Semiquantitative analysis of C-11 methionine PET may distinguish brain tumor recurrence from radiation necrosis even in small lesions

Okamoto, Susumu; Shiga, Tohru; Hattori, Naoya; Kubo, Naoki; Takei, Toshiki; Katoh, Norio; Sawamura, Yutaka; Nishijima, Ken‐ichi; Kuge, Yuji; Tamaki, Nagara

doi:10.1007/s12149-010-0450-2

Cited by 46 publications

(32 citation statements)

References 28 publications

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“…11 C-MET is the most widely used amino-acid tracer in the world and in patients with CNS tumors, including gliomas and metastatic brain tumors, 11 C-MET PET demonstrated high sensitivity (75%–93%) and high specificity (72.7%–100%) for the differentiation of BRN from tumor recurrence. 7–12,32 We adopted 18 F-BPA-PET in addition to 11 C-MET-PET in the present study. 18 F-BPA-PET had shown an excellent diagnostic power for malignant gliomas activity, 33 and the tracer uptake in the normal brain is less than that by 11 C-MET-PET, which provides high contrast in the L/N ratio between BRN and tumor progression.…”

Section: Discussionmentioning

confidence: 99%

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A prospective, multicentre, single-arm clinical trial of bevacizumab for patients with surgically untreatable, symptomatic brain radiation necrosis†

Furuse

Nonoguchi

Kuroiwa

et al. 2016

Neuro-Oncology Practice

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BackgroundBrain radiation necrosis (BRN) can be a complication of radiotherapy for primary and secondary brain tumors, as well as head and neck tumors. Since vascular endothelial growth factor (VEGF) is also a vascular permeability factor in the brain, bevacizumab, a humanized antibody that inhibits VEGF, would be expected to reduce perilesional edema that often accompanies BRN.MethodsPatients with surgically untreatable, symptomatic BRN refractory to conventional medical treatments (eg, corticosteroid, anticoagulants, or hyperbaric oxygen therapy) were enrolled. We judged that a major cause of perilesional edema with a lesion-to-normal brain ratio ≤1.8 on 11C-methionine or ≤2.5 on 18F-boronophenylalanine PET was BRN, not tumor recurrence, and 6 cycles of biweekly bevacizumab (5 mg/kg) were administered. The primary endpoint was a ≥30% reduction from the patients' registration for perilesional edema continuing for ≥1 month.ResultsOf the 41 patients enrolled, 38 were fully eligible for the response assessment. The primary endpoint was achieved in 30 of the 38 (78.9%) patients at 3.0 months (median) after enrollment. Sixteen patients (42.1%) experienced improvement of their Karnofsy Performance Score. Corticosteroid use could be reduced in 29 patients (76.3%). Adverse events at grade ≥3 occurred in 10 patients (24.4%).ConclusionsBevacizumab treatment offers certain clinical benefits for patients with surgically untreatable, symptomatic BRN. The determination of BRN using amino-acid PET, not biopsy, is adequate and less invasive for determining eligibility to receive bevacizumab.

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Section: Discussionmentioning

confidence: 99%

“…The authors have experience with PET using amino acid tracers for CNS lesions 7–12 and believe that it is useful for distinguishing BRN from tumor growth. The contrast between tumor and normal tissue shown by PET using some types of amino acids is much higher than that shown by 18 F-fluorodeoxyglucose PET.…”

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confidence: 99%

A prospective, multicentre, single-arm clinical trial of bevacizumab for patients with surgically untreatable, symptomatic brain radiation necrosis†

Furuse

Nonoguchi

Kuroiwa

et al. 2016

Neuro-Oncology Practice

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“…Several disorders such as cerebral infarction 5 or radiation necrosis 7 also show signs of high MET uptake because the tracer accumulates in the lesion of inflammatory change and reactive gliosis. 7 Because basal ganglia are one of the most important regions of the brain in which several neuronal pathways penetrate, overtreatment of tu- mors in this area should be avoided, especially additional radiotherapy, including stereotactic radiotherapy or radiosurgery, which can directly affect a patient's quality of life. MET uptake does not necessarily correspond to tumor residue when posttreatment assessment of basal ganglia GCTs is performed, especially in cases when a tumor's response to treatment is clearly observed.…”

