Journal of Neuro-Oncology

, Volume 106, Issue 2, pp 417–425

Imaging 18F-fluorodeoxy glucose/11C-methionine uptake decoupling for identification of tumor cell infiltration in peritumoral brain edema

  • Manabu Kinoshita
  • Tetsu Goto
  • Hideyuki Arita
  • Yoshiko Okita
  • Kayako Isohashi
  • Naoki Kagawa
  • Yasunori Fujimoto
  • Haruhiko Kishima
  • Eku Shimosegawa
  • Youichi Saitoh
  • Jun Hatazawa
  • Naoya Hashimoto
  • Toshiki Yoshimine
Clinical Study – Patient Study

DOI: 10.1007/s11060-011-0688-0

Cite this article as:
Kinoshita, M., Goto, T., Arita, H. et al. J Neurooncol (2012) 106: 417. doi:10.1007/s11060-011-0688-0

Abstract

Discriminating tumor infiltrative and vasogenic brain edema in malignant gliomas is important although challenging in clinical settings. This study challenged this issue by performing voxel-wise analysis of 18F-fluorodeoxy glucose (FDG) and 11C-methionine positron emission tomography (PET) in peritumoral brain edemas. The authors studied ten malignant glioma and nine meningioma patients with peritumoral brain edema. A voxel-wise analysis of FDG and 11C-methionine PET was performed in order to quantify the correlation between uptake of these tracers in normal brain tissue and peritumoral brain edema. Decoupling score of the uptake of two tracers was calculated as the z-score from the estimated correlation between uptake of the two tracers in normal brain tissue. The decoupling score was also converted into images for visual inspection. Average decoupling score in the peritumoral brain edema was calculated and compared between those obtained from malignant gliomas and meningiomas. FDG and 11C-methionine uptake showed a reproducible linear correlation in normal brain tissue. This correlation was preserved in peritumoral edema of meningioma, but not in that of malignant gliomas. In malignant gliomas, higher 11C-methionine uptake compared to that estimated by the FDG uptake in normal brain tissue was observed, thus suggesting that decoupling was caused by tumor infiltration. Visual inspection of the decoupling score enabled discrimination of tumor infiltrative and vasogenic edema. The average decoupling scores of the peritumoral brain edema in malignant gliomas were significantly higher than those in meningiomas (2.9 vs. 0.7, P = 0.0003). As a conclusion, FDG/11C-methionine uptake decoupling score can be used for the discrimination of tumor infiltrative and vasogenic brain edema. The proposed method also suggests the possibility of accurately detecting tumor infiltration into brain tissues in gliomas, providing significant information for treatment planning and follow-up.

Keywords

18F-fluorodeoxy glucose 11C-methionine Glioma Meningioma Brain edema 

Abbreviations

ADC

Apparent diffusion coefficient

DTI

Diffusion tenor imaging

FA

Fractional anisotropy

FDG

18F-fluorodeoxy glucose

MRI

Magnetic resonance imaging

PET

Positron emission tomography

ROI

Region of interest

VOI

Voxels of interest

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Manabu Kinoshita
    • 1
  • Tetsu Goto
    • 1
  • Hideyuki Arita
    • 1
  • Yoshiko Okita
    • 1
  • Kayako Isohashi
    • 2
  • Naoki Kagawa
    • 1
  • Yasunori Fujimoto
    • 1
  • Haruhiko Kishima
    • 1
  • Eku Shimosegawa
    • 2
  • Youichi Saitoh
    • 1
    • 3
  • Jun Hatazawa
    • 2
  • Naoya Hashimoto
    • 1
  • Toshiki Yoshimine
    • 1
  1. 1.Department of NeurosurgeryOsaka University Gradate School of MedicineSuitaJapan
  2. 2.Nuclear Medicine and Tracer KineticsOsaka University Gradate School of MedicineSuitaJapan
  3. 3.Department of Neuromodulation and Neurosurgery, Center for Advanced Science and InnovationOsaka UniversitySuitaJapan

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