Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2019

Open Access 01-12-2019 | Glioma | Research article

Diagnostic accuracy of 13N-ammonia PET, 11C-methionine PET and 18F-fluorodeoxyglucose PET: a comparative study in patients with suspected cerebral glioma

Authors: Qiao He, Linqi Zhang, Bing Zhang, Xinchong Shi, Chang Yi, Xiangsong Zhang

Published in: BMC Cancer | Issue 1/2019

Login to get access

Abstract

Background

The treatment of patients with glioma depended on the nature of the lesion and on histological grade of the tumor. Positron emission tomography (PET) using 13N-ammonia (NH3), 11C-methionine (MET) and 18F-fluorodeoxyglucose (FDG) have been used to assess brain tumors. Our aim was to compare their diagnostic accuracies in patients with suspected cerebral glioma.

Methods

Ninety patients with suspicion of glioma based on previous CT/MRI, who underwent NH3 PET, MET PET and FDG PET, were prospectively enrolled in the study. The reference standard was established by histology or clinical and radiological follow-up. Images were interpreted by visual evaluation and semi-quantitative analysis using the lesion-to-normal white matter uptake ratio (L/WM ratio).

Results

Finally, 30 high-grade gliomas (HGG), 27 low-grade gliomas (LGG), 10 non-glioma tumors and 23 non-neoplastic lesions (NNL) were diagnosed. On visual evaluation, sensitivity and specificity for differentiating tumors from NNL were 62.7% (42/67) and 95.7% (22/23) for NH3 PET, 94.0% (63/67) and 56.5% (13/23) for MET PET, and 35.8% (24/67) and 65.2% (15/23) for FDG PET. On semi-quantitative analysis, brain tumors showed significantly higher L/WM ratios than NNL both in NH3 and MET PET (both P < 0.001). The sensitivity, specificity and the area under the curve (AUC) by receiver operating characteristic (ROC) analysis, respectively, were 64.2, 100% and 0.819 for NH3; and 89.6, 69.6% and 0.840 for MET. Besides, the L/WM ratios of NH3, MET and FDG PET in HGG all significantly higher than that in LGG (all P < 0.001). The predicted (by ROC) accuracy of the tracers (AUC shown in parentheses) were 86.0% (0.896) for NH3, 87.7% (0.928) for MET and 93.0% (0.964) for FDG. While no significant differences in the AUC were seen between them.