Section: Discussionmentioning

confidence: 99%

Clinical interpretation of residual uptake in 11C-methionine positron emission tomography after treatment of basal ganglia germ cell tumors: report of 3 cases

Fukuoka

Yanagisawa

Watanabe

et al. 2015

PED

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Although 11C-methionine (MET)-PET has been used to diagnose intracranial germ cell tumors (GCTs) arising in the basal ganglia, whether this imaging technique is useful in assessing treatment response and residual tumor is still unclear. The authors report 3 cases of basal ganglia GCTs in which the residual MET uptake at the end of treatment did not develop into a relapse, even without additional treatment. Case 1 is a 22-year-old man who had a second relapse of a left basal ganglia germinoma with diffuse dissemination on the walls of both of his lateral ventricles. MET-PET revealed high MET accumulation around tumors and their surroundings (maximum standardized uptake value [SUVmax] 3.3). After all treatments, MET-PET demonstrated mild tracer accumulation in both basal ganglia (SUVmax 2.2). Progression-free survival was 56 months from the second relapse without any further treatment. Case 2 is a 17-year-old boy with a left basal ganglia germinoma that showed increased MET uptake (SUVmax 4.2). After treatment, MET-PET revealed residual MET uptake (SUVmax 2.4) along the left posterior limb of the internal capsule. Progression-free survival was 52 months from the start of treatment. Case 3 is a 7-year-old boy with a left basal ganglia choriocarcinoma with increased tumor MET uptake (SUVmax 2.5). A minor enhanced mass remained on MRI after treatment with residual MET accumulation (SUVmax 1.4). Progression-free survival was 44 months. Treatment strategies based on MET uptake on PET should be carefully designed in patients with basal ganglia GCTs to avoid overtreatment and complications.

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“…Altered metabolism seen in tumor recurrence may be leveraged to differentiate relapse from pseudoprogression. Metabolic imaging with amino acid PET has been shown to help distinguish the alteration in blood-brain-barrier and contrast enhancement observed after chemoradiation, which are seen in pseudoprogression, from true progression 149–153 . Both static and dynamic 18 F-FET PET parameters differentiate glioma progression or recurrence with greater accuracy than conventional MRI 154 .…”

Section: Integrating Metabolic Imaging With Clinical Care In Brain Tumentioning

confidence: 99%

Non-invasive metabolic imaging of brain tumours in the era of precision medicine

et al. 2016

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The genomic revolution in cancer has uncovered a variety of mutations in primary brain tumors. This has created an urgent need to develop non-invasive imaging biomarkers to assess and integrate this genetic information in the clinical management of patients. Metabolic reprogramming is a central hallmark of cancers including brain tumors. Many of the molecular pathways implicated in brain tumors directly reprogram metabolism. This provides the opportunity to devise in vivo metabolism-based imaging modalities for patient stratification, to improve diagnosis, and to monitor treatment response. Metabolic phenomena like the Warburg effect and altered mitochondrial metabolism can be leveraged to image brain tumors using techniques like positron emission tomography (PET) imaging and Magnetic Resonance (MR) metabolic imaging. Moreover, genetic alterations such as isocitrate dehydrogenase mutations produced unique metabolic signatures that can be detected using MR spectroscopy. There is a growing need to translate our understanding of the molecular aspects of brain tumors to in vivo imaging in patients. Metabolism-based imaging provides a unique platform to achieve this. In this review we examine the molecular basis for metabolic reprograming in brain tumors and examine current non-invasive metabolic imaging strategies to interrogate them, for the ultimate goal of guiding and improving patient care.

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Semiquantitative analysis of C-11 methionine PET may distinguish brain tumor recurrence from radiation necrosis even in small lesions

Abstract: Semiquantitative analysis of MET provided high diagnostic value even for PVE-affected small lesions. MET-PET enables early diagnosis of recurrence of brain tumor in the follow-up after the radiation therapy.

Cited by 46 publications

References 28 publications

A prospective, multicentre, single-arm clinical trial of bevacizumab for patients with surgically untreatable, symptomatic brain radiation necrosis†

A prospective, multicentre, single-arm clinical trial of bevacizumab for patients with surgically untreatable, symptomatic brain radiation necrosis†

Clinical interpretation of residual uptake in 11C-methionine positron emission tomography after treatment of basal ganglia germ cell tumors: report of 3 cases

Non-invasive metabolic imaging of brain tumours in the era of precision medicine

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