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Jeltema HR, van Dijken BRJ, Tamási K, Drost G, Heesters MAAM, van der Hoorn A, Glaudemans AWJM, van Dijk JMC. 11C-Methionine uptake in meningiomas after stereotactic radiotherapy. Ann Nucl Med 2024; 38:596-606. [PMID: 38720053 PMCID: PMC11282149 DOI: 10.1007/s12149-024-01932-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/16/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE 11C-Methionine positron emission tomography (MET-PET) is used for stereotactic radiotherapy planning in meningioma patients. The role of MET-PET during subsequent follow-up (FU) is unclear. We analyzed the uptake of 11C-Methionine before and after stereotactic radiotherapy (SRT) in patients with a complex meningioma and investigated if there was a difference between patients with progressive disease (PD) and stable disease (SD) during FU. METHODS This retrospective study investigates 62 MET-PETs in 29 complex meningioma patients. Standardized uptake value (SUV)max and SUVpeak tumor-to-normal ratios (T/N-ratios) were calculated, comparing the tumor region with both the mirroring intracranial area and the right frontal gray matter. The difference in 11C-Methionine uptake pre- and post-SRT was analyzed, as well as the change in uptake between PD or SD. RESULTS Median (IQR) FU duration was 67 months (50.5-91.0). The uptake of 11C-Methionine in meningiomas remained increased after SRT. Neither a statistically significant difference between MET-PETs before and after SRT was encountered, nor a significant difference in one of the four T/N-ratios between patients with SD versus PD with median (IQR) SUVmax T/NR front 2.65 (2.13-3.68) vs 2.97 (1.55-3.54) [p = 0.66]; SUVmax T/Nmirror 2.92 (2.19-3.71) vs 2.95 (1.74-3.60) [p = 0.61]; SUVpeak T/NR front 2.35 (1.64-3.40) vs 2.25 (1.44-3.74) [p = 0.80]; SUVpeak T/Nmirror 2.38 (1.91-3.36) vs 2.35 (1.56-3.72) [p = 0.95]. CONCLUSIONS Our data do not support use of MET-PET during FU of complex intracranial meningiomas after SRT. MET-PET could not differentiate between progressive or stable disease.
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Affiliation(s)
- Hanne-Rinck Jeltema
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB, Groningen, The Netherlands.
| | - Bart R J van Dijken
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Katalin Tamási
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea Drost
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mart A A M Heesters
- Department of Radiotherapy, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
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Filis P, Alexiou GA, Zigouris A, Sioka C, Filis N, Voulgaris S. Meningioma grading based on positron emission tomography: A systematic review and meta-analysis. World Neurosurg X 2023; 18:100167. [PMID: 36825220 PMCID: PMC9941365 DOI: 10.1016/j.wnsx.2023.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Meningiomas are the most common central nervous system tumor in adults. Knowledge of the tumor grade can guide optimal treatment timing and shape personalized follow-up strategies. Positron emission tomography (PET) has been utilized for the metabolic assessment of various intracranial space-occupying lesions. Herewith, we set out to evaluate the diagnostic accuracy of PET for the noninvasive assessment of meningioma's grade. Materials and methods The Medline, Scopus and Cochrane databases were systematically searched in March 2022 for studies that evaluated the sensitivity and specificity of PET compared to the gold standard of histological diagnosis in the grading of meningiomas. Summary statistics will be calculated and scatter plots, summary curve from the HSROC model and posterior predictions by empirical Bayes estimates will be presented. Results Five studies consisting of 242 patients with a total of 196 low-grade (Grade 1) and 46 high grade (Grade 2/3) meningiomas were included in our analysis. Three of the included studies used 18F-FDG, one study used 18F-FLT and one used(Whiting et al., 2011) 18 F-FET as PET tracers. The pooled sensitivity was 76% (95% CI: 52%-91%) and the pooled specificity was 89% (95% CI: 83%-93%). The diagnostic odds ratio was 27.17 (95% CI: 9.22-80.06), the positive likelihood ratio was 7.18 (95% CI: 4.54-11.34) and the negative likelihood ratio was 0.26 (95% CI: 0.11-0.61). Conclusion PET is a promising and viable option as a noninvasive imaging tool to differentiate the meningioma grades. However, currently it cannot overtake the gold standard of histological grade confirmation. More studies are required for further validation and refinement of this imaging technique and assessment of other radiotracers as well.
