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Gong X, Fu Y, Zhou L, Wei A, Pan C, Zhu T, Li H. Decoding chronic rhinosinusitis: A metabolomics-based approach. Int Forum Allergy Rhinol 2024; 14:828-840. [PMID: 38343156 DOI: 10.1002/alr.23331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a common and intractable disease in otorhinolaryngology, laying a heavy burden on healthcare systems. The worldwide researchers are making efforts to find solutions to this disease. Metabolomics has recently gained more and more traction, and might become a promising tool to unravel the complexity of CRS. This paper provides an overview of current studies on the metabolomics of various CRS subtypes. METHODS We conducted a comprehensive literature search in PubMed, Web of Science, EMBASE, Google Scholar, and Cochrane Library, up to May 25, 2023. Search strategies incorporated key terms such as "chronic rhinosinusitis" and "metabolomics" with relevant synonyms and MeSH terms. Titles and abstracts of 86 screened articles were assessed for relevance to CRS and metabolomics. Methodological robustness, data reliability, and relevance were considered for shortlisted articles. RESULTS After the refined process, a total of 26 articles were included in this study and sorted out by research themes, methodology and pivotal discoveries. These included studies identified the metabolic pathways and markers related to the pathophysiology in each subtype of CRS. CONCLUSIONS Metabolomics helps to shed light on the complexity of CRS. The mentioned findings highlight the importance of specific metabolic pathways and markers in understanding the pathophysiology of CRS. Despite that, challenges and future directions in metabolomics research for CRS would be worth being further explored.
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Affiliation(s)
- Xinru Gong
- Health and Rehabilitation College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yijie Fu
- School of Preclinical Medicine, Chengdu University, Chengdu, Sichuan, China
| | - Lei Zhou
- Health and Rehabilitation College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Aiming Wei
- Health and Rehabilitation College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chongsheng Pan
- Health and Rehabilitation College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Tianmin Zhu
- Health and Rehabilitation College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hui Li
- School of Preclinical Medicine, Chengdu University, Chengdu, Sichuan, China
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Bartman CR, Faubert B, Rabinowitz JD, DeBerardinis RJ. Metabolic pathway analysis using stable isotopes in patients with cancer. Nat Rev Cancer 2023; 23:863-878. [PMID: 37907620 PMCID: PMC11161207 DOI: 10.1038/s41568-023-00632-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 11/02/2023]
Abstract
Metabolic reprogramming is central to malignant transformation and cancer cell growth. How tumours use nutrients and the relative rates of reprogrammed pathways are areas of intense investigation. Tumour metabolism is determined by a complex and incompletely defined combination of factors intrinsic and extrinsic to cancer cells. This complexity increases the value of assessing cancer metabolism in disease-relevant microenvironments, including in patients with cancer. Stable-isotope tracing is an informative, versatile method for probing tumour metabolism in vivo. It has been used extensively in preclinical models of cancer and, with increasing frequency, in patients with cancer. In this Review, we describe approaches for using in vivo isotope tracing to define fuel preferences and pathway engagement in tumours, along with some of the principles that have emerged from this work. Stable-isotope infusions reported so far have revealed that in humans, tumours use a diverse set of nutrients to supply central metabolic pathways, including the tricarboxylic acid cycle and amino acid synthesis. Emerging data suggest that some activities detected by stable-isotope tracing correlate with poor clinical outcomes and may drive cancer progression. We also discuss current challenges in isotope tracing, including comparisons of in vivo and in vitro models, and opportunities for future discovery in tumour metabolism.
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Affiliation(s)
- Caroline R Bartman
- Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
| | - Brandon Faubert
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Joshua D Rabinowitz
- Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA.
| | - Ralph J DeBerardinis
- Howard Hughes Medical Institute and Children's Research Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Dynamic 11C-Methionine PET-CT: Prognostic Factors for Disease Progression and Survival in Patients with Suspected Glioma Recurrence. Cancers (Basel) 2021; 13:cancers13194777. [PMID: 34638262 PMCID: PMC8508090 DOI: 10.3390/cancers13194777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/19/2021] [Accepted: 09/10/2021] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Recurrence after initial treatments is an expected event in glioma patients, particularly for high-grade glioma, with a median progression-free survival of 8–11 weeks. The prognostic evaluation of disease is a crucial step in the planning of therapeutic strategies, in both the primary and recurrence stages of disease. The aim of our retrospective study was to assess the prognostic value of 11C-methionine PET-CT dynamic and semiquantitative parameters in patients with suspected glioma recurrence at MR, in terms of progression-free survival and overall survival. In a population of sixty-seven consecutive patients, both static and kinetic analyses provided parameters (i.e., tumour-to-background ratio and SUVmax associated with time-to-peak, respectively) able to predict both progression-free and overall survival in the whole population and in the high-grade glioma subgroup of patients. Dynamic 11C-methionine PET-CT can be a useful diagnostic tool, in patients with suspicion of glioma recurrence, able to produce significant prognostic indices. Abstract Purpose: The prognostic evaluation of glioma recurrence patients is important in the therapeutic management. We investigated the prognostic value of 11C-methionine PET-CT (MET-PET) dynamic and semiquantitative parameters in patients with suspected glioma recurrence. Methods: Sixty-seven consecutive patients who underwent MET-PET for suspected glioma recurrence at MR were retrospectively included. Twenty-one patients underwent static MET-PET; 46/67 underwent dynamic MET-PET. In all patients, SUVmax, SUVmean and tumour-to-background ratio (T/B) were calculated. From dynamic acquisition, the shape and slope of time-activity curves, time-to-peak and its SUVmax (SUVmaxTTP) were extrapolated. The prognostic value of PET parameters on progression-free (PFS) and overall survival (OS) was evaluated using Kaplan–Meier survival estimates and Cox regression. Results: The overall median follow-up was 19 months from MET-PET. Recurrence patients (38/67) had higher SUVmax (p = 0.001), SUVmean (p = 0.002) and T/B (p < 0.001); deceased patients (16/67) showed higher SUVmax (p = 0.03), SUVmean (p = 0.03) and T/B (p = 0.006). All static parameters were associated with PFS (all p < 0.001); T/B was associated with OS (p = 0.031). Regarding kinetic analyses, recurrence (27/46) and deceased (14/46) patients had higher SUVmaxTTP (p = 0.02, p = 0.01, respectively). SUVmaxTTP was the only dynamic parameter associated with PFS (p = 0.02) and OS (p = 0.006). At univariate analysis, SUVmax, SUVmean, T/B and SUVmaxTTP were predictive for PFS (all p < 0.05); SUVmaxTTP was predictive for OS (p = 0.02). At multivariate analysis, SUVmaxTTP remained significant for PFS (p = 0.03). Conclusion: Semiquantitative parameters and SUVmaxTTP were associated with clinical outcomes in patients with suspected glioma recurrence. Dynamic PET-CT acquisition, with static and kinetic parameters, can be a valuable non-invasive prognostic marker, identifying patients with worse prognosis who require personalised therapy.
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Schmidt DR, Patel R, Kirsch DG, Lewis CA, Vander Heiden MG, Locasale JW. Metabolomics in cancer research and emerging applications in clinical oncology. CA Cancer J Clin 2021; 71:333-358. [PMID: 33982817 PMCID: PMC8298088 DOI: 10.3322/caac.21670] [Citation(s) in RCA: 296] [Impact Index Per Article: 98.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
Cancer has myriad effects on metabolism that include both rewiring of intracellular metabolism to enable cancer cells to proliferate inappropriately and adapt to the tumor microenvironment, and changes in normal tissue metabolism. With the recognition that fluorodeoxyglucose-positron emission tomography imaging is an important tool for the management of many cancers, other metabolites in biological samples have been in the spotlight for cancer diagnosis, monitoring, and therapy. Metabolomics is the global analysis of small molecule metabolites that like other -omics technologies can provide critical information about the cancer state that are otherwise not apparent. Here, the authors review how cancer and cancer therapies interact with metabolism at the cellular and systemic levels. An overview of metabolomics is provided with a focus on currently available technologies and how they have been applied in the clinical and translational research setting. The authors also discuss how metabolomics could be further leveraged in the future to improve the management of patients with cancer.
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Affiliation(s)
- Daniel R. Schmidt
- Koch Institute, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Rutulkumar Patel
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC 27708 USA
| | - David G. Kirsch
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC 27708 USA
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC 27708 USA
| | - Caroline A. Lewis
- Whitehead Institute for Biomedical Research, Cambridge, MA 02142, USA
| | - Matthew G. Vander Heiden
- Koch Institute, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jason W. Locasale
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC 27708 USA
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Evaluation of Glycolytic Response to Multiple Classes of Anti-glioblastoma Drugs by Noninvasive Measurement of Pyruvate Kinase M2 Using [ 18F]DASA-23. Mol Imaging Biol 2021; 22:124-133. [PMID: 30989436 DOI: 10.1007/s11307-019-01353-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Pyruvate kinase M2 (PKM2) catalyzes the final step in glycolysis, the key process of tumor metabolism. PKM2 is found in high levels in glioblastoma (GBM) cells with marginal expression within healthy brain tissue, rendering it a key biomarker of GBM metabolic re-programming. Our group has reported the development of a novel radiotracer, 1-((2-fluoro- 6-[18F]fluorophenyl)sulfonyl)-4-((4-methoxyphenyl)sulfonyl)piperazine ([18F]DASA- 23), to non-invasively detect PKM2 levels with positron emission tomography (PET). PROCEDURE U87 human GBM cells were treated with the IC50 concentration of various agents used in the treatment of GBM, including alkylating agents (temozolomide, carmustine, lomustine, procarbazine), inhibitor of topoisomerase I (irinotecan), vascular endothelial and epidermal growth factor receptor inhibitors (cediranib and erlotinib, respectively) anti-metabolite (5-fluorouracil), microtubule inhibitor (vincristine), and metabolic agents (dichloroacetate and IDH1 inhibitor ivosidenib). Following drug exposure for three or 6 days (n = 6 replicates per condition), the radiotracer uptake of [18F]DASA-23 and 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) was assessed. Changes in PKM2 protein levels were determined via Western blot and correlated to radiotracer uptake. RESULTS Significant interactions were found between the treatment agent (n = 12 conditions total comprised 11 drugs and vehicle) and the duration of treatment (3- or 6-day exposure to each drug) on the cellular uptake of [18F]DASA-23 (p = 0.0001). The greatest change in the cellular uptake of [18F]DASA-23 was found after exposure to alkylating agents (p < 0. 0001) followed by irinotecan (p = 0. 0012), erlotinib (p = 0. 02), and 5-fluorouracil (p = 0. 005). Correlation of PKM2 protein levels and [18F]DASA-23 cellular uptake revealed a moderate correlation (r = 0.44, p = 0.15). CONCLUSIONS These proof of principle studies emphasize the superiority of [18F]DASA-23 to [18F]FDG in detecting the glycolytic response of GBM to multiple classes of anti-neoplastic drugs in cell culture. A clinical trial evaluating the diagnostic utility of [18F]DASA-23 PET in GBM patients (NCT03539731) is ongoing.
