Top

Annals of Nuclear Medicine

Published in:

01-02-2018 | Original Article

Diagnostic accuracy of ¹¹C-methionine PET in detecting neuropathologically confirmed recurrent brain tumor after radiation therapy

Authors: Annika Kits, Heather Martin, Alejandro Sanchez-Crespo, Anna F. Delgado

Published in: Annals of Nuclear Medicine | Issue 2/2018

Abstract

Objective

This study aims to determine the diagnostic test accuracy (DTA) of ¹¹C-methionine (MET) PET in the discrimination between recurrent tumor and radiation-induced injury in neuropathologically confirmed cases.

Methods

A retrospective cohort of 30 patients with previously irradiated intracranial tumors (23 gliomas, 6 metastases, and 1 meningioma) was included. All patients underwent a preoperative MET PET and postoperative neuropathological analysis. Maximum and mean standardized uptake values (SUV) were obtained in the lesion, in the contralateral mirror region, and in the contralateral frontal cortex. Lesion-to-background SUV ratios (SUR mirror and SUR cortex) were then calculated. The Mann–Whitney U test was used to evaluate differences in SUV ratios between confirmed recurrent tumor and radiation injury. DTA was determined through receiver operating characteristic (ROC) analysis.

Results

Twenty-one patients had recurrent tumor and nine had radiation injury. The area under the ROC curve (AUC) was 0.89 for SUR_maxmirror and 0.88 for SUR_maxcortex. The mean (SD) of SUR_maxmirror was 2.37 (0.58) in tumor recurrence and 1.57 (0.40) in radiation necrosis (P ≤ 0.001). The corresponding values for SUR_maxcortex were 2.13 (0.50) and 1.45 (0.37) (P = 0.001). Clinically relevant cutoffs were SUR_maxmirror ≥ 1.99 giving a specificity of 100% for tumor recurrence with a sensitivity of 76% and SUR_maxcortex ≥ 1.58 giving a sensitivity and specificity of 90 and 78%, respectively.

Conclusions

Based on neuropathologically confirmed cases, the DTA of SUR_maxmirror and SUR_maxcortex from ¹¹C-methionine PET was high when discriminating recurrent tumor from radiation injury.

Ruben JD, Dally M, Bailey M, Smith R, McLean CA, Fedele P. Cerebral radiation necrosis: incidence, outcomes, and risk factors with emphasis on radiation parameters and chemotherapy. Int J Radiat Oncol Biol Phys. 2006;65(2):499–508. https://doi.org/10.1016/j.ijrobp.2005.12.002.CrossRefPubMed

Stockham AL, Tievsky AL, Koyfman SA, Reddy CA, Suh JH, Vogelbaum MA, Barnett GH, Chao ST. Conventional MRI does not reliably distinguish radiation necrosis from tumor recurrence after stereotactic radiosurgery. J Neuro Oncol. 2012;109(1):149–58. https://doi.org/10.1007/s11060-012-0881-9.CrossRef

Raimbault A, Cazals X, Lauvin MA, Destrieux C, Chapet S, Cottier JP. Radionecrosis of malignant glioma and cerebral metastasis: a diagnostic challenge in MRI. Diagn Interv Imaging. 2014;95(10):985–1000. https://doi.org/10.1016/j.diii.2014.06.013.CrossRefPubMed

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.CrossRefPubMed

Roelcke U, Radu E, Ametamey S, Pellikka R, Steinbrich W, Leenders KL. Association of rubidium and C-methionine uptake in brain tumors measured by positron emission tomography. J Neurooncol. 1996;27(2):163–71.CrossRefPubMed

Okubo S, Zhen HN, Kawai N, Nishiyama Y, Haba R, Tamiya T. Correlation of L-methyl-11C-methionine (MET) uptake with L-type amino acid transporter 1 in human gliomas. J Neuro Oncol. 2010;99(2):217–25. https://doi.org/10.1007/s11060-010-0117-9.CrossRef

Okita Y, Kinoshita M, Goto T, Kagawa N, Kishima H, Shimosegawa E, Hatazawa J, Hashimoto N, Yoshimine T. (11)C-methionine uptake correlates with tumor cell density rather than with microvessel density in glioma: A stereotactic image-histology comparison. Neuroimage. 2010;49(4):2977–82. https://doi.org/10.1016/j.neuroimage.2009.11.024.CrossRefPubMed

Roelcke U, Radu EW, von Ammon K, Hausmann O, Maguire RP, Leenders KL. Alteration of blood-brain barrier in human brain tumors: comparison of [18F]fluorodeoxyglucose, [11C]methionine and rubidium-82 using PET. J Neurol Sci. 1995;132(1):20–7.CrossRefPubMed

Ishiwata K, Kubota K, Murakami M, Kubota R, Sasaki T, Ishii S, Senda M. Re-evaluation of amino acid PET studies: can the protein synthesis rates in brain and tumor tissues be measured in vivo? Journal of nuclear medicine: official publication. Soc Nucl Med. 1993;34(11):1936–43.

10.

Ullrich RT, Kracht L, Brunn A, Herholz K, Frommolt P, Miletic H, Deckert M, Heiss WD, Jacobs AH. Methyl-L-11C-methionine PET as a diagnostic marker for malignant progression in patients with glioma. J Nucl Med. 2009;50(12):1962–8. https://doi.org/10.2967/jnumed.109.065904.CrossRefPubMed

11.

Terakawa Y, Tsuyuguchi N, Iwai Y, Yamanaka K, Higashiyama S, Takami T, Ohata K. Diagnostic accuracy of 11C-methionine PET for differentiation of recurrent brain tumors from radiation necrosis after radiotherapy. J Nucl Med. 2008;49(5):694–9. https://doi.org/10.2967/jnumed.107.048082.CrossRefPubMed

12.

Minamimoto R, Saginoya T, Kondo C, Tomura N, Ito K, Matsuo Y, Matsunaga S, Shuto T, Akabane A, Miyata Y, Sakai S, Kubota K. Differentiation of Brain tumor recurrence from post-radiotherapy necrosis with 11C-methionine PET: visual assessment versus quantitative assessment. PloS One. 2015;10(7):e0132515. https://doi.org/10.1371/journal.pone.0132515.CrossRefPubMedPubMedCentral

13.

Skvortsova TY, Brodskaya ZL, Gurchin AF. (2014) [PET using 11C-methionine in recognition of pseudoprogression in cerebral glioma after combined treatment]. Zhurnal voprosy neirokhirurgii imeni N N Burdenko. 78 (4):50–8.PubMed

14.

Takenaka S, Asano Y, Shinoda J, Nomura Y, Yonezawa S, Miwa K, Yano H, Iwama T. Comparison of (11)C-methionine, (11)C-choline, and (18)F-fluorodeoxyglucose-PET for distinguishing glioma recurrence from radiation necrosis. Neurol Med Chir. 2014;54(4):280–9.CrossRef

15.

D’Souza MM, Sharma R, Jaimini A, Panwar P, Saw S, Kaur P, Mondal A, Mishra A, Tripathi RP. 11C-MET PET/CT and advanced MRI in the evaluation of tumor recurrence in high-grade gliomas. Clin Nucl Med. 2014;39(9):791–8. https://doi.org/10.1097/RLU.0000000000000532.CrossRefPubMed

16.

Jung TY, Min JJ, Bom HS, Jung S, Kim IY, Lim SH, Kim DY, Kwon SY. Prognostic value of post-treatment metabolic tumor volume from 11C-methionine PET/CT in recurrent malignant glioma. Neurosurg Rev. 2016. https://doi.org/10.1007/s10143-016-0748-1.PubMed

17.

Tsuyuguchi N, Sunada I, Iwai Y, Yamanaka K, Tanaka K, Takami T, Otsuka Y, Sakamoto S, Ohata K, Goto T, Hara M. Methionine positron emission tomography of recurrent metastatic brain tumor and radiation necrosis after stereotactic radiosurgery: is a differential diagnosis possible? J Neurosurg. 2003;98(5):1056–64. https://doi.org/10.3171/jns.2003.98.5.1056.CrossRefPubMed

18.

Tsuyuguchi N, Takami T, Sunada I, Iwai Y, Yamanaka K, Tanaka K, Nishikawa M, Ohata K, Torii K, Morino M, Nishio A, Hara M. Methionine positron emission tomography for differentiation of recurrent brain tumor and radiation necrosis after stereotactic radiosurgery-in malignant glioma. Ann Nucl Med. 2004;18(4):291–6.CrossRefPubMed

19.

Nakajima T, Kumabe T, Kanamori M, Saito R, Tashiro M, Watanabe M, Tominaga T. Differential diagnosis between radiation necrosis and glioma progression using sequential proton magnetic resonance spectroscopy and methionine positron emission tomography. Neurol Med Chir. 2009;49(9):394–401.CrossRef

20.