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Key Words
- 1/LR-, inverse of the negative likelihood ratio
- 11C-MET, 11C-methionine
- 18F-FDG, fluorine-18 fluorodeoxyglucose
- 18F-FET, O-(2-[18F]Fluoroethyl)-l-tyrosine
- CIs, 95% confidence intervals
- CT, computerized tomography
- DOR, diagnostic odds ratio
- HSROC, hierarchical summary receiver operating characteristic
- LR+, positive likelihood ratios
- LR−, negative likelihood ratios
- MRI, magnetic resonance imaging
- Mendingioma
- Meta-analysis
- PET
- PET, positron emission tomography
- SPECT, single-photon emission computerized tomography
- SUV, standardized uptake value
- SUVmax, maximum standardized uptake value
- TBR, tumour-to-brain ratios
- TGR, tumor-to-contralateral gray matter ratios
- WHO, World Health Organization
- [18F]FLT, 3′-deoxy-3′-[18F]fluorothymidine
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Affiliation(s)
- Panagiotis Filis
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece,Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Greece
| | - George A. Alexiou
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece,Corresponding author.
| | - Andreas Zigouris
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece
| | - Chrissa Sioka
- Department of Nuclear Medicine, University of Ioannina, Greece
| | - Nikolaos Filis
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece
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Galldiks N, Angenstein F, Werner JM, Bauer EK, Gutsche R, Fink GR, Langen KJ, Lohmann P. Use of advanced neuroimaging and artificial intelligence in meningiomas. Brain Pathol 2022; 32:e13015. [PMID: 35213083 PMCID: PMC8877736 DOI: 10.1111/bpa.13015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/09/2021] [Accepted: 08/02/2021] [Indexed: 01/04/2023] Open
Abstract
Anatomical cross‐sectional imaging methods such as contrast‐enhanced MRI and CT are the standard for the delineation, treatment planning, and follow‐up of patients with meningioma. Besides, advanced neuroimaging is increasingly used to non‐invasively provide detailed insights into the molecular and metabolic features of meningiomas. These techniques are usually based on MRI, e.g., perfusion‐weighted imaging, diffusion‐weighted imaging, MR spectroscopy, and positron emission tomography. Furthermore, artificial intelligence methods such as radiomics offer the potential to extract quantitative imaging features from routinely acquired anatomical MRI and CT scans and advanced imaging techniques. This allows the linking of imaging phenotypes to meningioma characteristics, e.g., the molecular‐genetic profile. Here, we review several diagnostic applications and future directions of these advanced neuroimaging techniques, including radiomics in preclinical models and patients with meningioma.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Cologne, Germany
| | - Frank Angenstein
- Functional Neuroimaging Group, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Magdeburg, Germany.,Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany.,Medical Faculty, Otto von Guericke University, Magdeburg, Germany
| | - Jan-Michael Werner
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elena K Bauer
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Robin Gutsche
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Cologne, Germany.,Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
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Jeltema HR, Jansen MR, Potgieser ARE, van Asselt ADI, Heesters MAAM, van de Hoorn A, Glaudemans AWJM, van Dijk JMC. Study on intracranial meningioma using PET ligand investigation during follow-up over years (SIMPLIFY). Neuroradiology 2021; 63:1791-1799. [PMID: 33694025 PMCID: PMC8528767 DOI: 10.1007/s00234-021-02683-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
Purpose Radiologic follow-up of patients with a meningioma at the skull base or near the venous sinuses with magnetic resonance imaging (MRI) after stereotactic radiotherapy (SRT) and neurosurgical resection(s) can be difficult to interpret. This study evaluates the addition of 11C-methionine positron emission tomography (MET-PET) to the regular MRI follow-up. Methods This prospective pilot study included patients with predominantly WHO grade I meningiomas at the skull base or near large vascular structures. Previous SRT was part of their oncological treatment. A MET-PET in adjunct to their regular MRI follow-up was performed. The standardized uptake value (SUV) was determined for the tumor and the healthy brain, on the pre-SRT target delineation MET-PET and the follow-up MET-PET. Tumor-to-normal ratios were calculated, and 11C-methionine uptake over time was analyzed. Agreement between the combined MRI/MET-PET report and the MRI-only report was determined using Cohen’s κ. Results Twenty patients with stable disease underwent an additional MET-PET, with a median follow-up of 84 months after SRT. Post-SRT SUV T/N ratios ranged between 2.16 and 3.17. When comparing the pre-SRT and the post-SRT MET-PET, five categories of SUV T/N ratios did not change significantly. Only the SUVpeak T/Ncortex decreased significantly from 2.57 (SD 1.02) to 2.20 (SD 0.87) [p = 0.004]. A κ of 0.77 was found, when comparing the MRI/MET-PET report to the MRI-only report, indicating no major change in interpretation of follow-up data. Conclusion In this pilot study, 11C-methionine uptake remained remarkably high in meningiomas with long-term follow-up after SRT. Adding MET-PET to the regular MRI follow-up had no impact on the interpretation of follow-up imaging.
