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Jochumsen MR, Overgaard DL, Vendelbo MH, Madsen MA, Tolbod LP, Gormsen LC, Barkholt TØ. Extracardiac findings with increased perfusion during clinical O-15-H 2O PET/CT myocardial perfusion imaging: A case series. J Nucl Cardiol 2023; 30:1458-1468. [PMID: 36600173 PMCID: PMC9812748 DOI: 10.1007/s12350-022-03156-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/08/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Coincidental extracardiac findings with increased perfusion were reported during myocardial perfusion imaging (MPI) with various retention radiotracers. Clinical parametric O-15-H2O PET MPI yielding quantitative measures of myocardial blood flow (MBF) was recently implemented at our facility. We aim to explore whether similar extracardiac findings are observed using O-15-H2O. METHODS AND RESULTS All patients (2963) were scanned with O-15-H2O PET MPI according to international guidelines and extracardiac findings were collected. In contrast to parametric O-15-H2O MBF images, extracardiac perfusion was assessed using summed images. Biopsy histopathology and other imaging modalities served as reference standards. Various malignant lesions with increased perfusion were detected, including lymphomas, large-celled neuroendocrine tumour, breast, and lung cancer plus metastases from colonic and renal cell carcinomas. Furthermore, inflammatory and hyperplastic benign conditions with increased perfusion were observed: rib fractures, gynecomastia, atelectasis, sarcoidosis, pneumonia, chronic lung inflammation and fibrosis, benign lung nodule, chronic diffuse lung infiltrates, pleural plaques and COVID-19 infiltrates. CONCLUSIONS Malignant and benign extracardiac coincidental findings with increased perfusion are readily visible and frequently seen on O-15-H2O PET MPI. We recommend evaluating the summed O-15-H2O PET images in addition to the low-dose CT attenuation images.
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Affiliation(s)
- Mads Ryø Jochumsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus N, Denmark
| | - David Lyse Overgaard
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Mikkel Holm Vendelbo
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000 Aarhus C, Denmark
| | - Michael Alle Madsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus N, Denmark
| | - Lars Christian Gormsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus N, Denmark
| | - Trine Ørhøj Barkholt
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
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Borja AJ, Saini J, Raynor WY, Ayubcha C, Werner TJ, Alavi A, Revheim ME, Nagaraj C. Role of Molecular Imaging with PET/MR Imaging in the Diagnosis and Management of Brain Tumors. PET Clin 2022; 17:431-451. [PMID: 35662494 DOI: 10.1016/j.cpet.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Gliomas are the most common primary brain tumors. Hybrid PET/MR imaging has revolutionized brain tumor imaging, allowing for noninvasive, simultaneous assessment of morphologic, functional, metabolic, and molecular parameters within the brain. Molecular information obtained from PET imaging may aid in the detection, classification, prognostication, and therapeutic decision making for gliomas. 18F-fluorodeoxyglucose (FDG) has been widely used in the setting of brain tumor imaging, and multiple techniques may be employed to optimize this methodology. More recently, a number of non-18F-FDG-PET radiotracers have been applied toward brain tumor imaging and are used in clinical practice.
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Affiliation(s)
- Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jitender Saini
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, Karnataka 560-029, India
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Cyrus Ayubcha
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Mona-Elisabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, Oslo 0315, Norway
| | - Chandana Nagaraj
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, Karnataka 560-029, India.