Grosu AL, Astner ST, Riedel E, Nieder C, Wiedenmann N, Heinemann F, Schwaiger M, Molls M, Wester HJ, Weber WA. An interindividual comparison of O-(2-[18F]fluoroethyl)-L-tyrosine (FET)- and L-[methyl-11C]methionine (MET)-PET in patients with brain gliomas and metastases. Int J Radiat Oncol Biol Phys. 2011;81(4):1049–58. https://doi.org/10.1016/j.ijrobp.2010.07.002.CrossRefPubMed

21.

Bossuyt PM, Cohen JF, Gatsonis CA, Korevaar DA, group S. STARD 2015: updated reporting guidelines for all diagnostic accuracy studies. Ann Transl Med. 2016;4(4):85. https://doi.org/10.3978/j.issn.2305-5839.2016.02.06.PubMedPubMedCentral

22.

Deng SM, Zhang B, Wu YW, Zhang W, Chen YY. Detection of glioma recurrence by (1)(1)C-methionine positron emission tomography and dynamic susceptibility contrast-enhanced magnetic resonance imaging: a meta-analysis. Nucl Med Commun. 2013;34(8):758–66. https://doi.org/10.1097/MNM.0b013e328361f598.CrossRefPubMed

23.

Nihashi T, Dahabreh IJ, Terasawa T. Diagnostic accuracy of PET for recurrent glioma diagnosis: a meta-analysis. AJNR Am J Neuroradiol. 2013;34(5):944–50. https://doi.org/10.3174/ajnr.A3324. S941–911.CrossRefPubMed

24.

Bhopal R. (2008) Concepts of epidemiology: integrating the ideas, theories, principles and methods of epidemiology. 2. Oxford University Press, Oxford.CrossRef

25.

Herholz K, Holzer T, Bauer B, Schroder R, Voges J, Ernestus RI, Mendoza G, Weber-Luxenburger G, Lottgen J, Thiel A, Wienhard K, Heiss WD. 11C-methionine PET for differential diagnosis of low-grade gliomas. Neurology. 1998;50(5):1316–22.CrossRefPubMed

26.

Zhao S, Kuge Y, Yi M, Zhao Y, Hatano T, Magota K, Nishijima K, Kohanawa M, Tamaki N. Dynamic 11C-methionine PET analysis has an additional value for differentiating malignant tumors from granulomas: an experimental study using small animal PET. Eur J Nucl Med Mol Imaging. 2011;38(10):1876–86. https://doi.org/10.1007/s00259-011-1865-2.CrossRefPubMed

27.

Aldape K, Simmons ML, Davis RL, Miike R, Wiencke J, Barger G, Lee M, Chen P, Wrensch M. Discrepancies in diagnoses of neuroepithelial neoplasms: the San Francisco Bay Area Adult Glioma Study. Cancer. 2000;88(10):2342–9.CrossRefPubMed

28.

Bruner JM, Inouye L, Fuller GN, Langford LA. Diagnostic discrepancies and their clinical impact in a neuropathology referral practice. Cancer. 1997;79(4):796–803.CrossRefPubMed

29.

Prayson RA, Agamanolis DP, Cohen ML, Estes ML, Kleinschmidt-DeMasters BK, Abdul-Karim F, McClure SP, Sebek BA, Vinay R. Interobserver reproducibility among neuropathologists and surgical pathologists in fibrillary astrocytoma grading. J Neurol Sci. 2000;175(1):33–9.CrossRefPubMed

Title: Diagnostic accuracy of 11C-methionine PET in detecting neuropathologically confirmed recurrent brain tumor after radiation therapy
Authors: Annika Kits
Heather Martin
Alejandro Sanchez-Crespo
Anna F. Delgado
Publication date: 01-02-2018
Publisher: Springer Japan
Published in: Annals of Nuclear Medicine / Issue 2/2018
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI: https://doi.org/10.1007/s12149-017-1227-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnostic accuracy of ¹¹C-methionine PET in detecting neuropathologically confirmed recurrent brain tumor after radiation therapy

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2018

A 3-variable prognostic score (3-PS) for overall survival prediction in metastatic castration-resistant prostate cancer treated with 223Radium-dichloride

Evaluation of amyloid status in a cohort of elderly individuals with memory complaints: validation of the method of quantification and determination of positivity thresholds

Use of quantitative SPECT/CT reconstruction in 99mTc-sestamibi imaging of patients with renal masses

Rational evaluation of the therapeutic effect and dosimetry of auger electrons for radionuclide therapy in a cell culture model

Do clinical and laboratory variables have any impact on the diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin?

Evaluation of bone metastatic burden by bone SPECT/CT in metastatic prostate cancer patients: defining threshold value for total bone uptake and assessment in radium-223 treated patients