Conclusion

NH3 PET has remarkably high specificity for the differentiation of brain tumors from NNL, but low sensitivity for the detection of LGG. MET PET was found to be highly useful for detection of brain tumors. However, like FDG, high MET uptake is frequently observed in some NNL. NH3, MET and FDG PET all appears to be valuable for evaluating the histological grade of gliomas.
Literature
1.
Ostrom QT, Gittleman H, Fulop J, Liu M, Blanda R, Kromer C, Wolinsky Y, Kruchko C, Barnholtz-Sloan JS. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2008-2012. Neuro-Oncology. 2015;17(Suppl 4):iv1–iv62.CrossRef
2.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29.CrossRef
3.
Direksunthorn T, Chawalparit O, Sangruchi T, Witthiwej T, Tritrakarn SO, Piyapittayanan S, Charnchaowanish P, Pornpunyawut P, Sathornsumetee S. Diagnostic performance of perfusion MRI in differentiating low-grade and high-grade gliomas: advanced MRI in glioma, a Siriraj project. J Med Assoc Thail. 2013;96(9):1183–90.
4.
Filss CP, Galldiks N, Stoffels G, Sabel M, Wittsack HJ, Turowski B, Antoch G, Zhang K, Fink GR, Coenen HH, et al. Comparison of 18F-FET PET and perfusion-weighted MR imaging: a PET/MR imaging hybrid study in patients with brain tumors. J Nucl Med. 2014;55(4):540–5.CrossRef
5.
Magalhaes A, Godfrey W, Shen Y, Hu J, Smith W. Proton magnetic resonance spectroscopy of brain tumors correlated with pathology. Acad Radiol. 2005;12(1):51–7.CrossRef
6.
Sahin N, Melhem ER, Wang S, Krejza J, Poptani H, Chawla S, Verma G. Advanced MR imaging techniques in the evaluation of nonenhancing gliomas: perfusion-weighted imaging compared with proton magnetic resonance spectroscopy and tumor grade. Neuroradiol J. 2013;26(5):531–41.CrossRef
7.
Schaller B. Usefulness of positron emission tomography in diagnosis and treatment follow-up of brain tumors. Neurobiol Dis. 2004;15(3):437–48.CrossRef
8.
Singhal T. Positron emission tomography applications in clinical neurology. Semin Neurol. 2012;32(4):421–31.PubMed
9.
Kim D, Kim S, Kim SH, Chang JH, Yun M. Prediction of overall survival based on Isocitrate dehydrogenase 1 mutation and 18F-FDG uptake on PET/CT in patients with cerebral gliomas. Clin Nucl Med. 2018;43(5):311–6.PubMed
10.
Song PJ, Lu QY, Li MY, Li X, Shen F. Comparison of effects of 18F-FDG PET-CT and MRI in identifying and grading gliomas. J Biol Regul Homeost Agents. 2016;30(3):833–8.PubMed
11.
Miyake K, Shinomiya A, Okada M, Hatakeyama T, Kawai N, Tamiya T. Usefulness of FDG, MET and FLT-PET studies for the management of human gliomas. J Biomed Biotechnol. 2012;2012:205818.CrossRef
12.
Sasaki M, Kuwabara Y, Yoshida T, Nakagawa M, Fukumura T, Mihara F, Morioka T, Fukui M, Masuda K. A comparative study of thallium-201 SPET, carbon-11 methionine PET and fluorine-18 fluorodeoxyglucose PET for the differentiation of astrocytic tumours. Eur J Nucl Med. 1998;25(9):1261–9.CrossRef
13.
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(6):1176–82.CrossRef
14.
Chung JK, Kim YK, Kim SK, Lee YJ, Paek S, Yeo JS, Jeong JM, Lee DS, Jung HW, Lee MC. 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(2):176–82.CrossRef
15.
Ito K, Matsuda H, Kubota K. Imaging Spectrum and pitfalls of (11)C-methionine positron emission tomography in a series of patients with intracranial lesions. Korean J Radiol. 2016;17(3):424–34.CrossRef
16.
Kawai N, Okauchi M, Miyake K, Sasakawa Y, Yamamoto Y, Nishiyama Y, Tamiya T. 11C-methionine positron emission tomography in nontumorous brain lesions. No Shinkei Geka. 2010;38(11):985–95.PubMed
17.
Nakajima R, Kimura K, Abe K, Sakai S. (11)C-methionine PET/CT findings in benign brain disease. Jpn J Radiol. 2017;35(6):279–88.CrossRef
18.
Xiangsong ZWC, Dianchao Y, et al. Usefulness of (13)N-NH (3) PET in the evaluation of brain lesions that are hypometabolic on (18)F-FDG PET. J Neuro-Oncol. 2011;105:103–7.CrossRef
19.
Shi X, Liu Y, Zhang X, Yi C, Wang X, Chen Z, Zhang B. The comparison of 13N-ammonia and 18F-FDG in the evaluation of untreated gliomas. Clin Nucl Med. 2013;38(7):522–6.CrossRef
20.