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3
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Ma H, Zhao J, Liu S, Xie D, Zhang Z, Nie D, Wen F, Yang Z, Tang G. 18F-Trifluoromethylated D-Cysteine as a Promising New PET Tracer for Glioma Imaging: Comparative Analysis With MRI and Histopathology in Orthotopic C6 Models. Front Oncol 2021; 11:645162. [PMID: 33996562 PMCID: PMC8117348 DOI: 10.3389/fonc.2021.645162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
Comparing MRI and histopathology, this study aims to comprehensively explore the potential application of 18F-trifluoromethylated D-cysteine (S-[18F]CF3-D-CYS) in evaluating glioma by using orthotopic C6 glioma models. Sprague-Dawley (SD) rats (n = 9) were implanted with C6 glioma cells. Tumor growth was monitored every week by multiparameter MRI [including dynamic contrast-enhanced MRI (DCE-MRI)], [18F]FDG, S-[18F]CF3-D-CYS, and [18F]FDOPA PET imaging. Repeated scans of the same rat with the two or three [18F]-labeled radiotracers were investigated. Initial regions of interest were manually delineated on T2WI and set on the same level of PET images, and tumor-to-normal brain uptake ratios (TNRs) were calculated to semiquantitatively assess the tracer accumulation in the tumor. The tumor volume in PET and histopathology was calculated. HE and Ki67 immunohistochemical staining were further performed. The correlations between the uptake of S-[18F]CF3-D-CYS and Ki67 were analyzed. Dynamic S-[18F]CF3-D-CYS PET imaging showed tumor uptake rapidly reached a peak, maintained plateau during 10-30 min after injection, then decreased slowly. Compared with [18F]FDG and [18F]FDOPA PET imaging, S-[18F]CF3-D-CYS PET demonstrated the highest TNRs (P < 0.05). There were no significant differences in the tumor volume measured on S-[18F]CF3-D-CYS PET or HE specimen. Furthermore, our results showed that the uptake of S-[18F]CF3-D-CYS was significantly positively correlated with tumor Ki67, and the poor accumulated S-[18F]CF3-D-CYS was consistent with tumor hemorrhage. There was no significant correlation between the S-[18F]CF3-D-CYS uptakes and the Ktrans values derived from DCE-MRI. In comparison with MRI and histopathology, S-[18F]CF3-D-CYS PET performs well in the diagnosis and evaluation of glioma. S-[18F]CF3-D-CYS PET may serve as a valuable tool in the clinical management of gliomas.
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Affiliation(s)
- Hui Ma
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Nuclear Medicine, Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Zhao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaoyu Liu
- Department of Nuclear Medicine, Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dingxiang Xie
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhanwen Zhang
- Department of Nuclear Medicine, Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dahong Nie
- Department of Nuclear Medicine, Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fuhua Wen
- Department of Nuclear Medicine, Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiyun Yang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ganghua Tang
- Department of Nuclear Medicine, Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Nanfang PET Center, Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
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4
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Abstract
OBJECTIVE. Diagnosing brain tumor recurrence, especially with changes that occur after treatment, is a challenge. MRI has an exceptional structural resolution, which is important from the perspective of treatment planning. However, its reliability in diagnosing recurrence is relatively lower, when compared to metabolic imaging. The latter is more sensitive to the early changes associated with recurrence and relatively immune to confounding by treatment related changes. CONCLUSION. There is no one-stop shop for the diagnosis of recurrence in brain tumors. The sensitivity of metabolic imaging is not a substitute for the resolution of the MRI, making a multi-modal approach the only way forward.
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Okita Y, Shofuda T, Kanematsu D, Yoshioka E, Kodama Y, Mano M, Kinoshita M, Nonaka M, Fujinaka T, Kanemura Y. The association between 11C-methionine uptake, IDH gene mutation, and MGMT promoter methylation in patients with grade II and III gliomas. Clin Radiol 2020; 75:622-628. [PMID: 32321646 DOI: 10.1016/j.crad.2020.03.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/23/2020] [Indexed: 01/08/2023]
Abstract
AIM To evaluate the association between 11C-methionine positron-emission tomography (11C-methionine PET) findings, isocitrate dehydrogenase (IDH) gene mutation, and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation in patients with grade II and III gliomas. MATERIALS AND METHODS Data were collected from 40 patients with grade II and III gliomas who underwent both magnetic resonance imaging (MRI) and 11C-methionine PET as part of their pre-surgical examination. IDH mutation was examined via DNA sequencing, and MGMT promoter methylation via quantitative methylation-specific polymerase chain reaction (PCR). RESULTS A threshold of MGMT promoter methylation of 1% was significantly associated with tumour/normal tissue (T/N) ratio. The T/N ratio in samples with MGMT promoter methylation ≥1% was higher than that in samples with MGMT promoter methylation <1%, and the difference was statistically significant (p=0.011). Reliable prediction of MGMT promoter methylation (<1% versus ≥1%) was possible using the T/N ratio under the receiver operator characteristic (ROC) curve with a sensitivity and specificity of 75% each (cut-off value=1.6: p=0.0226, area under the ROC curve [AUC]=0.76172). Conversely, the T/N ratio had no association with IDH mutation (p=0.6). The ROC curve revealed no reliable prediction of IDH mutation using the T/N ratio (p=0.606, AUC=0.60577). CONCLUSION 11C-methionine PET parameters can predict MGMT promoter methylation but not IDH mutation status. 11C-methionine uptake may have limited potential to reflect DNA methylation processes in grade II and III gliomas.