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Liu L, Li S, Pan W, Wang L, Zheng Y, An X, Zhou Y, Li Y, Na J, Zhang R, Mu H, Dong W, Gao Y, Sun W, Pan G, Yan L. Prevalence of mental health problems in Chinese schoolchildren: The influence of measuring impact score and combining information from multiple informants. Child Adolesc Psychiatry Ment Health 2020; 14:44. [PMID: 33292463 PMCID: PMC7654147 DOI: 10.1186/s13034-020-00346-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 10/05/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To measure the effects of using different combinations of multiple informants and the impact score on the estimated prevalence of mental health problems in Chinese schoolchildren. METHODS Complete information on the Strengths and Difficulties Questionnaire (SDQ) were obtained from students (S), parents (P), and teachers (T) for 4986 schoolchildren (11-17 years-old). We used 3 criteria to determine the prevalence of mental health problems: SDQ cut-off value (previously established in the United Kingdom), SDQ cut-off value plus an impact score of 1 or more, or plus an impact score of 2 or more. A student was defined as having a mental health problem if any informant (S, P, or T) classified the child as 'abnormal'. We compared the prevalence of mental health problems determined from 1 informant, 2 informants, and 3 informants. RESULTS The prevalence of overall mental health problems increased with rising number of informants, but decreased with increasing impact score. When the impact score was not considered, the prevalence was 8.2% to 14.2% when rated by 1 informant, 18.8% to 24.7% when rated by 2 informants, and 28.3% when rated by all 3 informants. Failure to measure the impact score led to a two to threefold greater estimate of the prevalence of mental health problems. CONCLUSIONS The types, number, and combinations of multiple informants and use of the impact score must be considered when comparing the results of different studies. It is preferable to use multiple informants and have the impact score taken the impact into account to reflect the real burden of mental health burden in children and adolescent.
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Affiliation(s)
- Li Liu
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122 P. R. China
- Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning P. R. China
| | - Shuang Li
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122 P. R. China
- Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning P. R. China
| | - Wen Pan
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122 P. R. China
- Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning P. R. China
| | - Lijuan Wang
- Anshan Municipal Center for Disease Control and Prevention, Anshan, P. R. China
| | - Yang Zheng
- Panjin Municipal Center for Disease Control and Prevention, Panjin, P. R. China
| | - Xiaoxia An
- Benxi Municipal Center for Disease Control and Prevention, Benxi, P. R. China
| | - Yan Zhou
- Dandong Municipal Center for Disease Control and Prevention, Dandong, P. R. China
| | - Yanxia Li
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122 P. R. China
- Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning P. R. China
| | - Jun Na
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122 P. R. China
- Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning P. R. China
| | - Rui Zhang
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122 P. R. China
- Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning P. R. China
| | - Huijuan Mu
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122 P. R. China
- Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning P. R. China
| | - Wen Dong
- Department of Personal Resource, Dalian Medical College, Dalian, P. R. China
| | - Yuan Gao
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, 110122 P. R. China
| | - Wei Sun
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, 110122 P. R. China
| | - Guowei Pan
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, 110122 P. R. China
| | - Lingjun Yan
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, 110122 P. R. China
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Yang Y, He MZ, Li T, Yang X. MRI combined with PET-CT of different tracers to improve the accuracy of glioma diagnosis: a systematic review and meta-analysis. Neurosurg Rev 2019; 42:185-195. [PMID: 28918564 PMCID: PMC6503074 DOI: 10.1007/s10143-017-0906-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 12/18/2022]
Abstract
Based on studies focusing on positron emission tomography (PET)-computed tomography (CT) combined with magnetic resonance imaging (MRI) in the diagnosis of glioma, we conducted a systematic review and meta-analysis evaluating the pros and cons and the accuracy of different examinations. PubMed and Cochrane Library were searched. The search was conducted until April 2017. Two reviewers independently conducted the literature search according to the criteria set initially. Based on the exclusion criteria, 15 articles are included in this study. Of all studies that used MRI examination, there are five involving 18F-fluorodeoxyglucose-PET, five involving 11C-methionine-PET, five involving 18F-fluoro-ethyl-tyrosine-PET, and three involving 18F-fluorothymidine-PET. Due to the limitations such as lack of data, small sample size, and unrepresentative studies, we use a non-quantitative methodology. MRI examination can provide the anatomy information of glioma more clearly. PET-CT examinations based on tumor metabolism using different tracers have more advantages in determining the degree of glioma malignancy and boundaries. However, information provided by PET-CT of different tracers is not the same. With respect to the novel hybrid MRI/PET examination equipment proposed in recent years, the combination of MRI and PET-CT can definitively improve the diagnostic accuracy of glioma.
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Affiliation(s)
- Yihan Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Mike Z He
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Tao Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Xuejun Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China.
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Fiedler L, Kellner M, Oos R, Böning G, Ziegler S, Bartenstein P, Zeidler R, Gildehaus FJ, Lindner S. Fully Automated Production and Characterization of 64 Cu and Proof-of-Principle Small-Animal PET Imaging Using 64 Cu-Labelled CA XII Targeting 6A10 Fab. ChemMedChem 2018; 13:1230-1237. [PMID: 29667369 DOI: 10.1002/cmdc.201800130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/09/2018] [Indexed: 01/26/2023]
Abstract
64 Cu is a cyclotron-produced radionuclide which offers, thanks to its characteristic decay scheme, the possibility of combining positron emission tomography (PET) investigations with radiotherapy. We evaluated the Alceo system from Comecer SpA to automatically produce 64 Cu for radiolabelling purposes. We established a 64 Cu production routine with high yields and radionuclide purity in combination with excellent operator radiation protection. The carbonic anhydrase XII targeting 6A10 antibody Fab fragment was successfully radiolabelled with the produced 64 Cu, and proof-of-principle small-animal PET experiments on mice bearing glioma xenografts were performed. We obtained a high tumor-to-contralateral muscle ratio, which encourages further in vivo investigations of the radioconjugate regarding a possible application in diagnostic tumor imaging.
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Affiliation(s)
- Luise Fiedler
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Markus Kellner
- Helmholtz-Zentrum München, German Research Center for Environmental Health, Research Group Gene Vectors, Marchioninistrasse 25, 81377, Munich, Germany
| | - Rosel Oos
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Guido Böning
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Sibylle Ziegler
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Reinhard Zeidler
- Helmholtz-Zentrum München, German Research Center for Environmental Health, Research Group Gene Vectors, Marchioninistrasse 25, 81377, Munich, Germany.,Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Franz Josef Gildehaus
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Simon Lindner
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Dadone-Montaudié B, Ambrosetti D, Dufour M, Darcourt J, Almairac F, Coyne J, Virolle T, Humbert O, Burel-Vandenbos F. [18F] FDOPA standardized uptake values of brain tumors are not exclusively dependent on LAT1 expression. PLoS One 2017; 12:e0184625. [PMID: 28937983 PMCID: PMC5609741 DOI: 10.1371/journal.pone.0184625] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/28/2017] [Indexed: 11/18/2022] Open
Abstract
[18F]-FDOPA is a labeled amino acid (AA) analog used for positron emission tomography (PET) which is gaining increasing interest in the evaluation of brain tumors (BT). The AA-transporter LAT1 has been shown to be involved in [18F]-FDOPA uptake. The aim of this study was to determine whether the [18F]-FDOPA uptake was correlated with level of LAT1 expression in BT. Twenty-eight BT (including 19 gliomas and 9 metastases) were investigated by [18F]-FDOPA-PET prior to surgery and by anti-LAT1 immunohistochemistry on surgical specimens. The quantitative [18F]-FDOPA measured parameters were SUVmax, SUVmean and SUVpeak. LAT1 expression was quantified using a score (0 to 400). A significant [18F]-FDOPA uptake was associated with a LAT1 score ≥ 100 (p = 0.02) but there was no linear correlation between intensity of [18F]-FDOPA uptake and score of LAT1 expression whatever the parameters considered. LAT1 expression alone is not sufficient to explain variation of intensity of [18F]-FDOPA uptake in BT.
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Affiliation(s)
- Bérengère Dadone-Montaudié
- Department of Pathology, University Hospital, Nice, France
- UCA, Université Côte d’Azur, Nice-Sophia-Antipolis, France
| | - Damien Ambrosetti
- Department of Pathology, University Hospital, Nice, France
- UCA, Université Côte d’Azur, Nice-Sophia-Antipolis, France
| | - Maxime Dufour
- UCA, Université Côte d’Azur, Nice-Sophia-Antipolis, France
- Department of Nuclear Medicine, Centre Antoine Lacassagne, Nice, France
- TIRO–UMR E 4320, University of Nice-Sophia-Antipolis, Nice, France
| | - Jacques Darcourt
- UCA, Université Côte d’Azur, Nice-Sophia-Antipolis, France
- Department of Nuclear Medicine, Centre Antoine Lacassagne, Nice, France
- TIRO–UMR E 4320, University of Nice-Sophia-Antipolis, Nice, France
| | - Fabien Almairac
- UCA, Université Côte d’Azur, Nice-Sophia-Antipolis, France
- Department of Neurosurgery, University Hospital, Nice, France
- UMR CNRS 7277-UMR INSERM 1091, Institute of Biology Valrose, University of Nice-Sophia-Antipolis, Nice, France
| | - John Coyne
- Department of Pathology, University Hospital, Nice, France
- UCA, Université Côte d’Azur, Nice-Sophia-Antipolis, France
| | - Thierry Virolle
- UCA, Université Côte d’Azur, Nice-Sophia-Antipolis, France
- UMR CNRS 7277-UMR INSERM 1091, Institute of Biology Valrose, University of Nice-Sophia-Antipolis, Nice, France
| | - Olivier Humbert
- UCA, Université Côte d’Azur, Nice-Sophia-Antipolis, France
- Department of Nuclear Medicine, Centre Antoine Lacassagne, Nice, France
- TIRO–UMR E 4320, University of Nice-Sophia-Antipolis, Nice, France
| | - Fanny Burel-Vandenbos
- Department of Pathology, University Hospital, Nice, France
- UCA, Université Côte d’Azur, Nice-Sophia-Antipolis, France
- UMR CNRS 7277-UMR INSERM 1091, Institute of Biology Valrose, University of Nice-Sophia-Antipolis, Nice, France
- * E-mail:
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Yano H, Shinoda J, Iwama T. Clinical Utility of Positron Emission Tomography in Patients with Malignant Glioma. Neurol Med Chir (Tokyo) 2017; 57:312-320. [PMID: 28458384 PMCID: PMC5566704 DOI: 10.2176/nmc.ra.2016-0312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Positron emission tomography (PET) is being increasingly utilized for the management of brain tumors. Herein, we primarily review our previous studies on the use of PET in glioma that utilize three types of tracers: 11C-methionine (MET), 11C-choline, and 18F-fluorodeoxyglucose. These studies included aspects such as tumor behavior, diagnosis, grade of malignancy, spread and invasion, viability, and genetic deletions; moreover, they also evaluated PET as a tool for planning radiation therapy (RT) and determining its outcome. MET-PET in particular is considered to be the most informative for diagnosis and therapeutic decision-making for glioma patients; it is therefore considered crucial for brain tumor therapy. MET-PET is expected to be widely used for brain tumor patients going forward.