Shi X, Yi C, Wang X, Zhang B, Chen Z, Tang G, Zhang X. 13N-ammonia combined with 18F-FDG could discriminate between necrotic high-grade gliomas and brain abscess. Clin Nucl Med. 2015;40(3):195–9.CrossRef
21.
Xiangsong Z, Changhong L, Weian C, Dong Z. PET imaging of cerebral astrocytoma with 13N-ammonia. J Neuro-Oncol. 2006;78(2):145–51.CrossRef
22.
Xiangsong Z, Weian C. Differentiation of recurrent astrocytoma from radiation necrosis: a pilot study with 13N-NH3 PET. J Neuro-Oncol. 2007;82(3):305–11.CrossRef
23.
Toorongian SA, Mulholland GK, Jewett DM, Bachelor MA, Kilbourn MR. Routine production of 2-deoxy-2-[18F]fluoro-D-glucose by direct nucleophilic exchange on a quaternary 4-aminopyridinium resin. Int J Rad Appl Instrum B. 1990;17(3):273–9.CrossRef
24.
D'Souza MMSR, Jaimini A, et al. Metabolic assessment of intracranial tuberculomas using 11C-methionine and 18F-FDG PET/CT. Nucl Med Commun. 2012;33:408–14.CrossRef
25.
Jacobs A. Amino acid uptake in ischemically compromised brain tissue. Stroke. 1995;26(10):1859–66.CrossRef
26.
Shirai S, Yabe I, Kano T, Shimizu Y, Sasamori T, Sato K, Hirotani M, Nonaka T, Takahashi I, Matsushima M, et al. Usefulness of 11C-methionine-positron emission tomography for the diagnosis of progressive multifocal leukoencephalopathy. J Neurol. 2014;261(12):2314–8.CrossRef
27.
Hutterer MNM, Putzer D, et al. [18F]-fluoro-ethyl-L-tyrosine PET: a valuable diagnostic tool in neuro-oncology, but not all that glitters is glioma. Neuro-Oncology. 2013;15(3):341–51.CrossRef
28.
Becherer A, Karanikas G, Szabo M, Zettinig G, Asenbaum S, Marosi C, Henk C, Wunderbaldinger P, Czech T, Wadsak W, et al. Brain tumour imaging with PET: a comparison between [18F]fluorodopa and [11C]methionine. Eur J Nucl Med Mol Imaging. 2003;30(11):1561–7.CrossRef
29.
Ceyssens S, Van Laere K, de Groot T, Goffin J, Bormans G, Mortelmans L. [11C]methionine PET, histopathology, and survival in primary brain tumors and recurrence. AJNR Am J Neuroradiol. 2006;27(7):1432–7.PubMed
30.
Moulin-Romsee G, D'Hondt E, de Groot T, Goffin J, Sciot R, Mortelmans L, Menten J, Bormans G, Van Laere K. Non-invasive grading of brain tumours using dynamic amino acid PET imaging: does it work for 11C-methionine? Eur J Nucl Med Mol Imaging. 2007;34(12):2082–7.CrossRef
31.
Li DL, Xu YK, Wang QS, Wu HB, Li HS. (1)(1)C-methionine and (1)(8)F-fluorodeoxyglucose positron emission tomography/CT in the evaluation of patients with suspected primary and residual/recurrent gliomas. Chin Med J. 2012;125(1):91–6.PubMed
32.
Ogawa T, Shishido F, Kanno I, Inugami A, Fujita H, Murakami M, Shimosegawa E, Ito H, Hatazawa J, Okudera T, et al. Cerebral glioma: evaluation with methionine PET. Radiology. 1993;186(1):45–53.CrossRef
33.
Singhal T, Narayanan TK, Jacobs MP, Bal C, Mantil JC. 11C-methionine PET for grading and prognostication in gliomas: a comparison study with 18F-FDG PET and contrast enhancement on MRI. J Nucl Med. 2012;53(11):1709–15.CrossRef
Metadata
Title
Diagnostic accuracy of 13N-ammonia PET, 11C-methionine PET and 18F-fluorodeoxyglucose PET: a comparative study in patients with suspected cerebral glioma
Authors
Qiao He
Linqi Zhang
Bing Zhang
Xinchong Shi
Chang Yi
Xiangsong Zhang
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2019
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-019-5560-1

Other articles of this Issue 1/2019

BMC Cancer 1/2019 Go to the issue

Research article

Prevalence of germline mutations in the TP53 gene in patients with early-onset breast cancer in the Mexican population

Research article

Risk prediction for breast Cancer in Han Chinese women based on a cause-specific Hazard model

Case report

Gastrointestinal stromal tumor with intracranial metastasis: case presentation and systematic review of literature

Research article

MicroRNA-1275 inhibits cell migration and invasion in gastric cancer by regulating vimentin and E-cadherin via JAZF1

Research article

Glioma malignancy is linked to interdependent and inverse AMOG and L1 adhesion molecule expression

Research article

LETM1 is a potential biomarker of prognosis in lung non-small cell carcinoma
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits