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Kim EY, Vavere AL, Snyder SE, Chiang J, Li Y, Patni T, Qaddoumi I, Merchant TE, Robinson GW, Holtrop JL, Shulkin BL, Bag AK. [11C]-methionine positron emission tomography in the evaluation of pediatric low-grade gliomas. Neurooncol Adv 2024; 6:vdae056. [PMID: 38680989 PMCID: PMC11055465 DOI: 10.1093/noajnl/vdae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Background [11C]-Methionine positron emission tomography (PET; [11C]-MET-PET) is principally used for the evaluation of brain tumors in adults. Although amino acid PET tracers are more commonly used in the evaluation of pediatric brain tumors, data on [11C]-MET-PET imaging of pediatric low-grade gliomas (pLGG) is scarce. This study aimed to investigate the roles of [11C]-MET-PET in the evaluation of pLGGs. Methods Eighteen patients with newly diagnosed pLGG and 26 previously treated pLGG patients underwent [11C]-MET-PET met the inclusion and exclusion criteria. Tumor-to-brain uptake ratio (TBR) and metabolic tumor volumes were assessed for diagnostic performances (newly diagnosed, 15; previously treated 26), change with therapy (newly diagnosed, 9; previously treated 7), and variability among different histology (n = 12) and molecular markers (n = 7) of pLGGs. Results The sensitivity of [11C]-MET-PET for diagnosing pLGG, newly diagnosed, and previously treated combined was 93% for both TBRmax and TBRpeak, 76% for TBRmean, and 95% for qualitative evaluation. TBRmax showed a statistically significant reduction after treatment, while other PET parameters showed a tendency to decrease. Median TBRmax, TBRpeak, and TBRmean values were slightly higher in the BRAFV600E mutated tumors compared to the BRAF fused tumors. Median TBRmax, and TBRpeak in diffuse astrocytomas were higher compared to pilocytic astrocytomas, but median TBRmean, was slightly higher in pilocytic astrocytomas. However, formal statistical analysis was not done due to the small sample size. Conclusions Our study shows that [11C]-MET-PET reliably characterizes new and previously treated pLGGs. Our study also shows that quantitative parameters tend to decrease with treatment, and differences may exist between various pLGG types.
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Affiliation(s)
- Emily Y Kim
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Amy L Vavere
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Scott E Snyder
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jason Chiang
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Yimei Li
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Tushar Patni
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Giles W Robinson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Joseph L Holtrop
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Asim K Bag
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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Giraudo C, Carraro S, Zucchetta P, Cecchin D. Pediatric Imaging Using PET/MR Imaging. Magn Reson Imaging Clin N Am 2023; 31:625-636. [PMID: 37741646 DOI: 10.1016/j.mric.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
PET/MR imaging is a one-stop shop technique for pediatric diseases allowing not only an accurate clinical assessment of tumors at staging and restaging but also the diagnosis of neurologic, inflammatory, and infectious diseases in complex cases. Moreover, applying PET kinetic analyses and sequences such as diffusion-weighted imaging as well as quantitative analysis investigating the relationship between disease metabolic activity and cellularity can be applied. Complex radiomics analysis can also be performed.
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Affiliation(s)
- Chiara Giraudo
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Silvia Carraro
- Unit of Pediatric Allergy and Respiratory Medicine, Women's and Children's Health Department, University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Pietro Zucchetta
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Diego Cecchin
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy.
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Juhász C, Bosnyák E. PET and SPECT studies in children with hemispheric low-grade gliomas. Childs Nerv Syst 2016; 32:1823-32. [PMID: 27659825 PMCID: PMC5120676 DOI: 10.1007/s00381-016-3125-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
Molecular imaging is playing an increasing role in the pretreatment evaluation of low-grade gliomas. While glucose positron emission tomography (PET) can be helpful to differentiate low-grade from high-grade tumors, PET imaging with amino acid radiotracers has several advantages, such as better differentiation between tumors and non-tumorous lesions, optimized biopsy targeting, and improved detection of tumor recurrence. This review provides a brief overview of single-photon emission computed tomography (SPECT) studies followed by a more detailed review of the clinical applications of glucose and amino acid PET imaging in low-grade hemispheric gliomas. We discuss key differences in the performance of the most commonly utilized PET radiotracers and highlight the advantage of PET/MRI fusion to obtain optimal information about tumor extent, heterogeneity, and metabolism. Recent data also suggest that simultaneous acquisition of PET/MR images and the combination of advanced MRI techniques with quantitative PET can further improve the pretreatment and post-treatment evaluation of pediatric brain tumors.
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Affiliation(s)
- Csaba Juhász
- Departments of Pediatrics, Wayne State University, Detroit, MI, USA. .,Departments of Neurology, Wayne State University, Detroit, MI, USA. .,PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Street, Detroit, MI, 48201, USA. .,Karmanos Cancer Institute, Detroit, MI, USA.
| | - Edit Bosnyák
- Department of Pediatrics, Wayne State University, Detroit, MI, USA,PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, USA
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Freebody J, Wegner EA, Rossleigh MA. 2-deoxy-2-( 18F)fluoro-D-glucose positron emission tomography/computed tomography imaging in paediatric oncology. World J Radiol 2014; 6:741-755. [PMID: 25349660 PMCID: PMC4209422 DOI: 10.4329/wjr.v6.i10.741] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/05/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
Positron emission tomography (PET) is a minimally invasive technique which has been well validated for the diagnosis, staging, monitoring of response to therapy, and disease surveillance of adult oncology patients. Traditionally the value of PET and PET/computed tomography (CT) hybrid imaging has been less clearly defined for paediatric oncology. However recent evidence has emerged regarding the diagnostic utility of these modalities, and they are becoming increasingly important tools in the evaluation and monitoring of children with known or suspected malignant disease. Important indications for 2-deoxy-2-(18F)fluoro-D-glucose (FDG) PET in paediatric oncology include lymphoma, brain tumours, sarcoma, neuroblastoma, Langerhans cell histiocytosis, urogenital tumours and neurofibromatosis type I. This article aims to review current evidence for the use of FDG PET and PET/CT in these indications. Attention will also be given to technical and logistical issues, the description of common imaging pitfalls, and dosimetric concerns as they relate to paediatric oncology.
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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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Alkonyi B, Mittal S, Zitron I, Chugani DC, Kupsky WJ, Muzik O, Chugani HT, Sood S, Juhász C. Increased tryptophan transport in epileptogenic dysembryoplastic neuroepithelial tumors. J Neurooncol 2011; 107:365-72. [PMID: 22048879 DOI: 10.1007/s11060-011-0750-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 10/24/2011] [Indexed: 12/26/2022]
Abstract
Dysembryoplastic neuroepithelial tumors (DNTs) are typically hypometabolic but can show increased amino acid uptake on positron emission tomography (PET). To better understand mechanisms of amino acid accumulation in epileptogenic DNTs, we combined quantitative α-[(11)C]methyl-L: -tryptophan (AMT) PET with tumor immunohistochemistry. Standardized uptake values (SUVs) of AMT and glucose were measured in 11 children with temporal lobe DNT. Additional quantification for AMT transport and metabolism was performed in 9 DNTs. Tumor specimens were immunostained for the L: -type amino acid transporter 1 (LAT1) and indoleamine 2,3-dioxygenase (IDO), a key enzyme of the immunomodulatory kynurenine pathway. All 11 tumors showed glucose hypometabolism, while mean AMT SUVs were higher than normal cortex in eight DNTs. Further quantification showed increased AMT transport in seven and high AMT metabolic rates in three DNTs. Two patients showing extratumoral cortical increases of AMT SUV had persistent seizures despite complete tumor resection. Resected DNTs showed moderate to strong LAT1 and mild to moderate IDO immunoreactivity, with the strongest expression in tumor vessels. These results indicate that accumulation of tryptophan in DNTs is driven by high amino acid transport, mediated by LAT1, which can provide the substrate for tumoral tryptophan metabolism through the kynurenine pathway, that can produce epileptogenic metabolites. Increased AMT uptake can extend to extratumoral cortex, and presence of such cortical regions may increase the likelihood of recurrent seizures following surgical excision of DNTs.
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Affiliation(s)
- Bálint Alkonyi
- PET Center, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA
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Dysembryoplastic neuroepithelial tumors: a prospective clinicopathologic and outcome study of 13 children. Pediatr Neurol 2010; 43:395-402. [PMID: 21093729 DOI: 10.1016/j.pediatrneurol.2010.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 09/28/2009] [Accepted: 06/24/2010] [Indexed: 11/22/2022]
Abstract
Dysembryoplastic neuroepithelial tumors (DNETs) are benign intracortical masses that are typically observed in children and young adults and are classified as glioneuronal tumors (WHO grade I). Large and retrospective series of patients with DNETs have been reported, but prospective studies on pediatric cohorts of patients with DNETs have been lacking. In the present study, 13 children (8 boys, 5 girls; age 8-18 years) who had simple (n = 2) or complex (n = 11) partial seizures (seizure duration range, 2-4 years; mean, 1.5 years; mode, 1.2 years) were prospectively enrolled and monitored over 13 years. The DNETs were located in the frontal (n = 2), temporal (n = 9), or occipital (n = 2) cortex. In 11/13 cases, the seizures were resistant to drug therapy, and all the children had surgery consisting of extended lesionectomy coupled with neuronavigation. Pathology examination revealed cortical dysplasia (n = 8), glial nodules (n = 11), calcification (n = 4), cellular atypia (n = 3), endothelial proliferation (n = 1), perivascular inflammation (n = 3), and meningeal involvement (n = 6). All children were seizure free throughout postsurgical follow-up of 2-11 years. This first prospective study with follow-up monitoring of a childhood population with DNETs confirms, on a long-term basis, that the coupled strategy of extended lesionectomy and neuronavigation has good outcome for long-term seizure control.
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Kasper BS, Struffert T, Kasper EM, Fritscher T, Pauli E, Weigel D, Kerling F, Hammen T, Graf W, Kuwert T, Prante O, Lorber B, Buchfelder M, Doerfler A, Schwab S, Stefan H, Linke R. 18Fluoroethyl-L-tyrosine-PET in long-term epilepsy associated glioneuronal tumors. Epilepsia 2010; 52:35-44. [PMID: 20946127 DOI: 10.1111/j.1528-1167.2010.02754.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Long-term epilepsy associated tumors (LEATs) are a frequent cause of drug-resistant partial epilepsy. A reliable tumor diagnosis has an important impact on therapeutic strategies and prognosis in patients with epilepsy, but often is difficult by magnetic resonance imaging (MRI) only. Herein we analyzed a large LEAT cohort investigated by 18fluoroethyl-L-tyrosine-positron emission tomography (FET-PET). METHODS Thirty-six patients with chronic partial epilepsy and a LEAT-suspect MRI lesion were analyzed by FET-PET using visual inspection and quantitative analysis of standard uptake values (SUV). PET results were correlated with clinical and histopathologic data. RESULTS FET-PET study was positive in 22 of 36 analyzed lesions and in 14 of 22 histologically verified LEAT lesions. The precise World Health Organization (WHO) tumoral entity was not predicted by FET-PET. Notably, FET uptake correlated strikingly with age at epilepsy onset (p = 0.001). Further correlations were seen for age at surgery (p = 0.007) and gadolinium-contrast enhancement on MRI (p < 0.05). DISCUSSION FET-PET is a helpful tool for LEAT diagnosis, particularly when MRI readings are ambiguous. FET uptake, which is likely mediated by the l-amino acid transporter (LAT) family, might indicate a principally important biologic property of certain LEATs, since LAT molecules also are involved in cell growth regulation.
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Affiliation(s)
- Burkhard S Kasper
- Department of Neurology, Epilepsy Center, Friedrich-Alexander University Erlangen, Erlangen, Germany.
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Abstract
Cerebral astrocytoma needs to be distinguished from dysembryoplastic neuroepithelial tumor (DNT) when a well-demarcated, cortically based and pseudo-cystic tumor with minimal mass effect is demonstrated on magnetic resonance imaging. We report an unusual case of DNT-like astrocytoma. 18F fluoro-deoxy-glucose (FDG) positron emission tomography showed a focal increase of FDG uptake in a deep part of the tumor. Histologic examination revealed predominantly microcystic change with oligodendrocyte-like cells, leading to a diagnosis of DNT. However, increased cellularity and nuclear atypia of astrocytes within the tumor were conspicuous as for DNT. Four years after excision, tumor recurrence was detected. FDG-positron emission tomography is useful for identifying the malignant potential of DNT-like astrocytoma.
