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Takano K, Kinoshita M, Arita H, Okita Y, Chiba Y, Kagawa N, Fujimoto Y, Kishima H, Kanemura Y, Nonaka M, Nakajima S, Shimosegawa E, Hatazawa J, Hashimoto N, Yoshimine T. Diagnostic and Prognostic Value of 11C-Methionine PET for Nonenhancing Gliomas. AJNR Am J Neuroradiol 2015; 37:44-50. [PMID: 26381556 DOI: 10.3174/ajnr.a4460] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/07/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Noninvasive radiologic evaluation of glioma can facilitate correct diagnosis and detection of malignant transformation. Although positron-emission tomography is considered valuable in the care of patients with gliomas, (18)F-fluorodeoxyglucose and (11)C-methionine have reportedly shown ambiguous results in terms of grading and prognostication. The present study compared the diagnostic and prognostic capabilities of diffusion tensor imaging, FDG, and (11)C-methionine PET in nonenhancing gliomas. MATERIALS AND METHODS Thirty-five consecutive newly diagnosed, histologically confirmed nonenhancing gliomas that underwent both FDG and (11)C-methionine PET were retrospectively investigated (23 grade II and 12 grade III gliomas). Apparent diffusion coefficient, fractional anisotropy, and tumor-to-normal tissue ratios of both FDG and (11)C-methionine PET were compared between grade II and III gliomas. Prognostic values of these parameters were also tested by using progression-free survival. RESULTS Grade III gliomas showed significantly higher average tumor-to-normal tissue and maximum tumor2-to-normal tissue than grade II gliomas in (11)C-methionine (P = .013, P = .0017, respectively), but not in FDG-PET imaging. There was no significant difference in average ADC, minimum ADC, average fractional anisotropy, and maximum fractional anisotropy. (11)C-methionine PET maximum tumor-to-normal tissue ratio of 2.0 was most suitable for detecting grade III gliomas among nonenhancing gliomas (sensitivity, 83.3%; specificity, 73.9%). Among patients not receiving any adjuvant therapy, median progression-free survival was 64.2 ± 7.2 months in patients with maximum tumor-to-normal tissue ratio of <2.0 for (11)C-methionine PET and 18.6 ± 6.9 months in patients with maximum tumor-to-normal tissue ratio of >2.0 (P = .0044). CONCLUSIONS (11)C-methionine PET holds promise for World Health Organization grading and could offer a prognostic imaging biomarker for nonenhancing gliomas.
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Affiliation(s)
- K Takano
- From the Department of Neurosurgery (K.T., M.K.), Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan Departments of Neurosurgery (K.T., M.K., H.A., Y.C., N.K., H.K., N.H., T.Y.)
| | - M Kinoshita
- From the Department of Neurosurgery (K.T., M.K.), Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan Departments of Neurosurgery (K.T., M.K., H.A., Y.C., N.K., H.K., N.H., T.Y.)
| | - H Arita
- Departments of Neurosurgery (K.T., M.K., H.A., Y.C., N.K., H.K., N.H., T.Y.)
| | - Y Okita
- Department of Neurosurgery (Y.O., Y.K., M.N., S.N.)
| | - Y Chiba
- Departments of Neurosurgery (K.T., M.K., H.A., Y.C., N.K., H.K., N.H., T.Y.) Department of Neurosurgery (Y.C.), Kansai Rosai Hospital, Itami, Japan
| | - N Kagawa
- Departments of Neurosurgery (K.T., M.K., H.A., Y.C., N.K., H.K., N.H., T.Y.)
| | - Y Fujimoto
- Department of Neurosurgery (Y.F.), Osaka Neurological Institute, Osaka, Japan
| | - H Kishima
- Departments of Neurosurgery (K.T., M.K., H.A., Y.C., N.K., H.K., N.H., T.Y.)
| | - Y Kanemura
- Department of Neurosurgery (Y.O., Y.K., M.N., S.N.) Division of Regenerative Medicine (Y.K.), Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - M Nonaka
- Department of Neurosurgery (Y.O., Y.K., M.N., S.N.) Department of Neurosurgery (M.N.), Kansai Medical University, Osaka, Japan
| | - S Nakajima
- Department of Neurosurgery (Y.O., Y.K., M.N., S.N.)
| | - E Shimosegawa
- Nuclear Medicine and Tracer Kinetics (E.S., J.H.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - J Hatazawa
- Nuclear Medicine and Tracer Kinetics (E.S., J.H.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - N Hashimoto
- Departments of Neurosurgery (K.T., M.K., H.A., Y.C., N.K., H.K., N.H., T.Y.)
| | - T Yoshimine
- Departments of Neurosurgery (K.T., M.K., H.A., Y.C., N.K., H.K., N.H., T.Y.)
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