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Affiliation(s)
- Hanne-Rinck Jeltema
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB, Groningen, the Netherlands.
| | - Marnix R Jansen
- Faculty of Medical Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Adriaan R E Potgieser
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB, Groningen, the Netherlands
| | - Antoinette D I van Asselt
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mart A A M Heesters
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anouk van de Hoorn
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB, Groningen, the Netherlands
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Slot KM, Verbaan D, Buis DR, Schoonmade LJ, Berckel BNM, Vandertop WP. Prediction of Meningioma WHO Grade Using PET Findings: A Systematic Review and Meta-Analysis. J Neuroimaging 2021; 31:6-19. [PMID: 33135239 PMCID: PMC7894181 DOI: 10.1111/jon.12795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND PURPOSE World Health Organization (WHO) grading of meningiomas reflects recurrence rate and prognosis. Positron emission tomography (PET) investigates metabolic activity, allowing for distinction between low- and high-grade tumors. As preoperative suspicion for malignant meningioma will influence surgical strategy in terms of timing, extent of resection, and risks taken to achieve a total resection, we systematically reviewed the literature on PET-imaging in meningiomas and relate these findings to histopathological analysis. METHODS Searches in PubMed, EMBASE, and The Cochrane Library, from inception to September 2019, included studies of patients who had undergone surgery for a histologically verified intracranial meningioma, with a PET-scan prior to surgery and description of (semi)quantitative PET values for meningiomas from two different WHO groups. Studies comparing more than 1 patient per WHO group were included in the meta-analysis. RESULTS Twenty-two studies (432 patients) were included. 18fluor-fluorodesoxyglucose (18F-FDG) PET was mostly described to differentiate benign from malignant meningiomas. Pooled data showed differences in mean (95% CI) Standardized Uptake Value (SUV) for WHO II/III compared to WHO I of 2.51 (1.36, 3.66), and in tumor-to-normal (T/N) ratio (T/N ratio) for WHO II/III versus WHO I of .42 (.12, .73). CONCLUSIONS We found that SUV and T/N ratio in 18F-FDG PET may be useful to noninvasively differentiate benign from malignant meningiomas. T/N ratio seems to have a high specificity for the detection of high-grade meningiomas. Other PET tracers were studied too infrequently to draw definitive conclusions. Before treatment strategies can be adapted based on 18F-FDG PET, prospective studies in larger cohorts are warranted to validate the optimal T/N ratio cutoff point.
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Affiliation(s)
- K. Mariam Slot
- Department of NeurosurgeryAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Dagmar Verbaan
- Department of NeurosurgeryAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Dennis R. Buis
- Department of NeurosurgeryAmsterdam University Medical CentersAmsterdamThe Netherlands
| | | | - Bart N. M. Berckel
- Department of Radiology and Nuclear MedicineAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - W. Peter Vandertop
- Department of NeurosurgeryAmsterdam University Medical CentersAmsterdamThe Netherlands
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6
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Laudicella R, Albano D, Annunziata S, Calabrò D, Argiroffi G, Abenavoli E, Linguanti F, Albano D, Vento A, Bruno A, Alongi P, Bauckneht M. Theragnostic Use of Radiolabelled Dota-Peptides in Meningioma: From Clinical Demand to Future Applications. Cancers (Basel) 2019; 11:cancers11101412. [PMID: 31546734 PMCID: PMC6826849 DOI: 10.3390/cancers11101412] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 12/14/2022] Open
Abstract
Meningiomas account for approximately 30% of all new diagnoses of intracranial masses. The 2016 World Health Organization's (WHO) classification currently represents the clinical standard for meningioma's grading and prognostic stratification. However, watchful waiting is frequently the chosen treatment option, although this means the absence of a certain histological diagnosis. Consequently, MRI (or less frequently CT) brain imaging currently represents the unique available tool to define diagnosis, grading, and treatment planning in many cases. Nonetheless, these neuroimaging modalities show some limitations, particularly in the evaluation of skull base lesions. The emerging evidence supporting the use of radiolabelled somatostatin receptor analogues (such as dota-peptides) to provide molecular imaging of meningiomas might at least partially overcome these limitations. Moreover, their potential therapeutic usage might enrich the current clinical offering for these patients. Starting from the strengths and weaknesses of structural and functional neuroimaging in meningiomas, in the present article we systematically reviewed the published studies regarding the use of radiolabelled dota-peptides in surgery and radiotherapy planning, in the restaging of treated patients, as well as in peptide-receptor radionuclide therapy of meningioma.
