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European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-06-2015 | Original Article

Prognostic value of volume-based measurements on ¹¹C-methionine PET in glioma patients

Authors: Kentaro Kobayashi, Kenji Hirata, Shigeru Yamaguchi, Osamu Manabe, Shunsuke Terasaka, Hiroyuki Kobayashi, Tohru Shiga, Naoya Hattori, Shinya Tanaka, Yuji Kuge, Nagara Tamaki

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 7/2015

Abstract

Purpose

¹¹C-methionine (MET) PET is an established diagnostic tool for glioma. Studies have suggested that MET uptake intensity in the tumor is a useful index for predicting patient outcome. Because MET uptake is known to reflect tumor expansion more accurately than MRI, we aimed to elucidate the association between volume-based tumor measurements and patient prognosis.

Methods

The study population comprised 52 patients with newly diagnosed glioma who underwent PET scanning 20 min after injection of 370 MBq MET. The tumor was contoured using a threshold of 1.3 times the activity of the contralateral normal cortex. Metabolic tumor volume (MTV) was defined as the total volume within the boundary. Total lesion methionine uptake (TLMU) was defined as MTV times the mean standardized uptake value (SUVmean) within the boundary. The tumor-to-normal ratio (TNR), calculated as the maximum standardized uptake value (SUVmax) divided by the contralateral reference value, was also recorded. All patients underwent surgery (biopsy or tumor resection) targeting the tissue with high MET uptake. The Kaplan-Meier method was used to estimate the predictive value of each measurement.

Results

Grade II tumor was diagnosed in 12 patients (3 diffuse astrocytoma, 2 oligodendroglioma, and 7 oligoastrocytoma), grade III in 18 patients (8 anaplastic astrocytoma, 6 anaplastic oligodendroglioma, and 4 anaplastic oligoastrocytoma), and grade IV in 22 patients (all glioblastoma). TNR, MTV and TLMU were 3.1 ± 1.2, 51.6 ± 49.9 ml and 147.7 ± 153.3 ml, respectively. None of the three measurements was able to categorize the glioma patients in terms of survival when all patients were analyzed. However, when only patients with astrocytic tumor (N = 33) were analyzed (i.e., when those with oligodendroglial components were excluded), MTV and TLMU successfully predicted patient outcome with higher values associated with a poorer prognosis (P < 0.05 and P < 0.01, respectively), while the predictive ability of TNR did not reach statistical significance (P = NS).

Conclusion

MTV and TLMU may be useful for predicting outcome in patients with astrocytic tumor.

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Rigau V, Zouaoui S, Mathieu-Daude H, Darlix A, Maran A, Tretarre B, et al. French brain tumor database: 5-year histological results on 25 756 cases. Brain Pathol. 2011;21:633–44. doi:10.1111/j.1750-3639.2011.00491.x.CrossRefPubMed

Behin A, Hoang-Xuan K, Carpentier AF, Delattre JY. Primary brain tumours in adults. Lancet. 2003;361:323–31. doi:10.1016/s0140-6736(03)12328-8.CrossRefPubMed

Glaudemans AW, Enting RH, Heesters MA, Dierckx RA, van Rheenen RW, Walenkamp AM, et al. Value of 11C-methionine PET in imaging brain tumours and metastases. Eur J Nucl Med Mol Imaging. 2013;40:615–35. doi:10.1007/s00259-012-2295-5.CrossRefPubMed

Becherer A, Karanikas G, Szabo M, Zettinig G, Asenbaum S, Marosi C, et al. Brain tumour imaging with PET: a comparison between [18F]fluorodopa and [11C]methionine. Eur J Nucl Med Mol Imaging. 2003;30:1561–7. doi:10.1007/s00259-003-1259-1.CrossRefPubMed

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.CrossRefPubMed

Nariai T, Tanaka Y, Wakimoto H, Aoyagi M, Tamaki M, Ishiwata K, et al. Usefulness of L-[methyl-11C] methionine-positron emission tomography as a biological monitoring tool in the treatment of glioma. J Neurosurg. 2005;103:498–507. doi:10.3171/jns.2005.103.3.0498.CrossRefPubMed

Pirotte B, Goldman S, Dewitte O, Massager N, Wikler D, Lefranc F, et al. Integrated positron emission tomography and magnetic resonance imaging-guided resection of brain tumors: a report of 103 consecutive procedures. J Neurosurg. 2006;104:238–53. doi:10.3171/jns.2006.104.2.238.CrossRefPubMed

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

Okamoto S, Shiga T, Hattori N, Kubo N, Takei T, Katoh N, et al. Semiquantitative analysis of C-11 methionine PET may distinguish brain tumor recurrence from radiation necrosis even in small lesions. Ann Nucl Med. 2011;25:213–20. doi:10.1007/s12149-010-0450-2.CrossRefPubMed

10.