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Affiliation(s)
- Hirohito Yano
- Department of Neurosurgery, Gifu University Graduate School of Medicine
| | - Jun Shinoda
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Department of Neurosurgery, Kizawa Memorial Hospital
| | - Toru Iwama
- Department of Neurosurgery, Gifu University Graduate School of Medicine
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Uehara T, Watanabe M, Suzuki H, Furusawa Y, Arano Y. Amino acid transport system - A substrate predicts the therapeutic effects of particle radiotherapy. PLoS One 2017; 12:e0173096. [PMID: 28245294 PMCID: PMC5330493 DOI: 10.1371/journal.pone.0173096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/15/2017] [Indexed: 11/19/2022] Open
Abstract
L-[methyl-11C]Methionine (11C-Met) is useful for estimating the therapeutic efficacy of particle radiotherapy at early stages of the treatment. Given the short half-life of 11C, the development of longer-lived 18F- and 123I-labeled probes that afford diagnostic information similar to 11C-Met, are being sought. Tumor uptake of 11C-Met is involved in many cellular functions such as amino acid transport System-L, protein synthesis, and transmethylation. Among these processes, since the energy-dependent intracellular functions involved with 11C-Met are more reflective of the radiotherapeutic effects, we evaluated the activity of the amino acid transport System-A as an another energy-dependent cellular function in order to estimate radiotherapeutic effects. In this study, using a carbon-ion beam as the radiation source, the activity of System-A was evaluated by a specific System-A substrate, alpha-[1-14C]-methyl-aminoisobutyric acid (14C-MeAIB). Cellular growth and the accumulation of 14C-MeAIB or 14C-Met were evaluated over time in vitro in cultured human salivary gland (HSG) tumor cells (3-Gy) or in vivo in murine xenografts of HSG tumors (6- or 25-Gy) before and after irradiation with the carbon-ion beam. Post 3-Gy irradiation, in vitro accumulation of 14C-Met and 14C-MeAIB decreased over a 5-day period. In xenografts of HSG tumors in mice, tumor re-growth was observed in vivo on day-10 after a 6-Gy irradiation dose, but no re-growth was detected after the 25-Gy irradiation dose. Consistent with the growth results, the in vivo tumor accumulation of 14C-MeAIB did not decrease after the 6-Gy irradiation dose, whereas a significant decrease was observed after the 25-Gy irradiation dose. These results indicate that the activity of energy dependent System-A transporter may reflect the therapeutic efficacy of carbon-ion radiotherapy and suggests that longer half-life radionuclide-labeled probes for System-A may also provide widely available probes to evaluate the effects of particle radiotherapy on tumors at early stage of the treatment.
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Affiliation(s)
- Tomoya Uehara
- Department of Molecular Imaging and Radiotherapy, Graduate School of Pharmaceutical Science, Chiba University, Chiba, Japan
- * E-mail:
| | - Mariko Watanabe
- Department of Molecular Imaging and Radiotherapy, Graduate School of Pharmaceutical Science, Chiba University, Chiba, Japan
| | - Hiroyuki Suzuki
- Department of Molecular Imaging and Radiotherapy, Graduate School of Pharmaceutical Science, Chiba University, Chiba, Japan
| | - Yoshiya Furusawa
- National Institutes for Quantum and Radiological Science and Technology, National Institute of Radiological Sciences, Chiba, Japan
| | - Yasushi Arano
- Department of Molecular Imaging and Radiotherapy, Graduate School of Pharmaceutical Science, Chiba University, Chiba, Japan
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Abstract
Positron emission tomography (PET) is an extraordinarily sensitive clinical imaging modality for interrogating tumor metabolism. Radiolabeled PET substrates can be traced at subphysiological concentrations, allowing noninvasive imaging of metabolism and intratumoral heterogeneity in systems ranging from advanced cancer models to patients in the clinic. There are a wide range of novel and more established PET radiotracers, which can be used to investigate various aspects of the tumor, including carbohydrate, amino acid, and fatty acid metabolism. In this review, we briefly discuss the more established metabolic tracers and describe recent work on the development of new tracers. Some of the unanswered questions in tumor metabolism are considered alongside new technical developments, such as combined PET/magnetic resonance imaging scanners, which could provide new imaging solutions to some of the outstanding diagnostic challenges facing modern cancer medicine.
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Affiliation(s)
- David Y. Lewis
- Cancer Research UK - Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
| | - Dmitry Soloviev
- Cancer Research UK - Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
| | - Kevin M. Brindle
- Cancer Research UK - Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
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Kuang Y, Wang F, Corn DJ, Tian H, Lee Z. Metabolism of radiolabeled methionine in hepatocellular carcinoma. Mol Imaging Biol 2014; 16:44-52. [PMID: 23921714 DOI: 10.1007/s11307-013-0678-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Radiolabeled methionine (Met) promises to be useful in the positron emission tomography (PET) imaging of hepatocellular carcinoma (HCC). However, its metabolic routes in HCC have not yet been fully understood. In this study, the metabolic pathway(s) of radiolabeled Met in HCC were investigated. PROCEDURES To simulate the rapid blood clearance of radiolabeled Met, pulse-chase experiments were conducted. L-[methyl-(3)H]-Met or L-[1-(14)C]-Met was pulsed over control or cycloheximide-treated WCH17 cells and rat hepatocytes for 5 min and chased with cold media. The water-soluble, lipid-soluble, DNA, RNA, and protein phases were subsequently extracted and measured from the acid-precipitable and acid-soluble fractions of whole cells. The radioactive metabolites Met, S-adenosylmethionine (SAM), S-adenosylhomocysteine, Met sulfoxide, and Met sulfone were further separated by radio thin layer chromatography. RESULTS (1) The uptake of L-[methyl-(3)H]-Met in both cell types was higher than that of L-[1-(14)C]-Met. In rat hepatocytes, the uptake of L-[methyl-(3)H]-Met was significantly higher than that of L-[1-(14)C]-Met, which may contribute to its physiologic accumulation in surrounding hepatic tissues seen in PET imaging of HCC using L-[methyl-(11)C]-Met. Compared to rat hepatocytes, WCH17 cells had significantly higher uptake of both radiotracers. (2) For L-[methyl-(3)H]-Met, the major intracellular uptake was found mostly in the protein phase and, to a lesser degree, in the phosphatidylethanolamine (PE) methylation pathway, which is fairly stabilized within the 55-min chase period (the main metabolites were SAM, Met, Met sulfoxide, and Met sulfone). In contrast, the uptake of Met in rat hepatocytes mainly points to phosphatidylcholine (PC) synthesis through the PE methylation pathway (the main metabolite was PC). (3) Both cell types incorporated L-[1-(14)C]-Met predominantly into protein synthesis. (4) Finally, when the protein synthesis pathway was inhibited, the incorporation of SAM derived from L-[methyl-(3)H]-Met to lipid class (PC was the main metabolite) occurred at a reduced rate in WCH17 cells, suggesting that the route may be impaired in HCC. CONCLUSIONS This study demonstrated that different metabolic pathways of radiolabeled Met exist between HCC and surrounding hepatic tissue and contribute to the patterns of increased uptake of radiolabeled Met in HCC.
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Affiliation(s)
- Yu Kuang
- Nuclear Medicine Division, Department of Radiology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
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Okita Y, Nonaka M, Shofuda T, Kanematsu D, Yoshioka E, Kodama Y, Mano M, Nakajima S, Kanemura Y. (11)C-methinine uptake correlates with MGMT promoter methylation in nonenhancing gliomas. Clin Neurol Neurosurg 2014; 125:212-6. [PMID: 25178915 DOI: 10.1016/j.clineuro.2014.08.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/29/2014] [Accepted: 08/03/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Several studies have aimed to detect biomarkers in glioma using noninvasive imaging techniques. However, few studies have been able to image 1p/19q deletion by (11)C-methionine positron emission tomography ((11)C-methionine PET) or 2-hydroxyglutarate (2HG) by proton magnetic resonance spectroscopy (MRS). This study examines the correlation between (11)C-methionine uptake and MGMT promoter methylation in grade II and grade III nonenhancing gliomas. PATIENTS AND METHODS Data was collected from 20 patients with grade II and III nonenhancing gliomas who underwent both MRI and (11)C-methionine PET as part of their pre-surgical examination. We examined MGMT promoter methylation by quantitative methylation-specific PCR. RESULTS The mean MGMT promoter methylation for tumors with T/N ratios ≥1.6 was 28.0±26.3, and that for tumors with T/N ratios <1.6 was 0.68±0.89. The MGMT promoter methylation for tumors with T/N ratios ≥1.6 was significantly higher than that for tumors with T/N ratios <1.6 (P<0.05). CONCLUSIONS A higher uptake in (11)C-methionine PET may reflect increased MGMT promoter methylation. (11)C-methionine PET could be a useful tool to detect MGMT promoter methylation in nonenhancing glioma.
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Affiliation(s)
- Yoshiko Okita
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
| | - Masahiro Nonaka
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan.
| | - Tomoko Shofuda
- Division of Stem Cell Research, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
| | - Daisuke Kanematsu
- Division of Regenerative Medicine, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
| | - Ema Yoshioka
- Division of Stem Cell Research, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
| | - Yoshinori Kodama
- Department of Central Laboratory and Surgical Pathology, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
| | - Masayuki Mano
- Department of Central Laboratory and Surgical Pathology, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
| | - Shin Nakajima
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
| | - Yonehiro Kanemura
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan; Division of Regenerative Medicine, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
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Ahmed R, Oborski MJ, Hwang M, Lieberman FS, Mountz JM. Malignant gliomas: current perspectives in diagnosis, treatment, and early response assessment using advanced quantitative imaging methods. Cancer Manag Res 2014; 6:149-70. [PMID: 24711712 PMCID: PMC3969256 DOI: 10.2147/cmar.s54726] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Malignant gliomas consist of glioblastomas, anaplastic astrocytomas, anaplastic oligodendrogliomas and anaplastic oligoastrocytomas, and some less common tumors such as anaplastic ependymomas and anaplastic gangliogliomas. Malignant gliomas have high morbidity and mortality. Even with optimal treatment, median survival is only 12–15 months for glioblastomas and 2–5 years for anaplastic gliomas. However, recent advances in imaging and quantitative analysis of image data have led to earlier diagnosis of tumors and tumor response to therapy, providing oncologists with a greater time window for therapy management. In addition, improved understanding of tumor biology, genetics, and resistance mechanisms has enhanced surgical techniques, chemotherapy methods, and radiotherapy administration. After proper diagnosis and institution of appropriate therapy, there is now a vital need for quantitative methods that can sensitively detect malignant glioma response to therapy at early follow-up times, when changes in management of nonresponders can have its greatest effect. Currently, response is largely evaluated by measuring magnetic resonance contrast and size change, but this approach does not take into account the key biologic steps that precede tumor size reduction. Molecular imaging is ideally suited to measuring early response by quantifying cellular metabolism, proliferation, and apoptosis, activities altered early in treatment. We expect that successful integration of quantitative imaging biomarker assessment into the early phase of clinical trials could provide a novel approach for testing new therapies, and importantly, for facilitating patient management, sparing patients from weeks or months of toxicity and ineffective treatment. This review will present an overview of epidemiology, molecular pathogenesis and current advances in diagnoses, and management of malignant gliomas.