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Affiliation(s)
- Riccardo Laudicella
- Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, 98125 Messina, Italy
| | - Domenico Albano
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia, 25123 Brescia, Italy
| | - Salvatore Annunziata
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Diletta Calabrò
- Nuclear Medicine, DIMES University of Bologna, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | | | - Elisabetta Abenavoli
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50134 Florence, Italy
| | - Flavia Linguanti
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50134 Florence, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Unità di Radiologia Diagnostica ed Interventistica, 20161 Milano, Italy
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, 90127 Palermo, Italy
| | - Antonio Vento
- Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, 98125 Messina, Italy
| | - Antonio Bruno
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Pierpaolo Alongi
- Unit of Nuclear Medicine, Fondazione Istituto G. Giglio, 90015 Cefalù, Italy
| | - Matteo Bauckneht
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
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Folate can promote the methionine-dependent reprogramming of glioblastoma cells towards pluripotency. Cell Death Dis 2019; 10:596. [PMID: 31395852 PMCID: PMC6687714 DOI: 10.1038/s41419-019-1836-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/29/2019] [Accepted: 06/10/2019] [Indexed: 12/11/2022]
Abstract
Methionine dependency of tumor growth, although not well-understood, is detectable by 11C-methionine positron emission tomography and may contribute to the aggressivity of glioblastomas (GBM) and meningiomas. Cytosolic folate cycle is required for methionine synthesis. Its dysregulation may influence cell reprogramming towards pluripotency. We evaluated methionine-dependent growth of monolayer (ML) cells and stem cell-like tumor spheres (TS) derived from 4 GBM (U251, U87, LN299, T98G) and 1 meningioma (IOMM-LEE) cell lines. Our data showed that for all cell lines studied, exogenous methionine is required for TS formation but not for ML cells proliferation. Furthermore, for GBM cell lines, regardless of the addition of folate cycle substrates (folic acid and formate), the level of 3 folate isoforms, 5-methytetrahydrofolate, 5,10-methenyltetrahydrofolate, and 10-formyltetrahydrofolate, were all downregulated in TS relative to ML cells. Unlike GBM cell lines, in IOMM-LEE cells, 5-methyltetrahydrofolate was actually more elevated in TS than ML, and only 5,10-methenyltetrahydrofolate and 10-formyltetrahydrofolate were downregulated. The functional significance of this variation in folate cycle repression was revealed by the finding that Folic Acid and 5-methyltetrahydrofolate promote the growth of U251 TS but not IOMM-LEE TS. Transcriptome-wide sequencing of U251 cells revealed that DHFR, SHMT1, and MTHFD1 were downregulated in TS vs ML, in concordance with the low activity cytosolic folate cycle observed in U251 TS. In conclusion, we found that a repressed cytosolic folate cycle underlies the methionine dependency of GBM and meningioma cell lines and that 5-methyltetrahydrofolate is a key metabolic switch for glioblastoma TS formation. The finding that folic acid facilitates TS formation, although requiring further validation in diseased human tissues, incites to investigate whether excessive folate intake could promote cancer stem cells formation in GBM patients.
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Abstract
Delineating the gross tumor volume (GTV) is a core task within radiation treatment planning. GTVs must be precisely defined irrespective of the region involved, but even more so in a sensitive area such as the brain. As precision medicine cannot exist without precision imaging, the current article aims to discuss the various imaging modalities employed in the radiation treatment planning of brain tumors.Gliomas, meningiomas, and paragangliomas are some of the most challenging tumors and the advancement in diagnostic imaging can significantly contribute to their delineation. For gliomas, irradiation based on multiparametric magnetic resonance imaging (MRI) and amino-acid positron emission tomography (PET)/computed tomography (CT) may have a higher sensitivity and specificity, which could lead to a better sparing of organs at risk and help distinguish between tumor, edema, and radiogenic alterations. Meningiomas and paragangliomas are often associated with a good prognosis. Therefore, GTV delineation according to MRI and somatostatin receptor ligand-PET/CT plays an essential role in sparing sensitive structures and maintaining a good quality of life for these patients.The combination of multiparametric MRI and PET/CT (possibly in the form of PET/MRI) presently appears to be the optimal approach for target volume delineation. The comparative efficacy of these imaging modalities has to be further evaluated in prospective trials.
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Viaene AN, Zhang B, Martinez-Lage M, Xiang C, Tosi U, Thawani JP, Gungor B, Zhu Y, Roccograndi L, Zhang L, Bailey RL, Storm PB, O’Rourke DM, Resnick AC, Grady MS, Dahmane N. Transcriptome signatures associated with meningioma progression. Acta Neuropathol Commun 2019; 7:67. [PMID: 31039818 PMCID: PMC6489307 DOI: 10.1186/s40478-019-0690-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022] Open
Abstract
Meningiomas are the most common primary brain tumor of adults. The majority are benign (WHO grade I), with a mostly indolent course; 20% of them (WHO grade II and III) are, however, considered aggressive and require a more complex management. WHO grade II and III tumors are heterogeneous and, in some cases, can develop from a prior lower grade meningioma, although most arise de novo. Mechanisms leading to progression or implicated in de novo grade II and III tumorigenesis are poorly understood. RNA-seq was used to profile the transcriptome of grade I, II, and III meningiomas and to identify genes that may be involved in progression. Bioinformatic analyses showed that grade I meningiomas that progress to a higher grade are molecularly different from those that do not. As such, we identify GREM2, a regulator of the BMP pathway, and the snoRNAs SNORA46 and SNORA48, as being significantly reduced in meningioma progression. Additionally, our study has identified several novel fusion transcripts that are differentially present in meningiomas, with grade I tumors that did not progress presenting more fusion transcripts than all other tumors. Interestingly, our study also points to a difference in the tumor immune microenvironment that correlates with histopathological grade.