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;53:1709–15. doi:10.2967/jnumed.111.102533.CrossRefPubMed

11.

Kaschten B, Stevenaert A, Sadzot B, Deprez M, Degueldre C, Del Fiore G, et al. Preoperative evaluation of 54 gliomas by PET with fluorine-18-fluorodeoxyglucose and/or carbon-11-methionine. J Nucl Med. 1998;39:778–85.PubMed

12.

Kim S, Chung JK, Im SH, Jeong JM, Lee DS, Kim DG, et al. 11C-methionine PET as a prognostic marker in patients with glioma: comparison with 18F-FDG PET. Eur J Nucl Med Mol Imaging. 2005;32:52–9. doi:10.1007/s00259-004-1598-6.CrossRefPubMed

13.

Ribom D, Eriksson A, Hartman M, Engler H, Nilsson A, Langstrom B, et al. Positron emission tomography (11)C-methionine and survival in patients with low-grade gliomas. Cancer. 2001;92:1541–9.CrossRefPubMed

14.

Boellaard R, Krak NC, Hoekstra OS, Lammertsma AA. Effects of noise, image resolution, and ROI definition on the accuracy of standard uptake values: a simulation study. J Nucl Med. 2004;45:1519–27.PubMed

15.

Liao S, Penney BC, Wroblewski K, Zhang H, Simon CA, Kampalath R, et al. Prognostic value of metabolic tumor burden on 18F-FDG PET in nonsurgical patients with non-small cell lung cancer. Eur J Nucl Med Mol Imaging. 2012;39:27–38. doi:10.1007/s00259-011-1934-6.CrossRefPubMed

16.

Chen HH, Chiu NT, Su WC, Guo HR, Lee BF. Prognostic value of whole-body total lesion glycolysis at pretreatment FDG PET/CT in non-small cell lung cancer. Radiology. 2012;264:559–66. doi:10.1148/radiol.12111148.CrossRefPubMed

17.

Ryu IS, Kim JS, Roh JL, Lee JH, Cho KJ, Choi SH, et al. Prognostic value of preoperative metabolic tumor volume and total lesion glycolysis measured by 18F-FDG PET/CT in salivary gland carcinomas. J Nucl Med. 2013;54:1032–8. doi:10.2967/jnumed.112.116053.CrossRefPubMed

18.

Chu KP, Murphy JD, La TH, Krakow TE, Iagaru A, Graves EE, et al. Prognostic value of metabolic tumor volume and velocity in predicting head-and-neck cancer outcomes. Int J Radiat Oncol Biol Phys. 2012;83:1521–7. doi:10.1016/j.ijrobp.2011.10.022.CrossRefPubMedCentralPubMed

19.

Kidd EA, Thomas M, Siegel BA, Dehdashti F, Grigsby PW. Changes in cervical cancer FDG uptake during chemoradiation and association with response. Int J Radiat Oncol Biol Phys. 2013;85:116–22. doi:10.1016/j.ijrobp.2012.02.056.CrossRefPubMedCentralPubMed

20.

Liao S, Lan X, Cao G, Yuan H, Zhang Y. Prognostic predictive value of total lesion glycolysis from 18F-FDG PET/CT in post-surgical patients with epithelial ovarian cancer. Clin Nucl Med. 2013;38:715–20. doi:10.1097/RLU.0b013e31829f57fa.CrossRefPubMed

21.

Arbizu J, Tejada S, Marti-Climent JM, Diez-Valle R, Prieto E, Quincoces G, et al. Quantitative volumetric analysis of gliomas with sequential MRI and 11C-methionine PET assessment: patterns of integration in therapy planning. Eur J Nucl Med Mol Imaging. 2012;39:771–81. doi:10.1007/s00259-011-2049-9.CrossRefPubMed

22.

Lee IH, Piert M, Gomez-Hassan D, Junck L, Rogers L, Hayman J, et al. Association of 11C-methionine PET uptake with site of failure after concurrent temozolomide and radiation for primary glioblastoma multiforme. Int J Radiat Oncol Biol Phys. 2009;73:479–85. doi:10.1016/j.ijrobp.2008.04.050.CrossRefPubMedCentralPubMed

23.

Galldiks N, Dunkl V, Kracht LW, Vollmar S, Jacobs AH, Fink GR, et al. Volumetry of [11C]-methionine positron emission tomographic uptake as a prognostic marker before treatment of patients with malignant glioma. Mol Imaging. 2012;11:516–27.PubMed

24.

