Imaging 18F-fluorodeoxy glucose/11C-methionine uptake decoupling for identification of tumor cell infiltration in peritumoral brain edema

Kinoshita, Manabu; Goto, Tetsu; Arita, Hideyuki; Okita, Yoshiko; Isohashi, Kayako; Kagawa, Naoki; Fujimoto, Yasunori; Kishima, Haruhiko; Shimosegawa, Eku; Saitoh, Youichi; Hatazawa, Jun; Hashimoto, Naoya; Yoshimine, Toshiki

doi:10.1007/s11060-011-0688-0

Cited by 23 publications

(16 citation statements)

References 19 publications

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“…When both tracer accumulations are high, the area is highly malignant as a tumor site and has high proliferative ability. However, it is difficult to make differential diagnosis, determine the recurrence of tumor, and determine the presence or absence of radiation necrosis using only one type of PET studies [31, 32]. Our study indicated that the combinational uses of FDG, MET, and FLT-PET help us evaluate the differences in malignancy grade of the tissues and predict the evaluation of histopathological components.…”

Section: Discussionmentioning

confidence: 79%

Usefulness of FDG, MET and FLT-PET Studies for the Management of Human Gliomas

Miyake

Shinomiya²,

Okada³

et al. 2012

Journal of Biomedicine and Biotechnology

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The use of positron imaging agents such as FDG, MET, and FLT is expected to lead the way for novel applications toward efficient malignancy grading and treatment of gliomas. In this study, the usefulness of FDG, MET and FLT-PET images was retrospectively reviewed by comparing their histopathological findings. FDG, MET, and FLT-PET were performed in 27 patients with WHO grade IV, 15 patients with WHO grade III, and 12 patients with WHO grade II during 5.5 years. The resulting PET images were compared by measuring SUVs and T/N ratios (tumor to normal tissue ratios). Although there were no significant differences in FDG-PET, there were significant differences in the T/N ratios in the MET-PET between WHO grades II and IV and in the FLT-PET between the WHO grades III and IV. In glioblastoma patients, the SUVs of the areas depicted by MRI in the MET-PET were different from those SUVs in the FLT-PET. Importantly, the areas with high SUVs in both MET-PET and FLT-PET were also high in Ki-67 index and were histologically highly malignant. PET imaging is a noninvasive modality that is useful in determining a tumor area for removal as well as improving preoperative diagnosis for gliomas.

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Section: Discussionmentioning

confidence: 79%

Usefulness of FDG, MET and FLT-PET Studies for the Management of Human Gliomas

Miyake

Shinomiya²,

Okada³

et al. 2012

Journal of Biomedicine and Biotechnology

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“…Conversely, low-grade meningiomas are non-infiltrative tumors with a clear interface between tumor and underlying cortex, and are associated with vasogenic edema. Therefore, meningiomas have been used as a model for pure vasogenic edema [33]. Since low-grade meningiomas avidly accumulate AMT (similar to high-grade gliomas), they are useful to generate a cutoff threshold, which can pick up adequate tumor volume while excluding non-infiltrative edema (including peri-glioma edema with low tumor cell infiltration) and non-tumoral brain tissue.…”

Section: Discussionmentioning

confidence: 99%

Tryptophan PET in pretreatment delineation of newly-diagnosed gliomas: MRI and histopathologic correlates

et al. 2013

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Pretreatment delineation of infiltrating glioma volume remains suboptimal with current neuroimaging techniques. Gadolinium-enhanced T1-weighted (T1-Gad) MR images often underestimate the true extent of the tumor, while T2-weighted images preferentially highlight peritumoral edema. Accumulation of α-[11C]methyl-l-tryptophan (AMT) on positron emission tomography(PET) has been shown in gliomas. To determine whether increased uptake on AMT–PET would detect tumor-infiltrated brain tissue outside the contrast-enhancing region and differentiate it from peritumoral vasogenic edema, volumes and spatial concordance of T1-Gad and T2 MRI abnormalities as well as AMT–PET abnormalities were analyzed in 28 patients with newly-diagnosed WHO grade II–IV gliomas. AMT-accumulating grade I meningiomas were used to define an AMT uptake cutoff threshold that detects the tumor but excludes peri-meningioma vasogenic edema. Tumor infiltration in AMT-accumulating areas was studied in stereotacticallyresected specimens from patients with glioblastoma. In the 28 gliomas, mean AMT–PET-defined tumor volumes were greater than the contrast-enhancing volume, but smaller than T2 abnormalities. Volume of AMT-accumulating tissue outside MRI abnormalities increased with higher tumor proliferative index and was the largest in glioblastomas. Tumor infiltration was confirmed by histopathology from AMT-positive regions outside contrast-enhancing glioblastoma mass, while no or minimal tumor cells were found in AMT-negative specimens. These results demonstrate that increased AMT accumulation on PET detects glioma-infiltrated brain tissue extending beyond the contrast-enhanced tumor mass. While tryptophan uptake is low in peritumoral vasogenic edema, AMT–PET can detect tumor-infiltrated brain outside T2-lesions. Thus, AMT–-PET may assist pretreatment delineation of tumor infiltration, particularly in high-grade gliomas.

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“…Amino acid and amino acid analogue PET tracers are particularly attractive for brain tumour imaging because of their high uptake in tumour tissue and low uptake in normal brain tissue. Most PET studies were performed with the amino acid 11 C methyl L methionine and show higher sensitivity and localisation accuracy than 18 [F]-FDG [8,9]. Although it has provided convincing clinical results, the use of 11 C methionine is still restricted to a few centres equipped with an in-house cyclotron due to the short half-life of 11 C (20 min).…”

Section: Available Tracers For Glioma Pet Imagingmentioning

confidence: 99%