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Nowosielski M, Galldiks N, Iglseder S, Kickingereder P, von Deimling A, Bendszus M, Wick W, Sahm F. Diagnostic challenges in meningioma. Neuro Oncol 2018; 19:1588-1598. [PMID: 28531331 DOI: 10.1093/neuonc/nox101] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Advances in molecular profiling and the application of advanced imaging techniques are currently refreshing diagnostic considerations in meningioma patients. Not only technical refinements but also sophisticated histopathological and molecular studies have the potential to overcome some of the challenges during meningioma management. Exact tumor delineation, assessment of tumor growth, and pathophysiological parameters were recently addressed by "advanced" MRI and PET. In the field of neuropathology, high-throughput sequencing and DNA methylation analysis of meningioma tissue has greatly advanced the knowledge of molecular aberrations in meningioma patients. These techniques allow for more reliable prediction of the biological behavior and clinical course of meningiomas and subsequently have the potential to guide individualized meningioma therapy. However, higher costs and longer duration of full molecular work-up compared with histological assessment may delay the implementation into clinical routine.This review highlights the diagnostic challenges of meningiomas from both the neuroimaging as well as the neuropathological side and presents the latest scientific achievements and studies potentially helping in overcoming these challenges. It complements the recently proposed European Association of Neuro-Oncology guidelines on treatment and diagnosis of meningiomas by integrating data on nonstandard imaging and molecular assessments most likely impacting the future.
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Affiliation(s)
- Martha Nowosielski
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Norbert Galldiks
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Sarah Iglseder
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Philipp Kickingereder
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Andreas von Deimling
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Martin Bendszus
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Wolfgang Wick
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Felix Sahm
- University Medical Center, Neurology, and Neurooncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria; Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; University Medical Center, Neuroradiology, Heidelberg, Germany; University Medical Center, Neuropathology, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
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11C-Methionine Positron Emission Tomography/Computed Tomography Versus 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Evaluation of Residual or Recurrent World Health Organization Grades II and III Meningioma After Treatment. J Comput Assist Tomogr 2018; 42:517-521. [PMID: 29613985 DOI: 10.1097/rct.0000000000000729] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to determine the assessment of positron emission tomography-computed tomography using C-methionine (MET PET/CT) for World Health Organization (WHO) grades II and III meningiomas; MET PET/CT was compared with PET/CT using F-fluorodeoxy glucose (FDG PET/CT). METHODS This study was performed in 17 cases with residual and/or recurrent WHO grades II and III meningiomas. Two neuroradiologists reviewed both PET/CT scans. For agreement, the κ coefficient was measured. Difference in tumor-to-normal brain uptake ratios (T/N ratios) between 2 PET/CT scans was analyzed. Correlation between the maximum tumor size and T/N ratio in PET/CT was studied. RESULTS For agreement by both reviewers, the κ coefficient was 0.51 (P < 0.05). The T/N ratio was significantly higher for MET PET/CT (3.24 ± 1.36) than for FDG PET/CT (0.93 ± 0.44) (P < 0.01). C-methionine ratio significantly correlated with tumor size (y = 8.1x + 16.3, n = 22, P < 0.05), but FDG ratio did not CONCLUSIONS: C-methionine PET/CT has superior potential for imaging of WHO grades II and III meningiomas with residual or recurrent tumors compared with FDG PET/CT.