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Affiliation(s)
- Y Okita
- Department of Neurosurgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan; Department of Neurosurgery, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan.
| | - T Shofuda
- Division of Stem Cell Research, Department of Biomedical Research and Innovation, Institute for Clinical Research, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan
| | - D Kanematsu
- Division of Regenerative Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan
| | - E Yoshioka
- Division of Stem Cell Research, Department of Biomedical Research and Innovation, Institute for Clinical Research, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan
| | - Y Kodama
- Division of Pathology Network, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe City, 650-0017, Japan; Department of Central Laboratory and Surgical Pathology, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan
| | - M Mano
- Department of Central Laboratory and Surgical Pathology, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan
| | - M Kinoshita
- Department of Neurosurgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan; Department of Neurosurgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - M Nonaka
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - T Fujinaka
- Department of Neurosurgery, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan
| | - Y Kanemura
- Department of Neurosurgery, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan; Division of Regenerative Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan
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6
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Histogram analysis of 11C-methionine integrated PET/MRI may facilitate to determine the O6-methylguanylmethyltransferase methylation status in gliomas. Nucl Med Commun 2019; 40:850-856. [PMID: 31135693 DOI: 10.1097/mnm.0000000000001039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We evaluate the O6-methylguanylmethyltransferase (MGMT) methylation status noninvasively by analyzing radiomics features of C-methionine (MET) PET images, which may reflect the detailed biological properties of gliomas. PATIENTS AND METHODS Fifty-seven patients with histopathologically confirmed gliomas, who were initially examined with C-MET PET/MR were retrospectively enrolled. Quantitative uptake of MET was assessed using conventional, histogram and texture features. These features were compared between the two groups classified by MGMT promoter methylation status. RESULTS The histogram features (Skewness and Kurtosis) of the MGMT methylated group were significantly higher than those of the MGMT unmethylated group (Skewness: 0.90 ± 0.71 vs. 0.49 ± 0.45; P = 0.01) (Kurtosis: 1.36 ± 2.30 vs. 0.08 ± 0.65; P = 0.003), but there were no significant differences in Skewness or Kurtosis between the groups in glioma-grade-matched subgroup analysis. Moreover, there was no significant difference in other features between the methylated group and unmethylated group. CONCLUSION The histogram features (Skewness and Kurtosis) of MET PET/MRI may be two key indicators to detect MGMT methylation status in gliomas and valuable predictors for the clinical responses of patients scheduled to receive temozolomide chemotherapeutics.
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7
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Kostenikov NA, Zhuikov BL, Chudakov VM, Iliuschenko YR, Shatik SV, Zaitsev VV, Sysoev DS, Stanzhevskiy AA. Application of 82 Sr/ 82 Rb generator in neurooncology. Brain Behav 2019; 9:e01212. [PMID: 30729720 PMCID: PMC6422714 DOI: 10.1002/brb3.1212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The applicability of "Rubidium Chloride, 82 Rb from Generator" radiopharmaceutical for brain tumors (BT) diagnostics is demonstrated on the basis of the application experience of the radiopharmaceutical in neurooncology. EXPERIMENTAL A total of 21 patients with various brain tumors and nonneoplastic abnormal brain masses were investigated. RESULTS AND DISCUSSIONS The results of the imaging and differential diagnostics of malignant and benign tumors, nonneoplastic abnormal brain masses and lesions revealed the prevalence of high uptake of the radiopharmaceutical in the malignant tumors in comparison with benign glioma and arteriovenous malformations in which 82 Rb-chloride accumulates in the vascular phase but does not linger further. The ultra-short half-life of radionuclide 82 Rb (76 s) along with a low absorbed radiation dose with 82 Rb-chloride by intravenous administration create a new possibility of successive use of two or more radiopharmaceuticals for the examination of the same patient. For instance, PET examination with 18 F-FDG, 11 C-methionine, 11 C-choline, or any other radiopharmaceutical can be carried out in just 7-15 min. after 82 Rb-chloride injection. CONCLUSION Research demonstrated an effectiveness of 82 Rb-chloride application as a diagnostic agent in neurooncology. A method of dosing and administration of the generator-produced radiopharmaceutical has been worked out. It is possible to do up to 600 PET sessions using one Russian 82 Rb generator GR-01. The generator is proved to be reliable and easy to use. The interest in 82 Rb-chloride as a tumor-seeking radiopharmaceutical rose due to the active application of the modern devices PET/CT in the routine clinical practice.
