP, Kaspers GJ: Diffuse intrinsicpontine gliomas: a systematic update on clinical trials and biology.
Cancer Treat Rev 2012, 38:27–35.
Brix G, Zaers J, Adam LE, Bellemann ME, Ostertag H, Trojan H, Haberkorn U,Doll J, Oberdorfer F, Lorenz WJ: Performance evaluation of a whole-bodyPET scanner using the NEMA protocol. National electrical manufacturersassociation. J Nucl Med 1997, 38:1614–1623.
Boel aard R, Lubberink M, De Jong HW, Krophol er M, Lammertsma AA:Application of various iterative reconstruction methods for quantitative 3Ddynamic brain PET studies. IEEE Nucl Sci Symp Conf Rec 2004, 4:2553–2556.
Jansen MH, Kaspers GJ: A new era for children with diffuse intrinsic pontineglioma: hope for cure? Expert Rev Anticancer Ther 2012, 12:1109–1112.
Goldman S, Levivier M, Pirotte B, Brucher JM, Wikler D, Damhaut P, Stanus E,Brotchi J, Hildebrand J: Regional glucose metabolism and histopathologyof gliomas. A study based on positron emission tomography-guidedstereotactic biopsy. Cancer 1996, 78:1098–1106.
Caretti V, Jansen MH, van Vuurden DG, Lagerweij T, Bugiani M, Horsman I,Wessels H, Van D, Cloos J, Noske DP, Vandertop WP, Wesseling P, WurdingerT, Hulleman E, Kaspers GJ: Implementation of a multi-institutional diffuseintrinsic pontine glioma autopsy protocol and characterization of aprimary cell culture. Neuropathol Appl Neurobiol 2012, 39:426–436.
Submit your manuscript to a
Hargrave D, Chuang N, Bouffet E: Conventional MRI cannot predict
journal and beneﬁ t from:
survival in childhood diffuse intrinsic pontine glioma. J Neurooncol 2008,86:313–319.
7 Convenient online submission
Boellaard R: Need for standardization of 18 F-FDG PET/CT for treatment
7 Rigorous peer review
response assessments. J Nucl Med 2011, 52(Suppl 2):93S–100S.
7 Immediate publication on acceptance
Roelcke U, Blasberg RG, von AK, Hofer S, Vontobel P, Maguire RP, Radu EW,Herrmann R, Leenders KL: Dexamethasone treatment and plasma glucose
7 Open access: articles freely available online
levels: relevance for fluorine-18-fluorodeoxyglucose uptake measure-
7 High visibility within the ﬁ eld
ments in gliomas. J Nucl Med 1998, 39:879–884.
7 Retaining the copyright to your article
Theodore WH, Fishbein D, Dietz M, Baldwin P: Complex partial seizures:cerebellar metabolism. Epilepsia 1987, 28:319–323.
Theodore WH: Antiepileptic drugs and cerebral glucose metabolism.
Submit your next manuscript at 7 springeropen.com
Epilepsia 1988, 29(Suppl 2):S48–S55.
Technology / Internet Trends November 5, 2008 Web 2.0 Summit – San Francisco Morgan Stanley does and seeks to do business with companies covered in Morgan Stanley Research. As a result, investors should be aware that the firm may have a conflict of interest that could affect the objectivity of Morgan Stanley Research. Investors should consider Morgan Stanley Research as only a single factor in making their investment decision. Customers of Morgan Stanley inthe US can receive independent, third-party research on companies covered in Morgan Stanley Research, at no cost to them, where such research is available. Customers can access this independent research at www.morganstanley.com/equityresearch or can call 1-800-624-2063 to request a copy of this research.For analyst certification and other important disclosures, refer to the Disclosure Section, located at the end of this report.
Gender differences and the medicalization of sexuality in the creation of sexual dysfunctions diagnosis CLAM. 2013. Sexuality, Culture and Politics - A South American Reader. Pp. 620-638. ISBN 978-85-89737-82-1 Sexuality, culture and politics A South American reader Although mature and vibrant, Latin American scholarship on sexuality still remains largely invisible to a global readership. In this collection of articles translated from Portuguese and Spanish, South American scholars explore the values, practices, knowledge, moralities and politics of sexuality in a variety of local contexts. While conventionally read as an intellectual legacy of Modernity, Latin American social thinking and research has in fact brought singular forms of engagement with, and new ways of looking at, political processes. Contributors to this reader have produced fresh and situated understandings of the relations between gender, sexuality, culture and society across the region. Topics in this volume include sexual politics and rights, sexual identities and communities, eroticism, pornography and sexual consumerism, sexual health and well-being, intersectional approaches to sexual cultures and behavior, sexual knowledge, and sexuality research methodologies in Latin America.