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12
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Correlation of 18F-FDG and 11C-methionine uptake on PET/CT with Ki-67 immunohistochemistry in newly diagnosed intracranial meningiomas. Ann Nucl Med 2018; 32:627-633. [PMID: 30032455 DOI: 10.1007/s12149-018-1284-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/18/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We evaluated the uptake of 2-deoxy-2-18F-fluoro-D-glucose (FDG) and L-[methyl-11C]-methionine (MET) in patients with newly diagnosed intracranial meningiomas and correlated the results with tumor proliferation. METHODS Data from 22 patients with newly diagnosed intracranial meningioma (12 grade I and 10 grade II) who underwent both FDG and MET brain PET/CT studies were retrospectively analyzed. The PET images were evaluated by a qualitative method and semiquantitative analysis using standardized uptake value (SUV) (SUVmax and SUVpeak) and tumor-to-reference tissue ratio (Tmax/N ratio and Tpeak/N ratio). Proliferative activity as indicated by the Ki-67 index was estimated in tissue specimens. RESULTS MET PET/CT showed a higher detection rate of meningioma than did FDG PET/CT (100 vs. 46%, respectively). The Tmax/N ratio and Tpeak/N ratio on MET PET/CT were significantly higher than those on FDG PET/CT (p < 0.001 and p < 0.001, respectively). There was a significant difference between grades I and II with respect to FDG SUVmax (p = 0.003), FDG SUVpeak (p = 0.003), FDG Tmax/N ratio (p = 0.02), FDG Tpeak/N ratio (p = 0.006), MET SUVmax (p = 0.002), MET SUVpeak (p = 0.002), MET Tmax/N ratio (p = 0.002), and MET Tpeak/N ratio (p = 0.002). There was a significant correlation between Ki-67 index and FDG PET/CT for SUVmax (p = 0.02), SUVpeak (p = 0.005), and Tpeak/N ratio (p = 0.05) and between Ki-67 index and MET PET/CT for SUVmax (p = 0.004), SUVpeak (p = 0.007), Tmax/N ratio (p = 0.002), and Tpeak/N ratio (p = 0.004). CONCLUSION MET PET/CT showed a high sensitivity compared with FDG PET/CT for detection of newly diagnosed WHO grades I and II intracranial meningiomas. Both FDG and MET uptake were found to be useful for evaluating tumor proliferation in meningiomas.
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13
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Galldiks N, Albert NL, Sommerauer M, Grosu AL, Ganswindt U, Law I, Preusser M, Le Rhun E, Vogelbaum MA, Zadeh G, Dhermain F, Weller M, Langen KJ, Tonn JC. PET imaging in patients with meningioma-report of the RANO/PET Group. Neuro Oncol 2017; 19:1576-1587. [PMID: 28605532 PMCID: PMC5716194 DOI: 10.1093/neuonc/nox112] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Meningiomas are the most frequent nonglial primary brain tumors and represent about 30% of brain tumors. Usually, diagnosis and treatment planning are based on neuroimaging using mainly MRI or, rarely, CT. Most common treatment options are neurosurgical resection and radiotherapy (eg, radiosurgery, external fractionated radiotherapy). For follow-up after treatment, a structural imaging technique such as MRI or CT is used. However, these structural imaging modalities have limitations, particularly in terms of tumor delineation as well as diagnosis of posttherapeutic reactive changes. Molecular imaging techniques such as PET can characterize specific metabolic and cellular features which may provide clinically relevant information beyond that obtained from structural MR or CT imaging alone. Currently, the use of PET in meningioma patients is steadily increasing. In the present article, we provide recommendations for the use of PET imaging in the clinical management of meningiomas based on evidence generated from studies being validated by histology or clinical course.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany
- Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany
| | - Nathalie L Albert
- Departments of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany
| | - Michael Sommerauer
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Anca L Grosu
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | - Ute Ganswindt
- Departments of Radiation Oncology, Ludwig Maximilians-University of Munich, Munich, Germany
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Preusser
- Department of Medicine I and Comprehensive Cancer Centre CNS Tumours Unit, Medical University of Vienna, Vienna, Austria
| | - Emilie Le Rhun
- Department of Neurosurgery, University Hospital Lille, Lille, France
| | - Michael A Vogelbaum
- Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gelareh Zadeh
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Frédéric Dhermain
- Department of Radiation Oncology, Gustave Roussy University Hospital, Villejuif, France
| | - Michael Weller
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany
- Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
| | - Jörg C Tonn
- Departments of Neurosurgery, Ludwig Maximilians-University of Munich, Munich, Germany
- German Cancer Consortium, Partner Sites, Freiburg and Munich, Germany
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14
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Long-term evaluation of the effect of hypofractionated high-energy proton treatment of benign meningiomas by means of (11)C-L-methionine positron emission tomography. Eur J Nucl Med Mol Imaging 2016; 43:1432-43. [PMID: 26819102 DOI: 10.1007/s00259-016-3310-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine if (11)C-L-methionine PET is a useful tool in the evaluation of the long-term effect of proton beam treatment in patients with meningioma remnant. METHODS Included in the study were 19 patients (4 men, 15 women) with intracranial meningioma remnants who received hypofractionated high-energy proton beam treatment. Patients were examined with (11)C-L-methionine PET and MRI prior to treatment and after 6 months, and 1, 2, 3, 5, 7 and 10 years. Temporal changes in methionine uptake ratio, meningioma volume, meningioma regrowth and clinical symptoms throughout the follow-up period were evaluated. RESULTS In 17 patients the tumour volume was unchanged throughout the follow-up. The methionine uptake ratio on PET decreased over the years in most patients. In two patients the tumour remnant showed progression on MRI. In these patients, prior to the volume increase on MRI, the methionine uptake ratio increased. One patient experienced transient clinical symptoms and showed radiological evidence of a radiation-induced reaction close to the irradiated field. CONCLUSION Proton beam treatment is a safe and effective treatment for achieving long-term growth arrest in meningioma remnants. Follow-up with (11)C-L-methionine PET may be a valuable adjunct to, but not a replacement for, standard radiological follow-up.
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Naito K, Yamagata T, Arima H, Abe J, Tsuyuguchi N, Ohata K, Takami T. Qualitative analysis of spinal intramedullary lesions using PET/CT. J Neurosurg Spine 2015; 23:613-619. [PMID: 26230418 DOI: 10.3171/2015.2.spine141254] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Although the usefulness of PET for brain lesions has been established, few reports have examined the use of PET for spinal intramedullary lesions. This study investigated the diagnostic utility of PET/CT for spinal intramedullary lesions. METHODS l-[methyl-11C]-methionine (MET)- or [18F]-fluorodeoxyglucose (FDG)-PET/CT was performed in 26 patients with spinal intramedullary lesions. The region of interest (ROI) within the spinal cord parenchyma was placed manually in the axial plane. Maximum pixel counts in the ROIs were normalized to the maximum standardized uptake value (SUVmax) using subject body weight. For FDG-PET the SUVmax was corrected for lean body mass (SULmax) to exclude any influence of the patient's body shape. Each SUV was analyzed based on histopathological results after surgery. The diagnostic validity of the SUV was further compared with the tumor proliferation index using the MIB-1 monoclonal antibody (MIB-1 index). RESULTS A total of 16 patients underwent both FDG-PET and MET-PET, and the remaining 10 patients underwent either FDG-PET or MET-PET. Pathological diagnoses included high-grade malignancy such as glioblastoma multiforme, anaplastic astrocytoma, or anaplastic ependymoma in 5 patients; low-grade malignancy such as hemangioblastoma, diffuse astrocytoma, or ependymoma in 12 patients; and nonneoplastic lesion including cavernous malformation in 9 patients. Both FDG and MET accumulated significantly in high-grade malignancy, and the SULmax and SUVmax correlated with the tumor proliferation index. Therapeutic response after chemotherapy or radiation in high-grade malignancy was well monitored. However, a significant difference in SULmax and SUVmax for FDG-PET and MET-PET was not evident between low-grade malignancy and nonneoplastic lesions. CONCLUSIONS Spinal PET/CT using FDG or MET for spinal intramedullary lesions appears useful and practical, particularly for tumors with high-grade malignancy. Differentiation of tumors with low-grade malignancy from nonneoplastic lesions may still prove difficult. Further technological refinement, including the selection of radiotracer or analysis evaluation methods, is needed.
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Affiliation(s)
- Kentaro Naito
- Department of Neurosurgery, Osaka City University Graduate School of Medicine; and
| | - Toru Yamagata
- Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan
| | | | - Junya Abe
- Department of Neurosurgery, Osaka City University Graduate School of Medicine; and
| | - Naohiro Tsuyuguchi
- Department of Neurosurgery, Osaka City University Graduate School of Medicine; and
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine; and
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka City University Graduate School of Medicine; and
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Furuse M, Nonoguchi N, Kawabata S, Miyata T, Toho T, Kuroiwa T, Miyatake SI. Intratumoral and peritumoral post-irradiation changes, but not viable tumor tissue, may respond to bevacizumab in previously irradiated meningiomas. Radiat Oncol 2015. [PMID: 26223253 PMCID: PMC4520201 DOI: 10.1186/s13014-015-0446-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The efficacy of bevacizumab has not been determined for treatment-refractory meningiomas. We treated meningiomas with low-dose bevacizumab and compared the radiological responses of non-irradiated meningiomas with previously irradiated meningiomas. In addition, we assessed intraparenchymal radiation necrosis following bevacizumab treatment. Six patients with meningiomas (three anaplastic, one atypical, and two grade I) who were previously treated with multiple sessions of radiotherapy and subsequently developed perilesional edema were treated with bevacizumab. Of six patients, two patients with anaplastic meningiomas developed three tumors following radiotherapy, which were defined as non-irradiated tumors. There were 12 pre-existing extra-axial tumors that were previously irradiated. Some of these tumors demonstrated adjacent intraparenchymal contrast enhancement. These tumors were defined as post-irradiated tumors. Four patients had intraparenchymal radiation necrosis. Low-dose bevacizumab was administered biweekly over 3–6 cycles to all patients. Four tumors decreased in contrast-enhanced volume, nine tumors were unchanged, and two tumors progressed. Of the three non-irradiated tumors, two tumors increased in volume (126 % and 198 %) and one tumor was stable (−5 %). The median reduction rates determined by contrast volume were −31 % and −71 % in post-irradiated tumors and radiation necrosis, respectively. Non-irradiated tumors had a significantly poorer response to bevacizumab than post-irradiated tumors and radiation necrosis (p = 0.0013 and p = 0.0005, respectively, Tukey-Kramer test). Low-dose bevacizumab did not demonstrate efficacy in the treatment of non-irradiated meningiomas. Responses to low-dose bevacizumab could be related to its effect on post-irradiation changes, rather than its effect on biologically active tumor tissue in post-irradiated meningiomas. Radiological responses to low-dose bevacizumab may distinguish biologically active tumors from post-irradiation changes in progressive meningiomas following radiotherapy.
