The roles of 11C-acetate PET/CT in predicting tumor differentiation and survival in patients with cerebral glioma

  • Soyoung Kim
  • Dongwoo Kim
  • Se Hoon Kim
  • Mi-ae Park
  • Jong Hee ChangEmail author
  • Mijin YunEmail author
Original Article



This prospective study aimed to evaluate the clinical values of 11C–acetate positron emission tomography/computed tomography (PET/CT) in predicting histologic grades and survival in patients with cerebral glioma.


Seventy-three patients with surgically confirmed cerebral gliomas (19 grade II, 21 grade III, and 33 grade IV) who underwent 11C–acetate PET/CT before surgery were included. Tumor-to-choroid plexus ratio (TCR), which was defined as the maximum standardized uptake value (SUV) of tumors to the mean SUV of choroid plexus, was compared between three World Health Organization (WHO) grade groups. Moreover, metabolic tumor volumes (MTV) were calculated. Progression-free survival (PFS) and overall survival (OS) curves were plotted using the Kaplan–Meier method, and differences in survival between groups were assessed using the log-rank test.


Median TCR was 1.20 (interquartile range [IQR], 1.14 to 1.4) in grade II, 1.65 (IQR, 1.26 to 1.79) in grade III, and 2.53 (IQR, 1.93 to 3.30) in grade IV gliomas. Significant differences in TCR were seen among the three WHO grade groups (P < 0.001). In Cox regression analysis including TCR, MTV, molecular markers, and other clinical factors, TCR was prognostic for PFS (P = 0.016) and TCR and MTV were prognostic for OS (P = 0.024 [TCR], P = 0.030 [MTV]). PFS and OS were significantly shorter in patients with a TCR ≥ 1.6 than in those with a TCR < 1.6. OS were significantly shorter in patients with a MTV ≥ 1 than in those with a TCR < 1.


TCR on 11C–acetate PET/CT significantly differed between low- and high-grade cerebral gliomas, and it showed the capability to further differentiate grade III from grade IV tumors. TCR and MTV were independent prognostic factors and predicted survival better than did the WHO grade.


Glioma Grading Acetate Prognosis Positron emission tomography 



This work was supported partially by a National Research Foundation of Korea grant funded by the Korean government (MSIP) (NRF-2011-0030086) and the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science and ICT (NRF-2016R1E1A1A01943303).


This study was supported partially by a National Research Foundation of Korea grant funded by the Korean government (MSIP) (NRF-2011-0030086) and the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT, and Future Planning (NRF-2016R1E1A1A01943303).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures involving human participants were performed in accordance with the ethical standards of the institutional research committee and in compliance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in this study.

Supplementary material

259_2018_3948_MOESM1_ESM.doc (156 kb)
ESM 1 (DOC 156 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Nuclear Medicine, Severance HospitalYonsei University College of MedicineSeoulSouth Korea
  2. 2.Department of Pathology, Severance HospitalYonsei University College of MedicineSeoulSouth Korea
  3. 3.Department of RadiologyBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  4. 4.Department of Neurosurgery, Severance HospitalYonsei University College of MedicineSeoulSouth Korea

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