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Affiliation(s)
- Rafay Ahmed
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew J Oborski
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Misun Hwang
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frank S Lieberman
- Department of Neurology and Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - James M Mountz
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
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Rheims S, Rubi S, Bouvard S, Bernard E, Streichenberger N, Guenot M, Le Bars D, Hammers A, Ryvlin P. Accuracy of distinguishing between dysembryoplastic neuroepithelial tumors and other epileptogenic brain neoplasms with [¹¹C]methionine PET. Neuro Oncol 2014; 16:1417-26. [PMID: 24598358 DOI: 10.1093/neuonc/nou022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dysembryoplastic neuroepithelial tumors (DNTs) represent a prevalent cause of epileptogenic brain tumors, the natural evolution of which is much more benign than that of most gliomas. Previous studies have suggested that [(11)C]methionine positron emission tomography (MET-PET) could help to distinguish DNTs from other epileptogenic brain tumors, and hence optimize the management of patients. Here, we reassessed the diagnostic accuracy of MET-PET for the differentiation between DNT and other epileptogenic brain neoplasms in a larger population. METHODS We conducted a retrospective study of 77 patients with focal epilepsy related to a nonrapidly progressing brain tumor on MRI who underwent MET-PET, including 52 with a definite histopathology. MET-PET data were assessed by a structured visual analysis that distinguished normal, moderately abnormal, and markedly abnormal tumor methionine uptake and by semiquantitative ratio measurements. RESULTS Pathology showed 21 DNTs (40%), 10 gangliogliomas (19%), 19 low-grade gliomas (37%), and 2 high-grade gliomas (4%). MET-PET visual findings significantly differed among the various tumor types (P < .001), as confirmed by semiquantitative analyses (P < .001 for all calculated ratios), regardless of gadolinium enhancement on MRI. All gliomas and gangliogliomas were associated with moderately or markedly increased tumor methionine uptake, whereas 9/21 DNTs had normal methionine uptake. Receiver operating characteristics analysis of the semiquantitative ratios showed an optimal cutoff threshold that distinguished DNTs from other tumor types with 90% specificity and 89% sensitivity. CONCLUSIONS Normal MET-PET findings in patients with an epileptogenic nonrapidly progressing brain tumor are highly suggestive of DNT, whereas a markedly increased tumor methionine uptake makes this diagnosis unlikely.
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Affiliation(s)
- Sylvain Rheims
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Sebastià Rubi
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Sandrine Bouvard
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Emilien Bernard
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Nathalie Streichenberger
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Marc Guenot
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Didier Le Bars
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Alexander Hammers
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Philippe Ryvlin
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
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Abstract
Brain tumors are one of the most challenging disorders encountered, and early and accurate diagnosis is essential for the management and treatment of these tumors. In this article, diagnostic modalities including single-photon emission computed tomography, positron emission tomography, magnetic resonance imaging, and optical imaging are reviewed. We mainly focus on the newly emerging, specific imaging probes, and their potential use in animal models and clinical settings.
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Affiliation(s)
- Huile Gao
- Key Laboratory of Smart Drug Delivery, Ministry of Education & PLA, School of Pharmacy, Fudan University, 826 Zhangheng Road, Shanghai 201203, China
| | - Xinguo Jiang
- Key Laboratory of Smart Drug Delivery, Ministry of Education & PLA, School of Pharmacy, Fudan University, 826 Zhangheng Road, Shanghai 201203, China
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Metabolic mapping of gliomas using hybrid MR-PET imaging: feasibility of the method and spatial distribution of metabolic changes. Invest Radiol 2013; 48:295-301. [PMID: 23296081 DOI: 10.1097/rli.0b013e31827188d6] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The most powerful adjunct to histopathology for the grading of gliomas seems to be the metabolic imaging using positron emission tomography and magnetic resonance spectroscopy (MRS). The purposes of this study were to examine the feasibility of simultaneous acquisition of both techniques for purposes of tumor grading in a newly launched hybrid magnetic resonance positron emission tomography (MR-PET) and to examine the spatial distributions of metabolic changes in gliomas. MATERIALS AND METHODS Twenty-eight consecutive patients with gliomas underwent simultaneous methionine (Met) MR-PET imaging for detection of the most malignant tumor part before surgical sampling. After coregistration and fusion of MR-PET and MRS data, tumor to normal brain (T/N) Met uptake ratios and the corresponding metabolites peaks (choline [Cho], creatine [Cr], and N-acetylaspartate [NAA]) in MRS were recorded. The patients were divided into 4 types on the basis of the relation between the Met uptake area and the increased metabolite ratios: type I, the increased Met uptake area had at least 50% overlap or was completely within the area of increased Cho/NAA ratio; type II, the increased Met uptake site had less than 50% overlap of increased Cho/NAA ratio site; type III, the increased Met uptake region had no spatial relationship with the "hot" lesions in the MRS maps; and type IV, there was no pathologically increased Met uptake. The surgical sampling was performed in the tumor part with the highest Met uptake and, in the absence of increased Met accumulation, in the site with the highest Cho/NAA ratio. All surgical samples were referred to the neuropathology division for histological grading. RESULTS A total of 16 low-grade gliomas (World Health Organization grade II) and 12 high-grade gliomas (World Health Organization grade III) were included. Three lesions (10%) of type I were identified. Four lesions (14%) were classified as type II and 6 lesions (21%) were classified as type 3, where the increased Met uptake region had no spatial relationship with the hot lesions in the MRS maps. In 15 of the 28 patients (54%), there was no increased Met accumulation (type 4 lesions). Maps of Cho/NAA and Cr/NAA showed a close spatial relationship in most of the patients. Median T/N Met uptake ratio in the pooled surgically sampled tumor sites was 1.6 (range, 1-3), and median Cho/NAA and Cho/Cr ratios were 2.1 (range, 0.9-5.8) and 1.5 (range, 0.5-8.3), respectively. Spearman rank correlations of the metabolic markers in the low-grade gliomas showed significant correlations between Met uptake and Cr/NAA ratio (ρ = 0.59; P = 0.015) as well as between Cho/NAA and Cr/NAA ratios (ρ = 0.79; P = 0.0002). The normalized tumor creatine was significantly higher in anaplastic tumors compared with the low-grade gliomas (P = 0.001). A tendency for a significant positive correlation was found between normalized tumor creatine and Met uptake in the anaplastic tumors. CONCLUSIONS Metabolic mapping before histological sampling is feasible using simultaneous MR-PET imaging. High T/N Met uptake ratio reflecting high expression of amino-acid membrane transporters, which is indicative of proliferating tumor cell populations, does not always spatially correlate with neuronal cell loss and cell membrane proliferation (Cho/NAA) seen in MRS. Increased Cr/NAA is associated with increased methionine uptake in low-grade gliomas, whereas normalized creatine in tumor tends to correlate with methionine accumulation, which indicates a possible coupling of these metabolic indices in anaplastic tumors. Thus, spatial distribution differences in gliomas should be taken into account when planning surgical sampling.
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Metabolic assessment of intracranial tuberculomas using 11C-methionine and 18F-FDG PET/CT. Nucl Med Commun 2012; 33:408-14. [DOI: 10.1097/mnm.0b013e32834f9b14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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The Assay of Enzyme Activity by Positron Emission Tomography. MOLECULAR IMAGING IN THE CLINICAL NEUROSCIENCES 2012. [DOI: 10.1007/7657_2012_53] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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21
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Galldiks N, Kracht LW, Dunkl V, Ullrich RT, Vollmar S, Jacobs AH, Fink GR, Schroeter M. Imaging of Non— or Very Subtle Contrast-Enhancing Malignant Gliomas with [11C]-Methionine Positron Emission Tomography. Mol Imaging 2011. [DOI: 10.2310/7290.2011.00014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In patients with World Health Organization (WHO) grade III glioma with a lack of or minimal (< 1 cm3) magnetic resonance imaging (MRI) contrast enhancement, the volume of the metabolically active part of the tumor was assessed by [ 11 C]-methionine positron emission tomography (MET-PET). Eleven patients with WHO grade III gliomas underwent MET-PET and MRI (contrast-enhanced T1-and T2-weighted images). To calculate the volumes in cubic centimeters, threshold-based volume of interest analyses of the metabolically active tumor (MET uptake index ≥ 1.3), contrast enhancement, and the T2 lesion were performed after coregistration of all images. In all patients, the metabolically active tumor volume was larger than the volume of gadolinium–diethylenetriamine pentaacetic acid (Gd-DTPA) enhancement (20.8 ± 18.8 vs 0.29 ± 0.25 cm3; p < .001). With the exception of one patient, the volumes of contrast enhancement were located within the metabolically active tumor volume. In contrast, in the majority of patients, MET uptake overlapped with the T<sb>2 lesion and reached beyond it (in 10 of 12 MRIs/MET-PET scans). The present data suggest that in patients with WHO grade III glioma with minimal or a lack of contrast enhancement, MET-PET delineates metabolically active tumor tissue. These findings support the use of combined PET-MRI with radiolabeled amino acids (eg, MET) for the delineating of the true extent of active tumor in the diagnosis and treatment planning of patients with gliomas.
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Affiliation(s)
- Norbert Galldiks
- From the Department of Neurology, University Hospital of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Lutz W. Kracht
- From the Department of Neurology, University Hospital of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Veronika Dunkl
- From the Department of Neurology, University Hospital of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Roland T. Ullrich
- From the Department of Neurology, University Hospital of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Stefan Vollmar
- From the Department of Neurology, University Hospital of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Andreas H. Jacobs
- From the Department of Neurology, University Hospital of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Gereon R. Fink
- From the Department of Neurology, University Hospital of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Michael Schroeter
- From the Department of Neurology, University Hospital of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and European Institute for Molecular Imaging, University of Münster, Münster, Germany
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Heiss WD, Raab P, Lanfermann H. Multimodality assessment of brain tumors and tumor recurrence. J Nucl Med 2011; 52:1585-600. [PMID: 21840931 DOI: 10.2967/jnumed.110.084210] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Neuroimaging plays a significant role in the diagnosis of intracranial tumors, especially brain gliomas, and must consist of an assessment of location and extent of the tumor and of its biologic activity. Therefore, morphologic imaging modalities and functional, metabolic, or molecular imaging modalities should be combined for primary diagnosis and for following the course and evaluating therapeutic effects. MRI is the gold standard for providing detailed morphologic information and can supply some additional insights into metabolism (MR spectroscopy) and perfusion (perfusion-weighted imaging) but still has limitations in identifying tumor grade, invasive growth into neighboring tissue, and treatment-induced changes, as well as recurrences. These insights can be obtained by various PET modalities, including imaging of glucose metabolism, amino acid uptake, nucleoside uptake, and hypoxia. Diagnostic accuracy can benefit from coregistration of PET results and MRI, combining the high-resolution morphologic images with the biologic information. These procedures are optimized by the newly developed combination of PET and MRI modalities, permitting the simultaneous assessment of morphologic, functional, metabolic, and molecular information on the human brain.
