TY - JOUR

T1 - 11 C-methionine pet in assessment of brain lesions in patients with glial tumors after combined treatment

AU - Skvortsova, T. Yu

AU - Gurchin, A. F.

AU - Savintseva, Zh I.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Positron emission tomography (PET) with amino acid-based radiopharmaceuticals is considered as an effective method to diagnose continued growth of cerebral gliomas, but the variability of11C-methionine uptake by brain lesions of different genesis after combined treatment still remains poorly understood. The aim of this study was to explore the information value of11C-methionine PET in delimitating progression of cerebral gliomas and stable disease and to assess the risk of tumor recurrence at different values of the11C-methionine uptake index. Material and methods. We performed a retrospective analysis of the results of11C-methionine PET or PET/CT in 324 patients suspected for continued growth of cerebral tumor based on magnetic resonance imaging (MRI) findings. A quantitative analysis of the results included calculation of the11C-methionine uptake index (UI). Results. A ROC analysis revealed that the specificity of PET in the diagnosis of continued tumor growth (CTG) was 98%, and the sensitivity was 71% for a UI of more than 1.9. We found that 98% of lesions with a negative level of RP uptake were related to radiation brain lesions (RBLs) or residual tumors combined with radiation pathomorphims. The UI in a range of 1.2―1.6 in 75% of lesions characterized a stable disease, but 25.5% of the lesions represented continued glioma growth. The proportion of recurrences increased to 40% in a UI range of 1.6―1.9, and 95.5% of brain lesions with a UI of more than 1.9 were tumor recurrences. Therefore, high11C-methionine uptake with the UI above 1.9 in brain lesions characterized by radiological signs of disease progression is a highly specific indicator of CTG; however, the UI may significantly vary during tumor growth, and a substantial fraction of recurrent gliomas may have lower radiopharmaceutical uptake. In the case of borderline UI values, early dynamic control or complementary additional MRI or CT techniques should be used.

AB - Positron emission tomography (PET) with amino acid-based radiopharmaceuticals is considered as an effective method to diagnose continued growth of cerebral gliomas, but the variability of11C-methionine uptake by brain lesions of different genesis after combined treatment still remains poorly understood. The aim of this study was to explore the information value of11C-methionine PET in delimitating progression of cerebral gliomas and stable disease and to assess the risk of tumor recurrence at different values of the11C-methionine uptake index. Material and methods. We performed a retrospective analysis of the results of11C-methionine PET or PET/CT in 324 patients suspected for continued growth of cerebral tumor based on magnetic resonance imaging (MRI) findings. A quantitative analysis of the results included calculation of the11C-methionine uptake index (UI). Results. A ROC analysis revealed that the specificity of PET in the diagnosis of continued tumor growth (CTG) was 98%, and the sensitivity was 71% for a UI of more than 1.9. We found that 98% of lesions with a negative level of RP uptake were related to radiation brain lesions (RBLs) or residual tumors combined with radiation pathomorphims. The UI in a range of 1.2―1.6 in 75% of lesions characterized a stable disease, but 25.5% of the lesions represented continued glioma growth. The proportion of recurrences increased to 40% in a UI range of 1.6―1.9, and 95.5% of brain lesions with a UI of more than 1.9 were tumor recurrences. Therefore, high11C-methionine uptake with the UI above 1.9 in brain lesions characterized by radiological signs of disease progression is a highly specific indicator of CTG; however, the UI may significantly vary during tumor growth, and a substantial fraction of recurrent gliomas may have lower radiopharmaceutical uptake. In the case of borderline UI values, early dynamic control or complementary additional MRI or CT techniques should be used.

KW - C-methionine uptake index

KW - Continued tumor growth

KW - Radiation-induced brain injury

KW - ROC analysis

UR - http://www.scopus.com/inward/record.url?scp=85067013656&partnerID=8YFLogxK

U2 - 10.17116/neiro20198302127

DO - 10.17116/neiro20198302127

M3 - Article

C2 - 31166315

AN - SCOPUS:85067013656

VL - 83

SP - 27

EP - 36

JO - ЖУРНАЛ ВОПРОСЫ НЕЙРОХИРУРГИИ ИМ. Н.Н. БУРДЕНКО

JF - ЖУРНАЛ ВОПРОСЫ НЕЙРОХИРУРГИИ ИМ. Н.Н. БУРДЕНКО

SN - 0042-8817

IS - 2

ER -