Fonti R, Larobina M, Del Vecchio S, De Luca S, Fabbricini R, Catalano L, et al. Metabolic tumor volume assessed by 18F-FDG PET/CT for the prediction of outcome in patients with multiple myeloma. J Nucl Med. 2012;53:1829–35. doi:10.2967/jnumed.112.106500.CrossRefPubMed

25.

Kato T, Shinoda J, Oka N, Miwa K, Nakayama N, Yano H, et al. Analysis of 11C-methionine uptake in low-grade gliomas and correlation with proliferative activity. AJNR Am J Neuroradiol. 2008;29:1867–71. doi:10.3174/ajnr.A1242.CrossRefPubMed

26.

Manabe O, Hattori N, Yamaguchi S, Hirata K, Kobayashi K, Terasaka S, et al. Oligodendroglial component complicates the prediction of tumor grading with metabolic imaging. Eur J Nucl Med Mol Imaging. 2015. doi:10.1007/s00259-015-2996-7.

27.

Galldiks N, Ullrich R, Schroeter M, Fink GR, Jacobs AH, Kracht LW. Volumetry of [11C]-methionine PET uptake and MRI contrast enhancement in patients with recurrent glioblastoma multiforme. Eur J Nucl Med Mol Imaging. 2010;37:84–92. doi:10.1007/s00259-009-1219-5.CrossRefPubMedCentralPubMed

28.

Kawai N, Maeda Y, Kudomi N, Miyake K, Okada M, Yamamoto Y, et al. Correlation of biological aggressiveness assessed by 11C-methionine PET and hypoxic burden assessed by 18F-fluoromisonidazole PET in newly diagnosed glioblastoma. Eur J Nucl Med Mol Imaging. 2011;38:441–50. doi:10.1007/s00259-010-1645-4.CrossRefPubMed

29.

Hirata K, Kobayashi K, Wong KP, Manabe O, Surmak A, Tamaki N, et al. A semi-automated technique determining the liver standardized uptake value reference for tumor delineation in FDG PET-CT. PLoS One. 2014;9:e105682. doi:10.1371/journal.pone.0105682.CrossRefPubMedCentralPubMed

30.

Yamaguchi S, Kobayashi H, Hirata K, Shiga T, Tanaka S, Murata J, et al. Detection of histological anaplasia in gliomas with oligodendroglial components using positron emission tomography with (18)F-FDG and (11)C-methionine: report of two cases. J Neurooncol. 2011;101:335–41. doi:10.1007/s11060-010-0262-1.CrossRefPubMed

31.

Yoshikawa K, Kajiwara K, Morioka J, Fujii M, Tanaka N, Fujisawa H, et al. Improvement of functional outcome after radical surgery in glioblastoma patients: the efficacy of a navigation-guided fence-post procedure and neurophysiological monitoring. J Neurooncol. 2006;78:91–7. doi:10.1007/s11060-005-9064-2.CrossRefPubMed

32.

Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114:97–109. doi:10.1007/s00401-007-0243-4.CrossRefPubMedCentralPubMed

33.

Miyazaki M, Nishihara H, Terasaka S, Kobayashi H, Yamaguchi S, Ito T, et al. Immunohistochemical evaluation of O6-methylguanine DNA methyltransferase (MGMT) expression in 117 cases of glioblastoma. Neuropathology. 2014;34:268–76. doi:10.1111/neup.12091.CrossRefPubMed

34.

Smits A, Westerberg E, Ribom D. Adding 11C-methionine PET to the EORTC prognostic factors in grade 2 gliomas. Eur J Nucl Med Mol Imaging. 2008;35:65–71. doi:10.1007/s00259-007-0531-1.CrossRefPubMed

35.

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.CrossRefPubMed

36.

Bading JR, Kan-Mitchell J, Conti PS. System A amino acid transport in cultured human tumor cells: implications for tumor imaging with PET. Nucl Med Biol. 1996;23:779–86.CrossRefPubMed

37.

Isselbacher KJ. Increased uptake of amino acids and 2-deoxy-D-glucose by virus-transformed cells in culture. Proc Natl Acad Sci U S A. 1972;69:585–9.CrossRefPubMedCentralPubMed

38.

Fuchs BC, Bode BP. Amino acid transporters ASCT2 and LAT1 in cancer: partners in crime? Semin Cancer Biol. 2005;15:254–66. doi:10.1016/j.semcancer.2005.04.005.CrossRefPubMed

39.