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Nowak AK, Francis RJ, Katz SI, Gerbaudo VH. A Multimodality Imaging Review of Malignant Pleural Mesothelioma Response Assessment. PET Clin 2011; 6:299-311. [PMID: 27156725 DOI: 10.1016/j.cpet.2011.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Assessment of response is important to interpret early phase clinical trial results and to guide individual patient management. In malignant pleural mesothelioma (MPM), the circumferential growth pattern of the disease, the presence of pleural effusion and atelectasis, and the common use of pleurodesis make this a challenging task for imaging specialists and clinicians. This article reviews the current evidence for radiological and positron emission tomography (PET) response assessment in MPM, and the pitfalls and challenges in its application. Current research and future directions in radiological and PET response are discussed, including the use of novel radiotracers.
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Affiliation(s)
- Anna K Nowak
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Nedlands, Perth 6009, Western Australia, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Verdun Street, Nedlands, Perth 6009, Western Australia, Australia
| | - Roslyn J Francis
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Nedlands, Perth 6009, Western Australia, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Verdun Street, Nedlands, Perth 6009, Western Australia, Australia
| | - Sharyn I Katz
- Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, 1 Silverstein Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Victor H Gerbaudo
- Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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24
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Colen RR, Kekhia H, Jolesz FA. Multimodality intraoperative MRI for brain tumor surgery. Expert Rev Neurother 2011; 10:1545-58. [PMID: 20945538 DOI: 10.1586/ern.10.145] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intraoperative MRI has already fundamentally changed the way current brain tumor surgery is performed. The ability to integrate high-field MRI into the operating room has allowed intraoperative MRI to emerge as an important adjunct to CNS tumor treatment. Furthermore, the ability of MRI to successfully couple with molecular imaging (PET and/or optical imaging), neuroendoscopy and therapeutic devices, such as focused ultrasound, will allow it to emerge as an important image-guidance modality for improving brain tumor therapy and outcomes.
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Affiliation(s)
- Rivka R Colen
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Volumetry of [(11)C]-methionine PET uptake and MRI contrast enhancement in patients with recurrent glioblastoma multiforme. Eur J Nucl Med Mol Imaging 2010; 37:84-92. [PMID: 19662410 PMCID: PMC2791473 DOI: 10.1007/s00259-009-1219-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Accepted: 07/01/2009] [Indexed: 11/06/2022]
Abstract
Purpose We investigated the relationship between three-dimensional volumetric data of the metabolically active tumour volume assessed using [11C]-methionine positron emission tomography (MET-PET) and the area of gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) enhancement assessed using magnetic resonance imaging (MRI) in patients with recurrent glioblastoma (GBM). Material and methods MET-PET and contrast-enhanced MRI with Gd-DTPA were performed in 12 uniformly pretreated patients with recurrent GBM. To calculate the volumes in cubic centimetres, a threshold-based volume-of-interest (VOI) analysis of the metabolically active tumour volume (MET uptake indexes of ≥1.3 and ≥1.5) and of the area of Gd-DTPA enhancement was performed after coregistration of all images. Results In all patients, the metabolically active tumour volume as shown using a MET uptake index of ≥1.3 was larger than the volume of Gd-DTPA enhancement (30.2 ± 22.4 vs. 13.7 ± 10.6 cm3; p = 0.04). Metabolically active tumour volumes as shown using MET uptake indexes of ≥1.3 and ≥1.5 and the volumes of Gd-DTPA enhancement showed a positive correlation (r = 0.76, p = 0.003, for an index of ≥1.3, and r = 0.74, p = 0.005, for an index of ≥1.5). Conclusion The present data suggest that in patients with recurrent GBM the metabolically active tumour volume may be substantially underestimated by Gd-DTPA enhancement. The findings support the notion that complementary information derived from MET uptake and Gd-DTPA enhancement may be helpful in developing individualized, patient-tailored therapy strategies in patients with recurrent GBM.
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Synthesis and analysis of 2-[211At]-L-phenylalanine and 4-[211At]-L-phenylalanine and their uptake in human glioma cell cultures in-vitro. Appl Radiat Isot 2010; 68:1060-5. [PMID: 20137958 DOI: 10.1016/j.apradiso.2009.12.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 12/15/2009] [Accepted: 12/28/2009] [Indexed: 11/24/2022]
Abstract
2-[211At]-L-phenylalanine and 4-[211At]-L-phenylalanine were prepared from the corresponding iodo and bromo derivatives using the Cu(+)-assisted nucleophilic exchange. 4-[211At]-L-phenylalanine was additionally prepared by destannylation of the BOC-derivatized 4-tributylstannyl-L-phenylalanine. Radiochemical yields of 2-[211At]-L-phenylalanine and 4-[211At]-L-phenylalanine by nucleophilic exchange were 52-74% and 65-85%. Radiochemical yield of 4-[211At]-L-phenylalanine by electrophilic destannylation was 35-50%. HPLC sequence analysis showed that 2-[211At]-L-phenylalanine followed the halogen sequence (F<Cl<Br<I<At) whereas 4-[211At]-L-phenylalanine eluted between 4-Br-L-phenylalanine and 4-I-L-phenylalanine (F<Cl<Br<At<I), independent on the production pathway. Uptake of 4-[211At]-L-phenylalanine and 4-[131I]-L-phenylalanine in DBTRG-05MG glioma cells was inhibited by l-phenylalanine 7-fold and 6-fold, respectively.
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Galldiks N, Kracht LW, Burghaus L, Ullrich RT, Backes H, Brunn A, Heiss WD, Jacobs AH. Patient-Tailored, Imaging-Guided, Long-Term Temozolomide Chemotherapy in Patients with Glioblastoma. Mol Imaging 2010. [DOI: 10.2310/7290.2010.00002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Norbert Galldiks
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Lutz W. Kracht
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Lothar Burghaus
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Roland T. Ullrich
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Heiko Backes
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Anna Brunn
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Wolf-Dieter Heiss
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Andreas H. Jacobs
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
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Okita Y, Kinoshita M, Goto T, Kagawa N, Kishima H, Shimosegawa E, Hatazawa J, Hashimoto N, Yoshimine T. (11)C-methionine uptake correlates with tumor cell density rather than with microvessel density in glioma: A stereotactic image-histology comparison. Neuroimage 2009; 49:2977-82. [PMID: 19931401 DOI: 10.1016/j.neuroimage.2009.11.024] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Revised: 11/01/2009] [Accepted: 11/11/2009] [Indexed: 11/19/2022] Open
Abstract
(11)C-methionine positron emission tomography ((11)C-methionine PET) provides accurate detection of brain tumors. Several reports have analyzed the correlation between uptake of (11)C-methionine and Ki-67 index or microvessel density non-stereotactically and suggested that (11)C-methionine uptake reflects both proliferation potential and angiogenic capability in gliomas. As gliomas possess heterogeneous histological architecture, non-stereotactic comparison of the histology and (11)C-methionine PET image may not be accurate. In the present study, the correlation between (11)C-methionine uptake and cell or microvessel density was analyzed using histological specimens obtained by stereotactic biopsy, and an exact local comparison of (11)C-methionine PET image and histological specimens was conducted. The tumor/normal tissue (T/N) ratio of (11)C-methionine positron emission tomography was found to correlate better with cell density (R=0.747, p=0.000042) and Ki-67 index (R=0.675, p=0.00041) than with microvessel density (R=0.467, p=0.025) in a histological comparison using a stereotactic image. Furthermore, multiple linear regression analysis revealed that cell density was the key determinant for predicting (11)C-methionine level while microvessel density was not. These results suggest that cell density contributes more to (11)C-methionine uptake than microvessel density in glioma tissues and that the previously reported correlation of (11)C-methionine uptake and microvessel density in glioma patients requires reevaluation.
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Affiliation(s)
- Yoshiko Okita
- Department of Neurosurgery, Osaka University Gradate School of Medicine, Suita, Osaka 565-0871, Japan
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Imaging biological activity of a glioblastoma treated with an individual patient-tailored, experimental therapy regimen. J Neurooncol 2009; 93:425-30. [PMID: 19183853 PMCID: PMC2758365 DOI: 10.1007/s11060-008-9790-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 12/30/2008] [Indexed: 01/13/2023]
Abstract
PURPOSE To monitor the metabolic effects of an individual patient-tailored, experimental glioma therapy regimen that included repetitive multiple neurosurgical resections, radiosurgical interventions, and an adjuvant maintenance therapy based on the tyrosine kinase inhibitor imatinib in combination with the chemotherapeutic agent hydroxyurea (HU). PROCEDURES Therapeutic effects were monitored in a 26-year-old male patient with a glioblastoma multiforme by multimodal imaging using sequential L: -[methyl-(11)C]-methionine positron emission tomography (MET-PET) and MRI. The normalized MET uptake and volume of the metabolically active tumor were assessed sequentially. RESULTS The individual patient-tailored, experimental glioma therapy caused a continuous decline of metabolically active tumor volume, associated with clinical remission over a period of more than two years. CONCLUSIONS MET-PET seems to be useful for monitoring patient-tailored, experimental glioma therapy regimens, especially when patients are treated with a multi-step therapeutic regimen. Monitoring and guidance of those experimental therapy regimens by MET-PET in a larger patient group are needed to confirm its clinical value.