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Affiliation(s)
- Nikolay A. Kostenikov
- Russian Research Center of Radiology and Surgical Technologies (RRCRST) of Ministry of Public HealthSaint‐PetersburgRussia
| | - Boris L. Zhuikov
- Institute for Nuclear Research of Russian Academy of Sciences (INR RAS)MoscowRussia
| | - Valeriy M. Chudakov
- Institute for Nuclear Research of Russian Academy of Sciences (INR RAS)MoscowRussia
| | - Yuriy R. Iliuschenko
- Russian Research Center of Radiology and Surgical Technologies (RRCRST) of Ministry of Public HealthSaint‐PetersburgRussia
| | - Sergey V. Shatik
- Russian Research Center of Radiology and Surgical Technologies (RRCRST) of Ministry of Public HealthSaint‐PetersburgRussia
| | - Vadim V. Zaitsev
- Russian Research Center of Radiology and Surgical Technologies (RRCRST) of Ministry of Public HealthSaint‐PetersburgRussia
| | - Dmitriy S. Sysoev
- Russian Research Center of Radiology and Surgical Technologies (RRCRST) of Ministry of Public HealthSaint‐PetersburgRussia
| | - Andrey A. Stanzhevskiy
- Russian Research Center of Radiology and Surgical Technologies (RRCRST) of Ministry of Public HealthSaint‐PetersburgRussia
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8
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Okita Y, Shofuda T, Kanematsu D, Yoshioka E, Kodama Y, Mano M, Kinoshita M, Nonaka M, Nakajima S, Fujinaka T, Kanemura Y. Stereotactic image-based histological analysis reveals a correlation between 11C-methionine uptake and MGMT promoter methylation in non-enhancing gliomas. Oncol Lett 2018; 16:1924-1930. [PMID: 30008885 DOI: 10.3892/ol.2018.8866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/24/2018] [Indexed: 12/28/2022] Open
Abstract
Gliomas are genetically and histopathologically heterogeneous. Intratumoral heterogeneity in the MGMT promoter methylation status is an important clinical biomarker of glioblastoma. A higher uptake of 11C-methionine in positron-emission tomography (PET) reportedly reflects increased MGMT promoter methylation; however, non-stereotactic comparison of MGMT methylation and 11C-methionine PET images may not be accurate. The present study examined the correlation between 11C-methionine uptake and MGMT promoter methylation in non-enhancing gliomas using stereotactic image-based histological analysis. Data were collected from 9 patients with newly diagnosed non-enhancing glioma who underwent magnetic resonance imaging and 11C-methionine PET during pre-surgical examination. Clinical data were also collected from 3 patients during repeat surgery. The correlation between 11C-methionine uptake and MGMT methylation or cell density was analyzed using histological specimens obtained by multiple stereotactic sampling and an exact local comparison of 11C-methionine PET images and histological specimens was made. A total of 31 stereotactic sample sites were identified. In newly diagnosed cases, the tumor to normal uptake (T/N) ratio revealed a significant positive correlation with MGMT methylation (R=0.54, P=0.009) and a marginal correlation with cell density (R=0.42, P=0.05). In recurrent cases, the T/N ratio demonstrated no correlation with MGMT methylation (R=0.01, P=0.97) or cell density (R=0.15, P=0.70). An increased uptake of 11C-methionine in PET may reflect increased MGMT promoter methylation according to stereotactic image-based histological analysis. 11C-methionine PET could therefore be a useful tool for detecting regional MGMT promoter methylation in non-enhancing primary glioma.
