[¹¹C]-Methionine Positron Emission Tomography in the Postoperative Imaging and Followup of Patients with Primary and Recurrent Gliomas

Abstract

We investigated the sensitivity and specificity of [11C]-methionine positron emission tomography ([11C]-MET PET) in the management of glioma patients. We retrospectively analysed data from 53 patients with primary gliomas (16 low grade astrocytomas, 15 anaplastic astrocytomas and 22 glioblastomas) and Karnofsky Performance Status (KPS) > 70. Patients underwent [11C]-MET PET scans (N = 249) and parallel contrast-enhanced MRI (N = 193) and/or CT (N = 113) controls. In low grade glioma patients, MRI or CT findings associated with [11C]-MET PET additional data allowed discrimination residual disease from postsurgical changes in 96.22% of these cases. [11C]-MET PET early allowed detection of malignant progression from low grade to anaplastic astrocytoma with high sensitivity (91.56%) and specificity (95.18%). In anaplastic astrocytomas, we registered high sensitivity (93.97%) and specificity (95.18%) in the postoperative imaging and during the followup of these patients. In GBM patients, CT and/or MRI scans with additional [11C]-MET PET data registered a sensitivity of 96.92% in the postsurgical evaluation and in the tumour assessment during temozolomide therapy. A significant correlation was found between [11C]-MET mean uptake index and histologic grading (P < 0.001). These findings support the notion that complementary information derived from [11C]-MET PET may be helpful in postoperative and successive tumor assessment of glioma patients.

Glioblastoma multiforme: emerging treatments and stratification markers beyond new drugs

“…In addition, [ 11 C]-MET-PET imaging increases the sensitivity of CT and/or MRI scans up to 97% in the post-surgical evaluation and even in the assessment during adjuvant therapy. 69 These aspects lend important information regarding the definition of target volume and margins. CTV margins of Gd-enhancing areas and suspect areas in T2 sequences differ considerably from those by amino acid PET.…”

Imaging of Brain Tumours

“…(i.e better signal to noise ratio) Methionine is involved in protein synthesis, energy production. I t is clear that MET is a powerful diagnostic tool for the detection of primary [61][62][63][64][65][66] and recurrent [42,52,62,[66][67][68][69][70] glioma, as well as having some benefit in prediction of survival. [30,55,[71][72][73][74] Numerous investigations have been performed comparing the diagnostic accuracy of FDG and MET, with reported findings clearly showing the superiority of MET in detection [21,30,75] and grading [30,31] of primary glioma.…”

“…Ceyssens et al [74] and Moulin-Romsee et al [79] reported that MET could not differentiate between glioma grades. However, Singhal et al [30] found that MET could discriminate between high and low-grade gliomas and Miyake et al [31] and Santoni et al [62] found the tracer could discriminate between grades II and IV and grades II, III and IV, respectively.…”

“…In addition to the above methods, there is now significant interest in the use of PET radiotracers for assessing tumour hypoxia. Many radiotracers exist for investigating tumour hypoxia [160][161][162][163][164][165][166][167][168][169][170], including 18 F-HX4, 18 F-FAZA, 18 F-EF5, [124]I-IAZA, [123] / [125]I-IAZP, 64 Cu-ATSM, 18 F-FENI, 62 Cu-diacetyl-bis(N 4 -methylthiosemicarbazone), 18 F-FETA, 18 F-EF1 and [ 18 F]fluoroerythronitroimidazole. However, 18 F-Fluoromisonidazole (FMISO) PET is clearly the most widely used, as it provides the best compromise between sensitivity, specificity and invasiveness.…”

Positron emission tomography with 11C-methionine in primary brain tumor diagnosis

“…Метионин, меченный углеродом-11 ( 11 С), стал таким РФП. Полученные в ходе дальнейших сравнительных исследований на большой группе пациентов (n=102) результаты продемонстрировали диагностические преимущества 11 С-метионина над 18 F-ФДГ в оценке степени злокачественности глиальных новообразований [3,4].…”