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Kato T, Shinoda J, Oka N, Miwa K, Nakayama N, Yano H, Maruyama T, Muragaki Y, Iwama T. Analysis of 11C-methionine uptake in low-grade gliomas and correlation with proliferative activity. AJNR Am J Neuroradiol 2008; 29:1867-71. [PMID: 18687745 DOI: 10.3174/ajnr.a1242] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The relationship of (11)C-methionine (MET) uptake and tumor activity in low-grade gliomas (those meeting the criteria for World Health Organization [WHO] grade II gliomas) remains uncertain. The aim of this study was to compare MET uptake in low-grade gliomas and to analyze whether MET positron-emission tomography (PET) can estimate tumor viability and provide evidence of malignant transformation. MATERIALS AND METHODS We studied glioma metabolic activity in 49 consecutive patients with newly diagnosed grade II gliomas by using MET PET before surgical resection. On MET PET, we measured tumor/normal brain uptake ratio (T/N ratio) in 21 diffuse astrocytomas (DAs), 12 oligodendrogliomas (ODs), and 16 oligoastrocytomas (OAs). We compared MET T/N ratio among these 3 tumors and investigated possible correlation with proliferative activity, as measured by Mib-1 labeling index (LI). RESULTS MET T/N ratios of DA, OD, and OA were 2.11 +/- 0.87, 3.75 +/- 1.43, and 2.76 +/- 1.27, respectively. The MET T/N ratio of OD was significantly higher than that of DA (P < .005). In comparison of MET T/N ratios with the Mib-1 LI, a significant correlation was shown in DA (r = 0.63; P < .005) but not in OD and OA. CONCLUSION MET uptake in DAs may be closely associated with tumor viability, which depends on increased amino acid transport by an activated carrier-mediated system. DAs with lower MET uptake were considered more quiescent lesions, whereas DA with higher MET uptake may act more aggressively.
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Affiliation(s)
- T Kato
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo City, Gifu, Japan.
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Terakawa Y, Tsuyuguchi N, Iwai Y, Yamanaka K, Higashiyama S, Takami T, Ohata K. Diagnostic Accuracy of 11C-Methionine PET for Differentiation of Recurrent Brain Tumors from Radiation Necrosis After Radiotherapy. J Nucl Med 2008; 49:694-9. [DOI: 10.2967/jnumed.107.048082] [Citation(s) in RCA: 279] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kato T, Shinoda J, Nakayama N, Miwa K, Okumura A, Yano H, Yoshimura S, Maruyama T, Muragaki Y, Iwama T. Metabolic assessment of gliomas using 11C-methionine, [18F] fluorodeoxyglucose, and 11C-choline positron-emission tomography. AJNR Am J Neuroradiol 2008; 29:1176-82. [PMID: 18388218 DOI: 10.3174/ajnr.a1008] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Positron-emission tomography (PET) is a useful tool in oncology. The aim of this study was to assess the metabolic activity of gliomas using (11)C-methionine (MET), [(18)F] fluorodeoxyglucose (FDG), and (11)C-choline (CHO) PET and to explore the correlation between the metabolic activity and histopathologic features. MATERIALS AND METHODS PET examinations were performed for 95 primary gliomas (37 grade II, 37 grade III, and 21 grade IV). We measured the tumor/normal brain uptake ratio (T/N ratio) on each PET and investigated the correlations among the tracer uptake, tumor grade, tumor type, and tumor proliferation activity. In addition, we compared the ease of visual evaluation for tumor detection. RESULTS All 3 of the tracers showed positive correlations with astrocytic tumor (AT) grades (II/IV and III/IV). The MET T/N ratio of oligodendroglial tumors (OTs) was significantly higher than that of ATs of the same grade. The CHO T/N ratio showed a significant positive correlation with histopathologic grade in OTs. Tumor grade and type influenced MET uptake only. MET T/N ratios of more than 2.0 were seen in 87% of all of the gliomas. All of the tracers showed significantly positive correlations with Mib-1 labeling index in ATs but not in OTs and oligoastrocytic tumors. CONCLUSION MET PET appears to be useful in evaluating grade, type, and proliferative activity of ATs. CHO PET may be useful in evaluating the potential malignancy of OTs. In terms of visual evaluation of tumor localization, MET PET is superior to FDG and CHO PET in all of the gliomas, due to its straightforward detection of "hot lesions".
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Affiliation(s)
- T Kato
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo City, Gifu, Japan.
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Demuth T, Rennert JL, Hoelzinger DB, Reavie LB, Nakada M, Beaudry C, Nakada S, Anderson EM, Henrichs AN, McDonough WS, Holz D, Joy A, Lin R, Pan KH, Lih CJ, Cohen SN, Berens ME. Glioma cells on the run - the migratory transcriptome of 10 human glioma cell lines. BMC Genomics 2008; 9:54. [PMID: 18230158 PMCID: PMC2275271 DOI: 10.1186/1471-2164-9-54] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 01/29/2008] [Indexed: 11/21/2022] Open
Abstract
Background Glioblastoma multiforme (GBM) is the most common primary intracranial tumor and despite recent advances in treatment regimens, prognosis for affected patients remains poor. Active cell migration and invasion of GBM cells ultimately lead to ubiquitous tumor recurrence and patient death. To further understand the genetic mechanisms underlying the ability of glioma cells to migrate, we compared the matched transcriptional profiles of migratory and stationary populations of human glioma cells. Using a monolayer radial migration assay, motile and stationary cell populations from seven human long term glioma cell lines and three primary GBM cultures were isolated and prepared for expression analysis. Results Gene expression signatures of stationary and migratory populations across all cell lines were identified using a pattern recognition approach that integrates a priori knowledge with expression data. Principal component analysis (PCA) revealed two discriminating patterns between migrating and stationary glioma cells: i) global down-regulation and ii) global up-regulation profiles that were used in a proband-based rule function implemented in GABRIEL to find subsets of genes having similar expression patterns. Genes with up-regulation pattern in migrating glioma cells were found to be overexpressed in 75% of human GBM biopsy specimens compared to normal brain. A 22 gene signature capable of classifying glioma cultures based on their migration rate was developed. Fidelity of this discovery algorithm was assessed by validation of the invasion candidate gene, connective tissue growth factor (CTGF). siRNA mediated knockdown yielded reduced in vitro migration and ex vivo invasion; immunohistochemistry on glioma invasion tissue microarray confirmed up-regulation of CTGF in invasive glioma cells. Conclusion Gene expression profiling of migratory glioma cells induced to disperse in vitro affords discovery of genomic signatures; selected candidates were validated clinically at the transcriptional and translational levels as well as through functional assays thereby underscoring the fidelity of the discovery algorithm.
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Affiliation(s)
- Tim Demuth
- Translational Genomics Research Institute, Phoenix, AZ 85004, USA.
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Miwa K, Shinoda J, Yano H, Iwama T. Relatively decreased 11C-methionine uptake within the anaplastic component of a mixed-grade oligodendroglioma. AJNR Am J Neuroradiol 2007; 28:2005-7. [PMID: 17905896 PMCID: PMC8134255 DOI: 10.3174/ajnr.a0695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A 56-year-old woman presented with a mixed-grade oligodendroglioma. On 11C-methionine [MET]-positron-emission tomography images, heterogeneous uptake of MET was demonstrated in the mass lesion. The part of the lesion with higher MET uptake was identified as an ordinary oligodendroglioma, whereas the part of the lesion with lower MET uptake was an anaplastic component of oligodendroglioma. With oligodendrogliomas, we should be aware of the possibility that MET uptake decreases paradoxically with an increased anaplastic component of oligodendroglioma cells.
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Affiliation(s)
- K Miwa
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Department of Neurosurgery, Kizawa Memorial Hospital, Gifu, Japan.
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Galldiks N, Kracht LW, Burghaus L, Thomas A, Jacobs AH, Heiss WD, Herholz K. Use of 11C-methionine PET to monitor the effects of temozolomide chemotherapy in malignant gliomas. Eur J Nucl Med Mol Imaging 2006; 33:516-24. [PMID: 16450140 DOI: 10.1007/s00259-005-0002-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Accepted: 09/09/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to monitor the metabolic effects of temozolomide (TMZ) chemotherapy in malignant gliomas by means of repeated positron emission tomography (PET) with [(11)C]methionine (MET). METHODS Fifteen patients with histologically proven malignant glioma were treated by TMZ chemotherapy. MET-PET studies were performed before and after the third cycle of TMZ chemotherapy in all patients, and in 12 patients also after the sixth cycle. Gadolinium-enhanced MRI studies were performed in 12 patients before the first and after the sixth cycle. Clinical status was assessed by the modified Rankin scale. Long-term outcome was assessed by calculating the time to progression (TTP) in months. RESULTS Decline in MET uptake during therapy corresponded to a stable clinical status. The median TTP was significantly longer in patients with decline in MET uptake than in those with increasing MET uptake (23 vs 3.5 months; p=0.01, log rank test). There was no significant correlation between change in MET uptake and change in contrast enhancement during treatment for all patients. CONCLUSION The present data demonstrate that clinical stability, which is often achieved under TMZ chemotherapy of malignant glioma, corresponds to a decline in or stability of tumour amino acid metabolism. Tumour responses can already be demonstrated with MET-PET after three cycles of chemotherapy, and absence of progression at that time indicates a high probability of further stability during the next three cycles. A reduction in MET uptake during TMZ treatment predicts a favourable clinical outcome. Molecular imaging of amino acid uptake by MET-PET offers a new method of measurement of the biological activity of recurrent glioma.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, University of Cologne, Cologne, Germany
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Abstract
Researchers have made great progress in defining genetic and molecular alterations that contribute to cancer. New therapeutic targets have been identified and targeted therapeutic agents have been developed, but our ability to evaluate potential drugs has not kept pace. Molecular imaging technologies that monitor biological processes and/or measure levels of targeted macromolecules can contribute significantly to preclinical and clinical drug evaluation. This article describes the drug discovery process, economic problems facing drug discovery and development, and successes and failures in this realm. We briefly describe the available molecular imaging tools, with emphasis on positron emission tomography. We discuss biological processes that are altered in tumors and can be measured by molecular imaging; examples include gene expression, signal transduction, tumor cell metabolism, proliferation, apoptosis, hypoxia, and angiogenesis. We conclude with a proposal to integrate molecular imaging into the drug development process.
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Affiliation(s)
- Johannes Czernin
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA.
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Rosenberg DS, Demarquay G, Jouvet A, Le Bars D, Streichenberger N, Sindou M, Kopp N, Mauguière F, Ryvlin P. [11C]-Methionine PET: dysembryoplastic neuroepithelial tumours compared with other epileptogenic brain neoplasms. J Neurol Neurosurg Psychiatry 2005; 76:1686-92. [PMID: 16291894 PMCID: PMC1739454 DOI: 10.1136/jnnp.2004.051607] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Brain tumours responsible for longstanding partial epilepsy are characterised by a high prevalence of dysembryoplastic neuroepithelial tumour (DNT), whose natural evolution is much more benign than that of gliomas. The preoperative diagnosis of DNT, which is not yet feasible on the basis of available clinical and imaging data, would help optimise the therapeutic strategy for this type of tumour. This study tested whether [(11)C]-methionine positron emission tomography (MET-PET) could help to distinguish DNTs from other epileptogenic brain tumours. METHODS Prospective study of 27 patients with partial epilepsy of at least six months duration related to a non-rapidly progressing brain tumour on magnetic resonance imaging (MRI). A structured visual analysis, which distinguished between normal, moderately abnormal, or markedly abnormal tumour methionine uptake, as well as various regions of interest and semiquantitative measurements were conducted. RESULTS Pathological results showed 11 DNTs (41%), 5 gangliogliomas (18%), and 11 gliomas (41%). MET-PET visual findings significantly differed between the various tumour types (p<0.0002), regardless of gadolinium enhancement on MRI, and were confirmed by semiquantitative analysis (p<0.001 for all calculated ratios). All gliomas and gangliogliomas were associated with moderately or markedly increased tumour methionine uptake, whereas 7/11 DNTs had a normal methionine uptake, including all six located in the mesiotemporal structures. No DNT presented with a marked MET-PET abnormality. CONCLUSION Normal MET-PET findings in patient with an epileptogenic and non-rapidly progressing brain tumour are suggestive of DNT, whereas a markedly increased tumour methionine uptake makes this diagnosis unlikely.
