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Usefulness of 11C-methionine positron emission tomography for treatment-decision making in cases of non-enhancing glioma-like brain lesions

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Abstract

The present study evaluated usefulness of the positron emission tomography with 11C-methionine for prediction of the clinical course and treatment decision-making in adult patients with newly diagnosed non-enhancing brain lesions mimicking low-grade gliomas. Retrospective analysis was done in 163 cases. In overall, 131 tumors underwent surgical resection, which in 34 cases was done after initial period of observation. Among the latter 5 patients were operated on after significant clinical deterioration. In overall, 3 resected neoplasms corresponded to WHO histopathological grade I, 87 to grade II, 39 to grade III, and 2 to grade IV. In all 163 cases the tumor/normal brain uptake ratio (T/N ratio) of 11C-methionine ranged from 0.68 to 8.02 (mean 2.21 ± 1.16, median 1.81). Mean T/N ratios of non-operated lesions, low-grade and high-grade tumors were 1.60 ± 0.85, 2.27 ± 1.22, and 2.54 ± 1.09, respectively (P < 0.0001), but overlap between 3 groups was prominent. In patients who had clinical deterioration during the period of observation T/N ratios of the lesion varied from 1.49 to 3.38 (mean 2.23 ± 0.70, median 2.15). Comparison of the deterioration-free survival of patients with T/N ratios of the lesion above and below 1.90 revealed statistically significant difference (P < 0.0001). In conclusion, “wait-and-scan” strategy with delay of surgical treatment does not seem reasonable option if T/N ratio of 11C-methionine in the non-enhancing glioma-like brain lesion constitutes ≥1.90, since it may be associated with significant risk of tumor progression and clinical deterioration during follow-up.

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References

  1. Kato T, Shinoda J, Nakayama N, Miwa K, Okumura A, Yano H, Yoshimura S, Maruyama T, Muragaki Y, Iwama T (2008) Metabolic assessment of gliomas using 11C-methionine, [18F] fluorodeoxyglucose, and 11C-choline positron-emission tomography. AJNR Am J Neuroradiol 29:1176–1182

    Article  PubMed  CAS  Google Scholar 

  2. Kato T, Shinoda J, Oka N, Miwa K, Nakayama N, Yano H, Maruyama T, Muragaki Y, Iwama T (2008) Analysis of 11C-methionine uptake in low-grade gliomas and correlation with proliferative activity. AJNR Am J Neuroradiol 29:1867–1871

    Article  PubMed  CAS  Google Scholar 

  3. Saito T, Maruyama T, Muragaki Y, Tanaka M, Nitta M, Shinoda J, Aki T, Iseki H, Kurisu K, Okada Y (2013) 11C-methionine uptake correlates with combined 1p and 19q loss of heterozygosity in oligodendroglial tumors. AJNR Am J Neuroradiol 34:85–91

    Article  PubMed  CAS  Google Scholar 

  4. Kapouleas I, Alavi A, Alves WM, Gur RE, Weiss DW (1991) Registration of three-dimensional MR and PET images of the human brain without markers. Radiology 181:731–739

    Article  PubMed  CAS  Google Scholar 

  5. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (eds) (2007) WHO classification of tumours of the central nervous system, 4th edn. IARC Press, Lyon

    Google Scholar 

  6. Recht L, Lew R, Smith T (1992) Suspected low-grade glioma: is deferring treatment safe? Ann Neurol 31:431–436

    Article  PubMed  CAS  Google Scholar 

  7. Agulnik M, Mason W (2006) The changing management of low-grade astrocytomas and oligodendrogliomas. Hematol Oncol Clin N Am 20:1249–1266

    Article  Google Scholar 

  8. Kondziolka D, Bernstein M, Resch L, Tator CH, Fleming JF, Vanderlinden RG, Schutz H (1987) Significance of hemorrhage into brain tumors: clinicopathological study. J Neurosurg 67:852–857

    Article  PubMed  CAS  Google Scholar 

  9. Koh M, Goh K, Chen C, Howe H (2002) Cerebral infarct mimicking glioma in Sjogren’s syndrome. Hong Kong Med J 8:292–294

    PubMed  CAS  Google Scholar 

  10. Mandrioli J, Ficarra G, Callari G, Sola P, Merelli E (2004) Monofocal acute large demyelinating lesion mimicking brain glioma. Neurol Sci 25(Suppl 4):S386–S388

    Article  PubMed  Google Scholar 

  11. Kawai N, Okauchi M, Miyake K, Sasakawa Y, Yamamoto Y, Nishiyama Y, Tamiya T (2010) 11C-methionine positron emission tomography in nontumorous brain lesions. No Shinkei Geka 38:985–995 (in Japanese)

    PubMed  Google Scholar 

  12. Harada Y, Hirata K, Kobayashi H, Usui R, Shiga T, Terae S, Shirato H, Tamaki N (2012) A pitfall of C-11 methionine PET: cerebral venous infarction mimicked a glioma. Clin Nucl Med 37:110–111

    Article  PubMed  Google Scholar 

  13. Sanai N, Chang S, Berger MS (2011) Low-grade gliomas in adults. J Neurosurg 115:948–965

    Article  PubMed  Google Scholar 

  14. Glaudemans AWJM, Enting RH, Heesters MAAM, Dierckx RAJO, van Rheenen RWJ, Walenkamp AME, Slart RHJA (2013) Value of 11C-methionine PET in imaging brain tumors and metastases. Eur J Nucl Med Mol Imaging 40:615–635

    Article  PubMed  CAS  Google Scholar 

  15. Herholz K, Hölzer T, Bauer B, Schröder R, Voges J, Ernestus R, Mendoza G, Weber-Luxenburger G, Lottgen J, Thiel A, Wienhard K, Heiss WD (1998) 11C-methionine PET for differential diagnosis of low-grade gliomas. Neurology 50:1316–1322

    Article  PubMed  CAS  Google Scholar 

  16. Chung J, Kim Y, Kim S, Lee Y, Paek S, Yeo J, Jeong JM, Lee DS, Jung HW, Lee MC (2002) 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 29:176–182

    Article  PubMed  CAS  Google Scholar 

  17. Nariai T, Tanaka Y, Wakimoto H, Aoyagi M, Tamaki M, Ishiwata K, Senda M, Ishii K, Hirakawa K, Ohno K (2005) Usefulness of L-[methyl-11C] methionine-positron emission tomography as a biological monitoring tool in the treatment of glioma. J Neurosurg 103:498–507

    Article  PubMed  Google Scholar 

  18. Ceyssens S, Van Laere K, de Groot T, Goffin J, Bormans G, Mortelmans L (2006) [11C]methionine PET, histopathology, and survival in primary brain tumors and recurrence. AJNR Am J Neuroradiol 27:1432–1437

    PubMed  CAS  Google Scholar 

  19. Galldiks N, Kracht LW, Dunkl V, Ullrich RT, Vollmar S, Jacobs AH, Fink GR, Schroeter M (2011) Imaging of non- or very subtle contrast-enhancing malignant gliomas with [11C]-methionine positron emission tomography. Mol Imaging 10:453–459

    PubMed  CAS  Google Scholar 

  20. Shinozaki N, Uchino Y, Yoshikawa K, Matsutani T, Hasegawa A, Saeki N, Iwadate Y (2011) Discrimination between low-grade oligodendrogliomas and diffuse astrocytoma with the aid of 11C-methionine positron emission tomography. J Neurosurg 114:1640–1647

    Article  PubMed  Google Scholar 

  21. Braun V, Dempf S, Weller R, Reske S, Schachenmayr W, Richter H (2002) Cranial neuronavigation with direct integration of 11C methionine positron emission tomography (PET) data—results of a pilot study in 32 surgical cases. Acta Neurochir (Wien) 144:777–782

    Article  CAS  Google Scholar 

  22. Kracht L, Miletic H, Busch S, Jacobs A, Voges J, Hoevels M, Klein JC, Herholz K, Heiss WD (2004) Delineation of brain tumor extent with [11C]l-methionine positron emission tomography: local comparison with stereotactic histopathology. Clin Cancer Res 10:7163–7170

    Article  PubMed  CAS  Google Scholar 

  23. Miwa K, Shinoda J, Yano H, Okumura A, Iwama T, Nakashima T, Sakai N (2004) 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 75:1457–1462

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  24. De Witte O, Goldberg I, Wikler D, Rorive S, Damhaut P, Monclus M, Salmon I, Brotchi J, Goldman S (2001) Positron emission tomography with injection of methionine as a prognostic factor in glioma. J Neurosurg 95:746–750

    Article  PubMed  Google Scholar 

  25. Smits A, Westerberg E, Ribom D (2008) Adding 11C-methionine PET to the EORTC prognostic factors in grade 2 gliomas. Eur J Nucl Med Mol Imaging 35:65–71

    Article  PubMed  CAS  Google Scholar 

  26. Ullrich RT, Kracht L, Brunn A, Herholz K, Frommolt P, Miletic H, Deckert M, Heiss WD, Jacobs AH (2009) Methyl-L-11C-methionine PET as a diagnostic marker for malignant progression in patients with glioma. J Nucl Med 50:1962–1968

    Article  PubMed  Google Scholar 

  27. Terakawa Y, Tsuyuguchi N, Iwai Y, Yamanaka K, Higashiyama S, Takami T, Ohata K (2008) Diagnostic accuracy of 11C-methionine PET for differentiation of recurrent brain tumors from radiation necrosis after radiotherapy. J Nucl Med 49:694–699

    Article  PubMed  Google Scholar 

  28. Tripathi M, Sharma R, Varshney R, Jaimini A, Jain J, Souza MM, Bal J, Pandey S, Kumar N, Mishra AK, Mondal A (2012) Comparison of F-18 FDG and C-11 methionine PET/CT for the evaluation of recurrent primary brain tumors. Clin Nucl Med 37:158–163

    Article  PubMed  Google Scholar 

  29. Nihashi T, Dahabreh IJ, Terasawa T (2013) Diagnostic accuracy of PET for recurrent glioma diagnosis: a meta-analysis. AJNR Am J Neuroradiol 34:944–950

    Article  PubMed  CAS  Google Scholar 

  30. Kracht LW, Friese M, Herholz K, Schroeder R, Bauer B, Jacobs A, Heiss WD (2003) Methyl-[11C]-l-methionine uptake as measured by positron emission tomography correlates to microvessel density in patients with glioma. Eur J Nucl Med Mol Imaging 30:868–873

    Article  PubMed  CAS  Google Scholar 

  31. Viel T, Boehm-Sturm P, Rapic S, Monfared P, Neumaier B, Hoehn M, Jacobs AH (2013) Non-invasive imaging of glioma vessel size and densities in correlation with tumour cell proliferation by small animal PET and MRI. Eur J Nucl Med Mol Imaging 40:1595–1606

    Article  PubMed  Google Scholar 

  32. Cheng S, Nagane M, Huang H, Cavenee W (1997) Intracerebral tumor-associated hemorrhage caused by overexpression of the vascular endothelial growth factor isoforms VEGF121 and VEGF165 but not VEGF189. Proc Natl Acad Sci USA 94:12081–12087

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  33. Abdulrauf S, Edvardsen K, Ho K, Yang X, Rock J, Rosenblum M (1998) Vascular endothelial growth factor expression and vascular density as prognostic markers of survival in patients with low-grade astrocytoma. J Neurosurg 88:513–520

    Article  PubMed  CAS  Google Scholar 

  34. Schmidt N, Westphal M, Hagel C, Ergün S, Stavrou D, Rosen E, Lamszus K (1999) Levels of vascular endothelial growth factor, hepatocyte growth factor/scatter factor and basic fibroblast growth factor in human gliomas and their relation to angiogenesis. Int J Cancer 84:10–18

    Article  PubMed  CAS  Google Scholar 

  35. Okita Y, Kinoshita M, Goto T, Kagawa N, Kishima H, Shimosegawa E, Hatazawa J, Hashimoto N, Yoshimine T (2010) 11C-methionine uptake correlates with tumor cell density rather than with microvessel density in glioma: a stereotactic image-histology comparison. Neuroimage 49:2977–2982

    Article  PubMed  Google Scholar 

  36. Okita Y, Nonaka M, Shofuda T, Kanematsu D, Yoshioka E, Kodama Y, Mano M, Nakajima S, Kanemura Y (2014) 11C-methinine uptake correlates with MGMT promoter methylation in nonenhancing gliomas. Clin Neurol Neurosurg 125:212–216

    Article  PubMed  Google Scholar 

  37. Muragaki Y, Chernov M, Maruyama T, Ochiai T, Taira T, Kubo O, Nakamura R, Iseki H, Hori T, Takakura K (2008) Low-grade glioma on stereotactic biopsy: how often is the diagnosis accurate? Minim Invasive Neurosurg 51:275–279

    Article  PubMed  CAS  Google Scholar 

  38. Massager N, David P, Goldman S, Pirotte B, Wikler D, Salmon I, Nagy N, Brotchi J, Levivier M (2000) Combined magnetic resonance imaging- and positron emission tomography-guided stereotactic biopsy in brainstem mass lesions: diagnostic yield in a series of 30 patients. J Neurosurg 93:951–957

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors are thankful to Drs. Tatsuki Aki, Soko Ikuta, Takayuki Kato, Osami Kubo, Kazuhiro Miwa, Noriyuki Nakayama, Naoki Oka, Shunsuke Takenaka, Shingo Yonezawa, and Mikhail Chernov for their help during the study and manuscript preparation.

Grant support

This study was supported by grants from the Japan National Cancer Research and Development Fund and Core Research for Evolutional Science and Technology (CREST), Japan Science and Technology Agency.

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Authors and Affiliations

  1. Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Atsushi Watanabe, Yoshihiro Muragaki & Takashi Maruyama

  2. Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan

    Atsushi Watanabe, Yoshihiro Muragaki, Takashi Maruyama & Yoshikazu Okada

  3. Hatsudai Rehabilitation Hospital, Tokyo, Japan

    Atsushi Watanabe

  4. Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo City, Gifu, Japan

    Jun Shinoda

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  1. Atsushi Watanabe
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Correspondence to Yoshihiro Muragaki.

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Watanabe, A., Muragaki, Y., Maruyama, T. et al. Usefulness of 11C-methionine positron emission tomography for treatment-decision making in cases of non-enhancing glioma-like brain lesions. J Neurooncol 126, 577–583 (2016). https://doi.org/10.1007/s11060-015-2004-x

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  • DOI: https://doi.org/10.1007/s11060-015-2004-x

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