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Kruer MC, Kaplan AM, Etzl MM, Carpentieri DF, Dickman PS, Chen K, Mathieson K, Irving A. The value of positron emission tomography and proliferation index in predicting progression in low-grade astrocytomas of childhood. J Neurooncol 2009; 95:239-245. [PMID: 19506815 DOI: 10.1007/s11060-009-9922-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 05/24/2009] [Indexed: 12/22/2022]
Abstract
Astrocytomas are the most common brain tumors of childhood and adolescence. Low-grade astrocytomas (LGAs), in general, have favorable prognosis, but recurrence or progressive disease with dissemination, malignant transformation, and death occur in some cases. Current clinical and pathological measures including age, sex, imaging characteristics, location and size of the tumor, histopathology, and degree of resection cannot predict with certainty which tumors will demonstrate aggressive behavior. The objective of the study is to determine the predictive value of positron emission tomography (PET) and a proliferation index (PI) in identifying high risk LGAs. We reviewed 46 cases ages 5 months to 17 years with low-grade (WHO I-II) astrocytomas. All patients had PET scans utilizing [(18)F] fluorodeoxyglucose (FDG) and 24 cases had measurements with Ki-67/MIB-1 immunohistochemistry. Review of our data confirmed progressive disease (PD) in 18/46 (39%) of cases with 9/21 (42%) occurring after subtotal resection and 9/25 (36%) after gross total resection. The mortality rate was 5/46 (10.8%). Tumors with FDG hypermetabolism were significantly more likely to demonstrate aggressive behavior and PD. Increased PI values also suggested PD. Progression-free survival and time to progression were significantly longer for patients with hypometabolic scans. Time to progression was significantly longer with lower PI values. Results demonstrate that PET and PI are useful measures in the identification and stratification of high risk LGAs. The ability to identify a subset of progressive LGAs earlier may suggest the need for second-look neurosurgical procedures or more intensified adjuvant treatment that may ultimately improve outcome and survival.
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Affiliation(s)
- Michael C Kruer
- Division of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ, 85016, USA.,Divisions of Pediatric Neurology and Developmental Pediatrics, Child Development and Rehabilitation Center, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Allen M Kaplan
- Division of Child Neurology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.
| | - Michael M Etzl
- Division of Hematology/Oncology, Phoenix Children's Hospital, Phoenix, AZ, 85016, USA
| | | | - Paul S Dickman
- Division of Pathology, Phoenix Children's Hospital, Phoenix, AZ, 85016, USA
| | - Kewei Chen
- Banner Samaritan PET Center, Phoenix, AZ, 85015, USA
| | - Kathleen Mathieson
- Department of Mathematics and Statistics, Arizona State University, Tempe, AZ, 85287, USA
| | - Alison Irving
- Banner Samaritan PET Center, Phoenix, AZ, 85015, USA
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Imaging malformations of cortical development. HANDBOOK OF CLINICAL NEUROLOGY 2008. [PMID: 18809040 DOI: 10.1016/s0072-9752(07)87026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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O'Brien DF, Farrell M, Delanty N, Traunecker H, Perrin R, Smyth MD, Park TS. The Children's Cancer and Leukaemia Group guidelines for the diagnosis and management of dysembryoplastic neuroepithelial tumours. Br J Neurosurg 2008; 21:539-49. [PMID: 18071981 DOI: 10.1080/02688690701594817] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Dysembryoplastic neuroepithelial tumours (DNETs) were incorporated into the new World Health Organization classification of brain tumours as part of the group of glioneuronal tumours in 1993. Large series of patients with DNETs and pharmaco-resistant epilepsy have been reported. DNETs are most often located in the temporal lobe, occurring in both mesial and lateral temporal locations. DNETs have also been reported in the insular cortex, brain stem, cerebellum, occipital lobe and striatum. Approximately 40% of DNETs are cystic, and solitary nodular, multinodular or diffuse forms have been recognized. Approximately 30% of DNETs are associated with subtle cortical dysplastic changes in the adjacent cortex. DNET nodules usually look like oligodendroglioma, whilst between the nodules it may be possible to recognize vertical columns of neurons surrounded by oligodendrocyte-like cells. Cytologically, oligodendroglial-like cells of DNETs are distinguished from oligodendroglioma by larger nuclei with frequent nuclear indentations and multiple, small nucleoli, whilst oligodendrogliomas consistently show nuclear roundness with one or two occasional nucleoli. Very rare cases of malignant transformation have been reported. DNETs are hypodense on CT and demonstrate decreased signal on the T1-weighted images and a hyper-intense signal on T2-weighted MRI. DNETs associated with pharmaco-resistant epilepsy should be removed early to achieve seizure freedom and prevent tumour progression. The surgical approach should be that of an extended lesionectomy, i.e. excision of the lesion and the abnormal dysplastic cortex around it. Use of MRI-based image guidance (neuronavigation) as a surgical tool to identify this area of abnormal cortex is very helpful to ensure that the extended lesionectomy includes any visibly dysplastic cortex. It is not advocated to use a stereotactic biopsy only, as this may generate an unrepresentative tissue sample consisting of an oligodendroglial component only and may lead to an incorrect diagnosis.
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Affiliation(s)
- D F O'Brien
- Department of Neurosurgery, Epilepsy Surgery Programme, Beaumont Hospital, Dublin, Ireland.
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Pirotte B, Acerbi F, Lubansu A, Goldman S, Brotchi J, Levivier M. PET imaging in the surgical management of pediatric brain tumors. Childs Nerv Syst 2007; 23:739-51. [PMID: 17356889 DOI: 10.1007/s00381-007-0307-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The present article illustrates whether positron-emission tomography (PET) imaging may improve the surgical management of pediatric brain tumors (PBT) at different steps. MATERIALS AND METHODS Among 400 consecutive PBT treated between 1995 and 2005 at Erasme Hospital, Brussels, Belgium, we have studied with (18) F-2-fluoro-2-deoxy-D-glucose (FDG)-PET and/or L-(methyl-(11)C)methionine (MET)-PET and integrated PET images in the diagnostic workup of 126 selected cases. The selection criteria were mainly based on the lesion appearance on magnetic resonance (MR) sequences. Cases were selected when MR imaging showed limitations for (1) assessing the evolving nature of an incidental lesion (n = 54), (2) selecting targets for contributive and accurate biopsy (n = 32), and (3) delineating tumor tissue for maximal resection (n = 40). Whenever needed, PET images were integrated in the planning of image-guided surgical procedures (frame-based stereotactic biopsies (SB), frameless navigation-based resections, or leksell gamma knife radiosurgery). RESULTS Like in adults, PET imaging really helped the surgical management of the 126 children explored, which represented about 30% of all PBT, especially when the newly diagnosed brain lesion was (1) an incidental finding so that the choice between surgery and conservative MR follow-up was debated, and (2) so infiltrative or ill-defined on MR that the choice between biopsy and resection was hardly discussed. Integrating PET into the diagnostic workup of these two selected groups helped to (1) take a more appropriate decision in incidental lesions by detecting tumor/evolving tissue; (2) better understand complex cases by differentiating indolent and active components of the lesion; (3) improve target selection and diagnostic yield of stereotactic biopsies in gliomas; (4) illustrate the intratumoral histological heterogeneity in gliomas; (5) provide additional prognostic information; (6) reduce the number of trajectories in biopsies performed in eloquent areas such as the brainstem or the pineal region; (7) better delineate ill-defined PBT infiltrative along functional cortex than magnetic resonance imaging (MRI); (8) increase significantly, compared to using MRI alone, the number of total tumor resection and the amount of tumor tissue removed in PBT for which a total resection is a key-factor of survival; (9) target the resection on more active areas; (10) improve detection of tumor residues in the operative cavity at the early postoperative stage; (11) facilitate the decision of early second-look surgery for optimizing the radical resection; (12) improve the accuracy of the radiosurgical dosimetry planning. CONCLUSIONS PET imaging may improve the surgical management of PBT at the diagnostic, surgical, and post-operative steps. Integration of PET in the clinical workup of PBT inaugurates a new approach in which functional data can influence the therapeutic decision process. Although metabolic information from PET are valid and relevant for the clinical purposes, further studies are needed to assess whether PET-guidance may decrease surgical morbidity and increase children survival.
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Affiliation(s)
- Benoit Pirotte
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium.
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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: 25] [Impact Index Per Article: 1.3] [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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Abstract
Over the past decade there have been many advances in data acquisition and analysis for structural and functional neuroimaging of people with epilepsy. New imaging sequences and analysis techniques have increased the resolution of images such that underlying structural pathology can be seen in many patients with "cryptogenic" epilepsy. When an epileptogenic lesion is present, antiepileptic drugs alone rarely prevent seizures. However, the success of surgical treatment is improved when a structural lesion has been identified. Lesions might not overlap with the area of the cortex generating seizures and may continue into areas sustaining normal functions. To prevent postsurgical morbidity, the spatial relation between functionally important areas and the epileptogenic lesion must be assessed before surgery. In this review we describe the potential of different neuroimaging techniques to show lesions, assess neuronal function, and assist with the prognosis of postsurgical outcome in patients with refractory focal epilepsy.
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Hahn K, Pfluger T. Has PET become an important clinical tool in paediatric imaging? Eur J Nucl Med Mol Imaging 2004; 31:615-21. [PMID: 14762700 DOI: 10.1007/s00259-004-1470-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Maehara T, Nariai T, Arai N, Kawai K, Shimizu H, Ishii K, Ishiwata K, Ohno K. Usefulness of [11C]Methionine PET in the Diagnosis of Dysembryoplastic Neuroepithelial Tumor with Temporal Lobe Epilepsy. Epilepsia 2004; 45:41-5. [PMID: 14692906 DOI: 10.1111/j.0013-9580.2004.20703.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE We assessed the diagnostic value of [11C]methionine (MET) positron emission tomography (PET) in the differential diagnosis of dysembryoplastic neuroepithelial tumors (DNETs) among benign tumors associated with temporal lobe epilepsy (TLE). METHODS This series consisted of seven TLE patients with benign tumors in the temporal lobe. After MET-PET study, all seven patients underwent tumor resection along with focus excision. The uptake of tracers was evaluated by the lesion-to-contralateral ratio (L/C ratio) and the standardized uptake value (SUV). We also assessed the relation between MET uptake and proliferation capacity observed in the surgical specimens. RESULTS Whereas four patients with DNETs did not show high MET uptake visually, the ganglioglioma and gliomas of the remaining three patients were identified as high-MET-uptake lesions. In the DNETs, the SUV ranged from 1.03 to 1.41, and the L/C ratio ranged from 0.99 to 1.14. MET uptake was significantly lower in the patients with DNETs than in the patients with ganglioglioma and brain gliomas (SUV, p = 0.045; L/C ratio, p = 0.0079). The Ki-67 labeling index was 4% in one patient with DNET and 5% in one patient with pleomorphic xanthoastrocytoma (higher labeling index). The higher labeling index was not related to high MET uptake based on the SUV (p = 0.91) and L/C ratio (p = 0.38). CONCLUSIONS Negative MET uptake in benign temporal lobe tumors with TLE is consistent with a preoperative diagnosis of DNET.
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Affiliation(s)
- Taketoshi Maehara
- Neurosurgery, Department of Brain Medical Science, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
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Richardson MP, Hammers A, Brooks DJ, Duncan JS. Benzodiazepine-GABA(A) receptor binding is very low in dysembryoplastic neuroepithelial tumor: a PET study. Epilepsia 2001; 42:1327-34. [PMID: 11737168 DOI: 10.1046/j.1528-1157.2001.44100.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the nature of abnormalities of gamma-aminobutyric acid (GABA)A-central benzodiazepine (BZD) receptor binding in patients with dysembryoplastic neuroepithelial tumor (DNET) in comparison with normal controls. METHODS Five patients with DNET and 24 normal controls underwent (11C)flumazenil positron emission tomography (PET) to measure (11C)flumazenil volume of distribution (FMZVD) at the voxel level. Patients were compared with normal controls by using statistical parametric mapping (SPM) and also a partial-volume effect (PVE) corrected volume-of-interest (VOI) analysis covering the entire brain. First, using SPM, the highest Z-score for the entire image representing FMZVD decreases in comparison with the normals was found. Second, regions of abnormal FMZVD were located using SPM, p < 0.001 uncorrected, corrected p < 0.05. Finally, PVE-corrected measures of FMZVD were calculated for each patient VOI and compared wih those of normals, using significance levels of >2.5 standard deviations (SD) for the DNET and >3 SD for all other regions. RESULTS In all cases, the highest Z-score across the whole image representing decreased FMZVD was within the DNET. In three cases SPM revealed a single region of significantly reduced FMZVD, within the DNET in all three. VOI analysis showed PVE-corrected FMZVD was significantly low in the DNET in four cases. VOI analysis also showed seven other regions of abnormal FMZVD; three were adjacent to a DNET, and two were in mesial temporal areas not affected by DNET. CONCLUSIONS FMZVD is low in DNET, probably contributing to epileptogenicity.
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