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Affiliation(s)
- D S Rosenberg
- Cermep, Hopital Neurologique, 59 Bd Pinel, Lyon 69003, France
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Huang MC, Shih YH, Chen MH, Chung WY, Ho DMT, Liu RS, Lee LM, Huang CI, Lee LS, Cheng H. Malignancy of intracerebral lesions evaluated with 11C-methionine-PET. J Clin Neurosci 2005; 12:775-80. [PMID: 16198917 DOI: 10.1016/j.jocn.2005.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Positron emission tomography (PET) allows examination of a variety of physiological parameter, including blood flow, glucose, amino acid and oxygen metabolism. However, correlation of PET scan findings and the degree of malignancy of intracerebral tumors continues to be controversial. Nine patients with primarily diagnosed intraparenchymal brain tumors were included in this study. We performed 11C-methionine-PET (met-PET) prior to surgical treatment and the differential absorption ratio (DAR) was calculated. All patients underwent open or stereotactic surgery and specimens for pathological diagnosis were obtained. The biological activity of each tumor was determined by calculation of the proliferation index from MIB-1 immunohistochemistry. The DAR of met-PET for individual tumors correlated with the histological diagnosis and degree of malignancy and this was further confirmed by good correlation with the MIB-1 proliferation index. We conclude that met-PET may be a reliable and effective preoperative evaluation to determine the type and malignancy of intraparenchymal brain lesions.
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Affiliation(s)
- Ming-Chao Huang
- Neural Regeneration Laboratory, Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
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De Witte O, Oulad Ben Taib N, Branle F, Rorive S, Brotchi J, Goldman S. [Contribution of PET to the management of patients with low-grade glioma]. Neurochirurgie 2005; 50:468-73. [PMID: 15547485 DOI: 10.1016/s0028-3770(04)98327-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Management of patients with low-grade glioma is a major challenge for the neurosurgeon. When is neurosurgery indicated? Should chemotherapy or radiotherapy be used? Many questions without an answer. We reviewed our experience with 65 patients treated for low-grade glioma who had preoperative PET images (FDG or/and MET). We examined the prognostic value of PET and also determined the sensitivity and the specificity of PET images to predict outcome. METHODS Sixty-five patients with a FDG or MET PET images were analyzed. We used two visual scales and had complete follow-up data for 63 patients. The free interval was the principal criterion for statistical analysis. The sensitivity and the specificity of PET images was determined. RESULTS Strong FDG uptake was correlated with a short free interval (p=0.001). Similar results were found with the MET analysis (p=0.0076). We had a PET with MET and FDG for 36 patients. The sensitivity was 66% and the specificity 94% for FDG PET. Sensitivity was 100% and specificity 53% for MET PET. CONCLUSIONS PET imaging provides a prognostic factor independent from histology. MET PET is the best exam for the follow-up of patients with low-grade glioma and is helpful for separating aggressive from low-grade glioma.
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Affiliation(s)
- O De Witte
- Service de Neurochirurgie (Clinique Neurochirurgicale d'Oncologie),
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40
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Tang BNT, Sadeghi N, Branle F, De Witte O, Wikler D, Goldman S. Semi-quantification of methionine uptake and flair signal for the evaluation of chemotherapy in low-grade oligodendroglioma. J Neurooncol 2005; 71:161-8. [PMID: 15690133 DOI: 10.1007/s11060-004-9654-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED 11C-Methionine (MET) is a useful positron emission tomography (PET) tracer for the evaluation of low-grade gliomas. Among these tumors, a high percentage of low-grade oligodendrogliomas (ODG) are sensitive to chemotherapy with procarbazine, CCNU, and vincristine (PCV). We aimed at: (1) objectively assessing ODG response to PCV by a metabolic index (the Activity Volume Index or AVI) generated from an automated semi-quantification of PET with MET (PET-MET); (2) comparing AVI and quantitative magnetic resonance imaging (MRI) measurements of response to PCV. METHODS seven patients with ODG were followed for a period of 19.9+/-6.6 months after the completion of PCV chemotherapy. Regions of interest (ROI) were generated by covering all voxels with count values above a threshold level set at 120% of the mean cerebellar activity. On each slice, ROI volume and mean count values were calculated. AVI was calculated as the sum over all ROI of tumor volumex(tumor mean count/cerebellum count). Tumor volume measurements on MRI, were based on signal abnormalities visually detected on fluid-attenuated inversion recovery (FLAIR) sequences. RESULTS PCV therapy was associated with a drastic decrease in AVI (mean+/-SD, cm3): AVI post-PCV=0.80+/-1.45 vs. AVI prior PCV=12.94+/-11.46 (P=0.03). Likewise, we observed a decrease in tumor volume estimated from the FLAIR signal (31.37+/-11.99 post-PCV vs. 67.95+/-39.96 prior PCV, P=0.03) although AVI decrease after PCV was significantly more pronounced (P=0.015). CONCLUSION This study, based on limited number of patients and follow-up period indicates that AVI may be a sensitive and observer-independent method applicable to the assessment of ODG responsiveness to PCV treatment and may offer a major added value to both clinical assessment and MRI evaluation of chemotherapeutic outcomes.
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Affiliation(s)
- Bich-Ngoc-Thanh Tang
- Department of Nuclear Medicine and PET/Biomedical-Cyclotron Unit, Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium.
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Smith CB, Schmidt KC, Qin M, Burlin TV, Cook MP, Kang J, Saunders RC, Bacher JD, Carson RE, Channing MA, Eckelman WC, Herscovitch P, Laverman P, Vuong BK. Measurement of regional rates of cerebral protein synthesis with L-[1-11C]leucine and PET with correction for recycling of tissue amino acids: II. Validation in rhesus monkeys. J Cereb Blood Flow Metab 2005; 25:629-40. [PMID: 15703697 DOI: 10.1038/sj.jcbfm.9600066] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The confounding effect of recycling of amino acids derived from tissue protein breakdown into the precursor pool for protein synthesis has been an obstacle to adapting in vivo methods for determination of regional rates of cerebral protein synthesis (rCPS) to positron emission tomography (PET). We used a kinetic modeling approach to estimate lambda, the fraction of the precursor pool for protein synthesis derived from arterial plasma, and to measure rCPS in three anesthetized adult monkeys dynamically scanned after a bolus injection of L-[1-11C]leucine. In the same animals, lambda was directly measured in a steady-state terminal experiment, and values showed excellent agreement with those estimated in the PET studies. In three additional monkeys rCPS was determined with the quantitative autoradiographic L-[1-14C]leucine method. In whole brain and cerebellum, rates of protein synthesis determined with the autoradiographic method were in excellent agreement with those determined with PET, and regional values were in good agreement when differences in spatial resolution of the two methods were taken into account. Low intrasubject variability was found on repeated PET studies. Our results in anesthetized monkey indicate that, by using a kinetic modeling approach to correct for recycling of tissue amino acids, quantitatively accurate and reproducible measurement of rCPS is possible with L-[1-11C]leucine and PET.
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Affiliation(s)
- Carolyn Beebe Smith
- Unit on Neuroadaptation and Protein Metabolism, Laboratory of Cerebral Metabolism, National Institute of Mental Health, Bethesda, Maryland 20892-4030, USA.
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Hustinx R, Pourdehnad M, Kaschten B, Alavi A. PET imaging for differentiating recurrent brain tumor from radiation necrosis. Radiol Clin North Am 2005; 43:35-47. [PMID: 15693646 DOI: 10.1016/j.rcl.2004.09.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The exact incidence of true radiation necrosis is largely unknown. It is probably much less frequent than indicated by MR or CT findings. Differentiating radiation necrosis from recurrent tumor is a diagnostic challenge, however, and has important implications for the patient's management. Even though the first results were published 20 years ago, the total number of case studies using FDG-PET in this indication remains limited. Several reports are also hampered by methodologic limitations. The technique has been largely criticized, notably in articles that themselves were not completely free of methodological flaws. Overall however, FDG-PET seems to be a valuable clinical tool. As a general rule, suspicious lesions on MR imaging that show increased FDG uptake (ie, uptake equal to or great than that in normal cortex) are likely to represent tumor recurrence. Sensitivity is an issue, especially but not exclusively with low-grade gliomas. Although false-positive results may occur, specificity is usually high in routine clinical practice. Coregistration with MR imaging surely improves the diagnostic performances of FDG-PET because it helps delineate the suspicious area. Another important aspect is the prognostic value of FDG uptake, which is now well established. It seems clear that only the combination of FDG with a radiolabeled amino acid analogue (MET or a more recent fluorinated compound) can provide a comprehensive characterization of suspected brain tumor recurrence.
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Affiliation(s)
- Roland Hustinx
- Division of Nuclear Medicine, University Hospital of Liège, Campus Universitaire du Sart Tilman, B35 4000 Sart Tilman, Belgium.
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Abstract
The role of molecular neuroimaging techniques is increasing in the understanding of pathophysiological mechanism of diseases. To date, positron emission tomography is the most powerful tool for the non-invasive study of biochemical and molecular processes in humans and animals in vivo. With the development in radiochemistry and tracer technology, a variety of endogenously expressed and exogenously introduced genes can be analyzed by PET. This opens up the exciting and rapidly field of molecular imaging, aiming at the non-invasive localisation of a biological process of interest in normal and diseased cells in animal models and humans in vivo. Besides its usefulness for basic research positron emission tomography has been proven to be superior to conventional diagnostic methods in several clinical indications. This is illustrated by detection of biological or anatomic changes that cannot be demonstrated by computed tomography or magnetic resonance imaging, as well as even before symptoms are expressed. The present review summarizes the clinical use of positron emission tomography in neuroscience that has helped elucidate the pathophysiology of a number of diseases and has suggested strategies in the treatment of these patients. Special reference is given to the neurovascular, neurodegenerative and neurooncological disease.