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Affiliation(s)
- Motomasa Furuse
- Department of Neurosurgery, Osaka Medical College, 2-7, Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Naosuke Nonoguchi
- Department of Neurosurgery, Osaka Medical College, 2-7, Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Shinji Kawabata
- Department of Neurosurgery, Osaka Medical College, 2-7, Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Tomo Miyata
- Department of Neurosurgery, Osaka Medical College, 2-7, Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Taichiro Toho
- Department of Neurosurgery, Osaka Medical College, 2-7, Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Toshihiko Kuroiwa
- Department of Neurosurgery, Osaka Medical College, 2-7, Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Shin-Ichi Miyatake
- Department of Neurosurgery, Osaka Medical College, 2-7, Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
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Abstract
PURPOSE OF REVIEW Brain tumors differ in histology, biology, prognosis and treatment options. Although structural magnetic resonance is still the gold standard for morphological tumor characterization, molecular imaging has gained an increasing importance in assessment of tumor activity and malignancy. RECENT FINDINGS Amino acid PET is frequently used for surgery and biopsy planning as well as therapy monitoring in suspected primary brain tumors as well as metastatic lesions, whereas 18F-fluorodeoxyglucose (18F-FDG) remains the tracer of choice for evaluation of patients with primary central nervous system lymphoma. Application of somatostatin receptor ligands has improved tumor delineation in skull base meningioma and concurrently opened up new treatment possibilities in recurrent or surgically not assessable tumors.Recent development focuses on the implementation of hybrid PET/MRI as well as on the development of new tracers targeting tumor hypoxia, enzymes involved in neoplastic metabolic pathways and the combination of PET tracers with therapeutic agents. SUMMARY Implementation of molecular imaging in the clinical routine continues to improve management in patients with brain tumors. However, more prospective large sample studies are needed to validate the additional informative value of PET.
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18
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Bosnyák E, Kamson DO, Guastella AR, Varadarajan K, Robinette NL, Kupsky WJ, Muzik O, Michelhaugh SK, Mittal S, Juhász C. Molecular imaging correlates of tryptophan metabolism via the kynurenine pathway in human meningiomas. Neuro Oncol 2015; 17:1284-92. [PMID: 26092774 DOI: 10.1093/neuonc/nov098] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/06/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Increased tryptophan metabolism via the kynurenine pathway (KP) is a key mechanism of tumoral immune suppression in gliomas. However, details of tryptophan metabolism in meningiomas have not been elucidated. In this study, we evaluated in vivo tryptophan metabolism in meningiomas and compared it with gliomas using α-[(11)C]-methyl-L-tryptophan (AMT)-PET. We also explored expression patterns of KP enzymes in resected meningiomas. METHODS Forty-seven patients with MRI-detected meningioma (n = 16) and glioma (n = 31) underwent presurgical AMT-PET scanning. Tumoral AMT uptake and tracer kinetic parameters (including K and k3' evaluating unidirectional uptake and trapping, respectively) were measured, correlated with meningioma grade, and compared between meningiomas and gliomas. Patterns of KP enzyme expression were assessed by immunohistochemistry in all meningiomas. RESULTS Meningioma grade showed a positive correlation with AMT k3' tumor/cortex ratio (r = 0.75, P = .003), and this PET parameter distinguished grade I from grade II/III meningiomas with 92% accuracy. Kinetic AMT parameters could differentiate meningiomas from both low-grade gliomas (97% accuracy by k3' ratios) and high-grade gliomas (83% accuracy by K ratios). Among 3 initial KP enzymes (indoleamine 2,3-dioxygenase 1/2, and tryptophan 2,3-dioxygenase 2 [TDO2]), TDO2 showed the strongest immunostaining, particularly in grade I meningiomas. TDO2 also showed a strong negative correlation with AMT k3' ratios (P = .001). CONCLUSIONS PET imaging of tryptophan metabolism can provide quantitative imaging markers for differentiating grade I from grade II/III meningiomas. TDO2 may be an important driver of in vivo tryptophan metabolism in these tumors. These results can have implications for pharmacological targeting of the KP in meningiomas.
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Affiliation(s)
- Edit Bosnyák
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - David O Kamson
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - Anthony R Guastella
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - Kaushik Varadarajan
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - Natasha L Robinette
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - William J Kupsky
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - Otto Muzik
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - Sharon K Michelhaugh
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - Sandeep Mittal
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
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