Miwa K, Shinoda J, Yano H, Okumura A, Iwama T, Nakashima T, et al. Discrepancy between lesion distributions on methionine PET and MR images in patients with glioblastoma multiforme: insight from a PET and MR fusion image study. J Neurol Neurosurg Psychiatry. 2004;75:1457–62. doi:10.1136/jnnp.2003.028480.CrossRefPubMedCentralPubMed

40.

Ichimura K. Molecular pathogenesis of IDH mutations in gliomas. Brain Tumor Pathol. 2012;29:131–9. doi:10.1007/s10014-012-0090-4.CrossRefPubMed

41.

Cairncross JG, Ueki K, Zlatescu MC, Lisle DK, Finkelstein DM, Hammond RR, et al. Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. J Natl Cancer Inst. 1998;90:1473–9.CrossRefPubMed

42.

Brandes AA, Tosoni A, Cavallo G, Reni M, Franceschi E, Bonaldi L, et al. Correlations between O6-methylguanine DNA methyltransferase promoter methylation status, 1p and 19q deletions, and response to temozolomide in anaplastic and recurrent oligodendroglioma: a prospective GICNO study. J Clin Oncol. 2006;24:4746–53. doi:10.1200/jco.2006.06.3891.CrossRefPubMed

43.

Erdem-Eraslan L, Gravendeel LA, de Rooi J, Eilers PH, Idbaih A, Spliet WG, et al. Intrinsic molecular subtypes of glioma are prognostic and predict benefit from adjuvant procarbazine, lomustine, and vincristine chemotherapy in combination with other prognostic factors in anaplastic oligodendroglial brain tumors: a report from EORTC study 26951. J Clin Oncol. 2013;31:328–36. doi:10.1200/jco.2012.44.1444.CrossRefPubMedCentralPubMed

44.

Salvati M, Formichella AI, D’Elia A, Brogna C, Frati A, Giangaspero F, et al. Cerebral glioblastoma with oligodendrogliomal component: analysis of 36 cases. J Neurooncol. 2009;94:129–34. doi:10.1007/s11060-009-9815-6.CrossRefPubMed

45.

Tanaka Y, Nariai T, Momose T, Aoyagi M, Maehara T, Tomori T, et al. Glioma surgery using a multimodal navigation system with integrated metabolic images. J Neurosurg. 2009;110:163–72. doi:10.3171/2008.4.17569.CrossRefPubMed

46.

Grosu AL, Weber WA, Riedel E, Jeremic B, Nieder C, Franz M, et al. L-(methyl-11C) methionine positron emission tomography for target delineation in resected high-grade gliomas before radiotherapy. Int J Radiat Oncol Biol Phys. 2005;63:64–74. doi:10.1016/j.ijrobp.2005.01.045.CrossRefPubMed

47.

Stupp R, Brada M, van den Bent MJ, Tonn JC, Pentheroudakis G. High-grade glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25 Suppl 3:iii93–iii101. doi:10.1093/annonc/mdu050.CrossRefPubMed

48.

Stummer W, Reulen HJ, Meinel T, Pichlmeier U, Schumacher W, Tonn JC, et al. Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery. 2008;62:564–76; discussion 564–76. doi:10.1227/01.neu.0000317304.31579.17.CrossRefPubMed

49.

Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg. 2001;95:190–8. doi:10.3171/jns.2001.95.2.0190.CrossRefPubMed

50.

Suchorska B, Jansen NL, Linn J, Kretzschmar H, Janssen H, Eigenbrod S, et al. Biological tumor volume in 18FET-PET before radiochemotherapy correlates with survival in GBM. Neurology. 2015;84:710–9. doi:10.1212/wnl.0000000000001262.CrossRefPubMed

51.

Jansen NL, Suchorska B, Wenter V, Schmid-Tannwald C, Todica A, Eigenbrod S, et al. Prognostic significance of dynamic 18F-FET PET in newly diagnosed astrocytic high-grade glioma. J Nucl Med. 2015;56:9–15. doi:10.2967/jnumed.114.144675.CrossRefPubMed

Title: Prognostic value of volume-based measurements on 11C-methionine PET in glioma patients
Authors: Kentaro Kobayashi
Kenji Hirata
Shigeru Yamaguchi
Osamu Manabe
Shunsuke Terasaka
Hiroyuki Kobayashi
Tohru Shiga
Naoya Hattori
Shinya Tanaka
Yuji Kuge
Nagara Tamaki
Publication date: 01-06-2015
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 7/2015
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-015-3046-1

At a glance: The STEP trials

Springer Medicine

Prognostic value of volume-based measurements on ¹¹C-methionine PET in glioma patients

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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