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Affiliation(s)
- B Schaller
- Max-Planck-Institut für Neurologische Forschung, Köln
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Miwa K, Shinoda J, Yano H, Okumura A, Iwama T, Nakashima T, Sakai N. Discrepancy between lesion distributions on methionine PET and MR images in patients with glioblastoma multiforme: insight from a PET and MR fusion image study. J Neurol Neurosurg Psychiatry 2004; 75:1457-62. [PMID: 15377696 PMCID: PMC1738776 DOI: 10.1136/jnnp.2003.028480] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine (11)C-methyl methionine (MET) accumulation on positron emission tomographic (PET) imaging of glioblastoma multiforme to determine the distribution of metabolic abnormality compared with magnetic resonance imaging (MRI). METHODS Contemporaneous MRI was superimposed on corresponding MET-PET images in 10 patients with newly diagnosed glioblastoma multiforme before treatment. Differences between the extended area of MET accumulation on PET imaging (MET area), the gadolinium (Gd) enhanced area on T1 weighted images (Gd area), and the abnormal high signal intensity area on T2 weighted images (T2-high area) were assessed. RESULTS The MET area was larger than the Gd area and included the entire Gd area. The discrepancy in volume between the MET and Gd areas became greater with increasing tumour diameter. On average, 58.6% of the MET area was located within the Gd area, 90.1% within 10 mm outside the Gd area, 98.1% within 20 mm, and 99.8% within 30 mm. A newly developed Gd area had emerged in five of the 10 cases up to the time of study. In three of the five cases this was in the MET area even after complete surgical resection of the Gd area on the initial MRI; in the remaining two it originated in the residual Gd area after surgery. In all cases, the T2-high area was larger than the MET area. The MET area extended partly beyond the T2-high area in nine cases, and was completely within it in one. CONCLUSIONS Glioblastoma multiforme cells may extend over the Gd area and more widely with increasing tumour size on Gd-MRI. The T2-high area includes the greater part of the tumour but not its entire area. The methods reported may be useful in planning surgical resection, biopsy, or radiosurgery.
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Affiliation(s)
- K Miwa
- Department of Neurosurgery, Gifu University School of Medicine, 40 Tsukasa-machi, Gifu 500-8705, Japan
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Abstract
Energy metabolism and amino acid transport and incorporation are important components of the pathophysiology of gliomas, about which molecular imaging is providing regional biologic information that is useful to clinical practice. Imaging hypoxia is straightforward and proliferation imaging with FLT shows significant promise. Neither has been exploited thoroughly enough to allow judgement of their potential benefit to the practice of neuro-oncology. Although cell division is the most distinguishing function of growth in tumors, probing membrane biosynthesis with PET and 1-[11C]acetate or a choline tracer may yield information as helpful as protein or DNA synthesis. Because astrocytic gliomas frequently carry epidermal growth factor receptor mutations at a frequency that is related to grade, a PET tracer that is specific for this mutated receptor could be useful for grading and prognosis [35]. Methods for imaging angiogenesis are being developed; 18F-labeling of a cyclic RGD-containing glycopeptide, cyclo(-Arg-Gly-Asp-D-Phe-Lys(sugar amino acid)-), with 4-nitro-phenyl 2-[18F]fluoropropionate has been reported [136]. 18F-labeled annexin V is being tested as a new PET agent for quantitating tumor cell death and predicting response to therapy. Annexin V binds to surface membranes that have exposed phosphatidyl serine residues resulting from programmed cell destruction. Recently, a Tc-99m-labeled derivative has been shown to accumulate in late stage lung cancer and lymphoma in response to chemotherapy [137]. As molecular pathways leading to and sustaining neoplasia become better understood, so will our capacity improve to measure them in vivo and intervene to the patient's advantage.
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Affiliation(s)
- Alexander M Spence
- Department of Neurology, University of Washington School of Medicine, Seattle, WA 98185, USA.
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Herholz K, Kracht LW, Heiss WD. Monitoring the Effect of Chemotherapy in a Mixed Glioma by C-11-Methionine PET. J Neuroimaging 2003. [DOI: 10.1111/j.1552-6569.2003.tb00190.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bénard F, Romsa J, Hustinx R. Imaging gliomas with positron emission tomography and single-photon emission computed tomography. Semin Nucl Med 2003; 33:148-62. [PMID: 12756647 DOI: 10.1053/snuc.2003.127304] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Over the last two decades the large volume of research involving various brain tracers has shed invaluable light on the pathophysiology of cerebral neoplasms. Yet the question remains as to how best to incorporate this newly acquired insight into the clinical context. Thallium is the most studied radiotracer with the longest track record. Many, but not all studies, show a relationship between (201)Tl uptake and tumor grade. Due to the overlap between tumor uptake and histologic grades, (201)Tl cannot be used as the sole noninvasive diagnostic or prognostic tool in brain tumor patients. However, it may help differentiating a high-grade tumor recurrence from radiation necrosis. MIBI is theoretically a better imaging agent than (201)Tl but it has not convincingly been shown to differentiate tumors according to grade. MDR-1 gene expression as demonstrated by MIBI does not correlate with chemoresistance in high grade gliomas. Currently, MIBI's clinical role in brain tumor imaging has yet to be defined. IMT, a radio-labeled amino acid analog, may be useful for identifying postoperative tumor recurrence and, in this application, appears to be a cheaper, more widely available tool than positron emission tomography (PET). However, its ability to accurately identify tumor grade is limited. 18 F-2-Fluoro-2-deoxy-d-glucose (FDG) PET predicts tumor grade, and the metabolic activity of brain tumors has a prognostic significance. Whether FDG uptake has an independent prognostic value above that of histology remains debated. FDG-PET is effective in differentiating recurrent tumor from radiation necrosis for high-grade tumors, but has limited value in defining the extent of tumor involvement and recurrence of low-grade lesions. Amino-acid tracers, such as MET, perform better for this purpose and thus play a complementary role to FDG. Given the poor prognosis of patients with gliomas, particularly with high-grade lesions, the overall clinical utility of single photon emission computed tomography (SPECT) and PET in characterizing recurrent lesions remains dependent on the availability of effective treatments. These tools are thus mostly suited to the evaluation of treatment response in experimental protocols designed to improve the patients' outcome.
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Affiliation(s)
- François Bénard
- Department of Nuclear Medicine and Radiation Biology, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Levivier M, Wikler D, Massager N, David P, Devriendt D, Lorenzoni J, Pirotte B, Desmedt F, Simon S, Goldman S, Van Houtte P, Brotchi J. The integration of metabolic imaging in stereotactic procedures including radiosurgery: a review. J Neurosurg 2002. [DOI: 10.3171/jns.2002.97.supplement_5.0542] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. The authors review their experience with the clinical development and routine use of positron emission tomography (PET) during stereotactic procedures, including the use of PET-guided gamma knife radiosurgery (GKS).
Methods. Techniques have been developed for the routine use of stereotactic PET, and accumulated experience using PET-guided stereotactic procedures over the past 10 years includes more than 150 stereotactic biopsies, 43 neuronavigation procedures, and 34 cases treated with GKS. Positron emission tomography—guided GKS was performed in 24 patients with primary brain tumors (four pilocytic astrocytomas, five low-grade astrocytomas or oligodendrogliomas, seven anaplastic astrocytomas or ependymomas, five glioblastomas, and three neurocytomas), five patients with metastases (single or multiple lesions), and five patients with pituitary adenomas.
Conclusions. Data obtained with PET scanning can be integrated with GKS treatment planning, enabling access to metabolic information with high spatial accuracy. Positron emission tomography data can be successfully combined with magnetic resonance imaging data to provide specific information for defining the target volume for the radiosurgical treatment in patients with recurrent brain tumors, such as glioma, metastasis, and pituitary adenoma. This approach is particularly useful for optimizing target selection for infiltrating or ill-defined brain lesions. The use of PET scanning contributed data in 31 cases (93%) and information that was specifically utilized to adapt the target volume in 25 cases (74%). It would seem that the integration of PET data into GKS treatment planning may represent an important step toward further developments in radiosurgery: this approach provides additional information that may open new perspectives for the optimization of the treatment of brain tumors.
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Nakagawa M, Kuwabara Y, Sasaki M, Koga H, Chen T, Kaneko O, Hayashi K, Morioka T, Masuda K. 11C-methionine uptake in cerebrovascular disease: a comparison with 18F-fDG PET and 99mTc-HMPAO SPECT. Ann Nucl Med 2002; 16:207-11. [PMID: 12126046 DOI: 10.1007/bf02996302] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Carbon-11-L-methyl-methionine (11C-methionine) has been reported to be useful for evaluating brain tumors, but several other brain disorders have also shown signs of high methionine uptake. We retrospectively evaluated the significance of 11C-methionine uptake in cerebrovascular diseases, and also compared our results with those for 18F-FDG PET and 99mTc-HMPAO SPECT. METHODS Seven patients, including 3 patients with a cerebral hematoma and 4 patients with a cerebral infarction, were examined. All 7 patients underwent both 11C-methionine PET and 99mTc-HMPAO SPECT, and 6 of them underwent 18F-FDG PET. RESULTS A high 11C-methionine uptake was observed in all 3 patients with cerebral hematoma. Increased 99mTc-HMPAO uptake was observed in 2 out of 3 patients, and all 3 patients had decreased 18F-FDG uptake. Of 4 patients with a cerebral infarction, high 11C-methionine uptake was observed in 3. Increased 99mTc-HMPAO uptake was also observed in one patient, whereas 3 patients had decreased 18F-FDG uptake. CONCLUSIONS We should keep in mind that high 11C-methionine uptake is frequently observed in cerebrovascular diseases. CVD should therefore be included in the differential diagnosis when encounting patients with a high 11C-methionine uptake.
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Affiliation(s)
- Makoto Nakagawa
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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De Witte O, Goldberg I, Wikler D, Rorive S, Damhaut P, Monclus M, Salmon I, Brotchi J, Goldman S. Positron emission tomography with injection of methionine as a prognostic factor in glioma. J Neurosurg 2001; 95:746-50. [PMID: 11702862 DOI: 10.3171/jns.2001.95.5.0746] [Citation(s) in RCA: 168] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Positron emission tomography with L-[methyl-11C]methionine (MET-PET) provides information on the metabolism of gliomas. The aim of this study was to determine the predictive value of MET-PET in the treatment of patients with gliomas. METHODS Since 1992, 85 patients with a World Health Organization (WHO) classification-verified glioma underwent PET studies in which MET was injected before (74 cases) or after treatment (11 cases). Analysis of PET data was conducted by the same investigator using two scales: a qualitative visual grading scale and a quantitative scale (ratio between tumor uptake and normal brain uptake, classified on a seven-level scale). Uptake of MET was present in 98% of gliomas. The investigator judged this uptake to be moderate to very high based on visual inspection (qualitative scale). For all grades of gliomas, a visual grade of 3 was statistically associated with a shorter patient survival period (p < 0.005). The tumor/normal brain uptake ratio was significantly influenced by the histological grade of the tumor. A statistically poor outcome was demonstrated when this ratio was higher than a threshold of 2.2 for a WHO Grade II tumor and 2.8 for WHO Grade III tumor. For Grade II and III tumors, oligodendrogliomas had a higher uptake of MET than astrocytomas. CONCLUSIONS Uptake of MET was present in 98% of the gliomas studied. A high uptake is statistically associated with a poor survival time. The intensity of MET uptake represents a prognostic factor for WHO Grade II and III tumors considered separately.
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Affiliation(s)
- O De Witte
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
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