Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-10-2009 | Original Article

¹⁸F-FDG PET in the assessment of tumor grade and prediction of tumor recurrence in intracranial meningioma

Authors: Jeong Won Lee, Keon Wook Kang, Sung-Hye Park, Sang Mi Lee, Jin Chul Paeng, June-Key Chung, Myung Chul Lee, Dong Soo Lee

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 10/2009

Abstract

Purpose

The purpose of this study was to investigate the role of ¹⁸F-fluorodeoxyglucose (FDG) PET in detecting high-grade meningioma and predicting the recurrence in patients with meningioma after surgical resection.

Methods

Fifty-nine patients (27 men and 32 women) with intracranial meningioma who underwent preoperative FDG PET and subsequent surgical resection were enrolled. All patients underwent clinical follow-up for tumor recurrence with a mean duration of 34±20 months. The tumor to gray matter ratio (TGR) of FDG uptake was calculated and a receiver-operating characteristic (ROC) curve of the TGR was drawn to determine the cutoff value of the TGR for detection of high-grade meningioma. Further, univariate analysis with the log-rank test was performed to assess the predictive factors of meningioma recurrence.

Results

The TGR in high-grade meningioma (WHO grade II and III) was significantly higher than that in low-grade ones (WHO grade I) (p=0.002) and significantly correlated with the MIB-1 labeling index (r=0.338, p=0.009) and mitotic count of the tumor (r=0.284, p=0.03). The ROC analysis revealed that the TGR of 1.0 was the best cutoff value for detecting high-grade meningioma with a sensitivity of 43%, specificity of 95%, and accuracy of 81%. Of 59 patients, 5 (9%) had a recurrent event. In the log-rank test, the TGR, MIB-1 labeling index, presence of brain invasion, and WHO grade were significantly associated with tumor recurrence. The cumulative recurrence-free survival rate of patients with a TGR of 1.0 or less was significantly higher than that of patients with a TGR of more than 1.0 (p=0.0003)

Conclusion

FDG uptake in meningioma was the significant predictive factor of tumor recurrence and significantly correlated with the proliferative potential of the tumor.

Marosi C, Hassler M, Roessler K, Reni M, Sant M, Mazza E, et al. Meningioma. Crit Rev Oncol Hematol 2008;67:153–71. doi:10.1016/j.critrevonc.2008.01.010.PubMedCrossRef

McCarthy BJ, Davis FG, Freels S, Surawicz TS, Damek DM, Grutsch J, et al. Factors associated with survival in patients with meningioma. J Neurosurg 1998;88:831–9.PubMedCrossRef

Maier H, Ofner D, Hittmair A, Kitz K, Budka H. Classic, atypical, and anaplastic meningioma: three histopathological subtypes of clinical relevance. J Neurosurg 1992;77:616–23.PubMedCrossRef

Commins DL, Atkinson RD, Burnett ME. Review of meningioma histopathology. Neurosurg Focus 2007;23:E3. doi:10.3171/FOC-07/10/E3.PubMedCrossRef

Goyal LK, Suh JH, Mohan DS, Prayson RA, Lee J, Barnett GH. Local control and overall survival in atypical meningioma: a retrospective study. Int J Radiat Oncol Biol Phys 2000;46:57–61. doi:10.1016/S0360-3016(99)00349-1.PubMedCrossRef

Takahashi JA, Ueba T, Hashimoto N, Nakashima Y, Katsuki N. The combination of mitotic and Ki-67 indices as a useful method for predicting short-term recurrence of meningiomas. Surg Neurol 2004;61:149–55. doi:10.1016/S0090-3019(03)00575-5.PubMedCrossRef

Delbeke D, Meyerowitz C, Lapidus RL, Maciunas RJ, Jennings MT, Moots PL, et al. Optimal cutoff levels of F-18 fluorodeoxyglucose uptake in the differentiation of low-grade from high-grade brain tumors with PET. Radiology 1995;195:47–52.PubMed

Padma MV, Said S, Jacobs M, Hwang DR, Dunigan K, Satter M, et al. Prediction of pathology and survival by FDG PET in gliomas. J Neurooncol 2003;64:227–37. doi:10.1023/A:1025665820001.PubMedCrossRef

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. doi:10.1016/j.rcl.2004.09.009.PubMedCrossRef

10.

Di Chiro G, Hatazawa J, Katz DA, Rizzoli HV, De Michele DJ. Glucose utilization by intracranial meningiomas as an index of tumor aggressivity and probability of recurrence: a PET study. Radiology 1987;164:521–6.PubMed

11.

Cremerius U, Bares R, Weis J, Sabri O, Mull M, Schröder JM, et al. Fasting improves discrimination of grade 1 and atypical or malignant meningioma in FDG-PET. J Nucl Med 1997;38:26–30.PubMed

12.

Lippitz B, Cremerius U, Mayfrank L, Bertalanffy H, Raoofi R, Weis J, et al. PET-study of intracranial meningiomas: correlation with histopathology, cellularity and proliferation rate. Acta Neurochir Suppl 1996;65:108–11.PubMed

13.

Park YS, Jeon BC, Oh HS, Lee SM, Chun BK, Chang HK. FDG PET/CT assessment of the biological behavior of meningiomas. J Korean Neurosurg Soc 2006;40:428–33.

14.

Perry A, Louis DN, Scheithauer BW, Budka H, von Deimling A. Meningiomas. In: Louis DN, Ohgaki H, Wiestler OD, et al., editors. World Health Organization classification of tumours of the central nervous system. 4th ed. Lyon: IARC; 2007. p. 164–72.

15.

Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology 2004;231:305–32. doi:10.1148/radiol.2312021185.PubMedCrossRef

16.

Iuchi T, Iwasate Y, Namba H, Osato K, Saeki N, Yamaura A, et al. Glucose and methionine uptake and proliferative activity in meningiomas. Neurol Res 1999;21:640–4.PubMed

17.

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. doi:10.1053/snuc.2003.127304.PubMedCrossRef

18.

Singhal T, Narayanan TK, Jain V, Mukherjee J, Mantil J. 11C-L-methionine positron emission tomography in the clinical management of cerebral gliomas. Mol Imaging Biol 2008;10:1–18. doi:10.1007/s11307-007-0115-2.PubMedCrossRef

19.

Weber WA, Wester HJ, Grosu AL, Herz M, Dzewas B, Feldmann HJ, et al. O-(2-[18F]fluoroethyl)-L-tyrosine and L-[methyl-11C]methionine uptake in brain tumours: initial results of a comparative study. Eur J Nucl Med 2000;27:542–9. doi:10.1007/s002590050541.PubMedCrossRef

20.

Chung JK, Kim YK, Kim SK, Lee YJ, Paek S, Yeo JS, et al. Usefulness of 11C-methionine PET in the evaluation of brain lesions that are hypo- or isometabolic on 18F-FDG PET. Eur J Nucl Med Mol Imaging 2002;29:176–82. doi:10.1007/s00259-001-0690-4.PubMedCrossRef

21.

Gudjonsson O, Blomquist E, Lilja A, Ericson H, Bergström M, Nyberg G. Evaluation of the effect of high-energy proton irradiation treatment on meningiomas by means of 11C-L-methionine PET. Eur J Nucl Med 2000;27:1793–9. doi:10.1007/s002590000335.PubMedCrossRef

22.

Grosu AL, Weber WA, Astner ST, Adam M, Krause BJ, Schwaiger M, et al. 11C-methionine PET improves the target volume delineation of meningiomas treated with stereotactic fractionated radiotherapy. Int J Radiat Oncol Biol Phys 2006;66:339–44. doi:10.1016/j.ijrobp. 2006.02.047.PubMed

23.

Ko KW, Nam DH, Kong DS, Lee JI, Park K, Kim JH. Relationship between malignant subtypes of meningioma and clinical outcome. J Clin Neurosci 2007;14:747–53. doi:10.1016/j.jocn.2006.05.005.PubMedCrossRef

24.

Böker DK, Meurer H, Gullotta F. Recurring intracranial meningiomas. Evaluation of some factors predisposing for tumor recurrence. J Neurosurg Sci 1985;29:11–7.PubMed

25.

Sasaki R, Komaki R, Macapinlac H, Erasmus J, Allen P, Forster K, et al. [18F] fluorodeoxyglucose uptake by positron emission tomography predicts outcome of non-small-cell lung cancer. J Clin Oncol 2005;23:1136–43. doi:10.1200/JCO.2005.06.129.PubMedCrossRef

26.

Swisher SG, Maish M, Erasmus JJ, Correa AM, Ajani JA, Bresalier R, et al. Utility of PET, CT, and EUS to identify pathologic responders in esophageal cancer. Ann Thorac Surg 2004;78:1152–60. doi:10.1016/j.athoracsur.2004.04.046.PubMedCrossRef

27.

Nakata B, Nishimura S, Ishikawa T, Ohira M, Nishino H, Kawabe J, et al. Prognostic predictive value of 18F-fluorodeoxyglucose positron emission tomography for patients with pancreatic cancer. Int J Oncol 2001;19:53–8.PubMed

28.

Alavi JB, Alavi A, Chawluk J, Kushner M, Powe J, Hickey W, et al. Positron emission tomography in patients with glioma. A predictor of prognosis. Cancer 1988;62:1074–8. doi:10.1002/1097-0142(19880915)62:6<1074::AID-CNCR2820620609>3.0.CO;2-H.PubMedCrossRef

29.

Mineura K, Sasajima T, Kowada M, Ogawa T, Hatazawa J, Shishido F, et al. Perfusion and metabolism in predicting the survival of patients with cerebral gliomas. Cancer 1994;73:2386–94. doi:10.1002/1097-0142(19940501)73:9<2386::AID-CNCR2820730923>3.0.CO;2-W.PubMedCrossRef

30.

Jääskeläinen J, Haltia M, Servo A. Atypical and anaplastic meningiomas: radiology, surgery, radiotherapy, and outcome. Surg Neurol 1986;25:233–42. doi:10.1016/0090-3019(86)90233-8.PubMedCrossRef

Title: 18F-FDG PET in the assessment of tumor grade and prediction of tumor recurrence in intracranial meningioma
Authors: Jeong Won Lee
Keon Wook Kang
Sung-Hye Park
Sang Mi Lee
Jin Chul Paeng
June-Key Chung
Myung Chul Lee
Dong Soo Lee
Publication date: 01-10-2009
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 10/2009
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-009-1133-x

2024 ASCO Annual Meeting

Springer Medicine

¹⁸F-FDG PET in the assessment of tumor grade and prediction of tumor recurrence in intracranial meningioma

Abstract

Purpose

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2009

Myocardial perfusion quantitation with 15O-labelled water PET: high reproducibility of the new cardiac analysis software (Carimas™)

18F-FDG PET/CT for early prediction of response to neoadjuvant chemotherapy in breast cancer

Myocardial perfusion quantitation with PET: time to do our homework

Advances in quantitative assessment of myocardial blood flow and coronary reserve

Yttrium-90 TOF PET scan demonstrates high-resolution biodistribution after liver SIRT

A portrait of the scientist as a young woman