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Affiliation(s)
- Yoshiko Okita
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Chuo-ku, Osaka 540-0006, Japan
| | - Tomoko Shofuda
- Division of Stem Cell Research, Osaka National Hospital, National Hospital Organization, Chuo-ku, Osaka 540-0006, Japan
| | - Daisuke Kanematsu
- Division of Regenerative Medicine, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, Chuo-ku, Osaka 540-0006, Japan
| | - Ema Yoshioka
- Division of Stem Cell Research, Osaka National Hospital, National Hospital Organization, Chuo-ku, Osaka 540-0006, Japan
| | - Yoshinori Kodama
- Department of Pathology and Applied Neurobiology, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Masayuki Mano
- Department of Central Laboratory and Surgical Pathology, Osaka National Hospital, National Hospital Organization, Chuo-ku, Osaka 540-0006, Japan
| | - Manabu Kinoshita
- Department of Neurosurgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Masahiro Nonaka
- Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Shin Nakajima
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Chuo-ku, Osaka 540-0006, Japan
| | - Toshiyuki Fujinaka
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Chuo-ku, Osaka 540-0006, Japan
| | - Yonehiro Kanemura
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Chuo-ku, Osaka 540-0006, Japan.,Division of Regenerative Medicine, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, Chuo-ku, Osaka 540-0006, Japan
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9
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Zmuda F, Blair A, Liuzzi MC, Malviya G, Chalmers AJ, Lewis D, Sutherland A, Pimlott SL. An 18F-Labeled Poly(ADP-ribose) Polymerase Positron Emission Tomography Imaging Agent. J Med Chem 2018; 61:4103-4114. [PMID: 29630818 PMCID: PMC6007963 DOI: 10.1021/acs.jmedchem.8b00138] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Indexed: 11/29/2022]
Abstract
Poly(ADP-ribose) polymerase (PARP) is involved in repair of DNA breaks and is over-expressed in a wide variety of tumors, making PARP an attractive biomarker for positron emission tomography (PET) and single photon emission computed tomography imaging. Consequently, over the past decade, there has been a drive to develop nuclear imaging agents targeting PARP. Here, we report the discovery of a PET tracer that is based on the potent PARP inhibitor olaparib (1). Our lead PET tracer candidate, [18F]20, was synthesized and evaluated as a potential PARP PET radiotracer in mice bearing subcutaneous glioblastoma xenografts using ex vivo biodistribution and PET-magnetic resonance imaging techniques. Results showed that [18F]20 could be produced in a good radioactivity yield and exhibited specific PARP binding allowing visualization of tumors over-expressing PARP. [18F]20 is therefore a potential candidate radiotracer for in vivo PARP PET imaging.
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Affiliation(s)
- Filip Zmuda
- WestCHEM,
School of Chemistry, University of Glasgow, The Joseph Black Building, Glasgow G12 8QQ, U.K.
- Wolfson
Whol Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow G61 1QH, U.K.
| | - Adele Blair
- WestCHEM,
School of Chemistry, University of Glasgow, The Joseph Black Building, Glasgow G12 8QQ, U.K.
| | - Maria Clara Liuzzi
- WestCHEM,
School of Chemistry, University of Glasgow, The Joseph Black Building, Glasgow G12 8QQ, U.K.
- School of Medicine, College of Medical, Veterinary
and Life Sciences, University of Glasgow, Glasgow G12 8QQ, U.K.
| | - Gaurav Malviya
- Cancer
Research UK Beatson Institute, Glasgow G61 1BD, U.K.
| | - Anthony J. Chalmers
- Wolfson
Whol Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow G61 1QH, U.K.
| | - David Lewis
- Cancer
Research UK Beatson Institute, Glasgow G61 1BD, U.K.
| | - Andrew Sutherland
- WestCHEM,
School of Chemistry, University of Glasgow, The Joseph Black Building, Glasgow G12 8QQ, U.K.
| | - Sally L. Pimlott
- West
of Scotland
PET Centre, Greater Glasgow and Clyde NHS
Trust, Glasgow G12 0YN, U.K.
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10
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Diagnostic accuracy of 11C-methionine PET in detecting neuropathologically confirmed recurrent brain tumor after radiation therapy. Ann Nucl Med 2017; 32:132-141. [DOI: 10.1007/s12149-017-1227-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
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11
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Roberts BR, Doecke JD, Rembach A, Yévenes LF, Fowler CJ, McLean CA, Lind M, Volitakis I, Masters CL, Bush AI, Hare DJ. Rubidium and potassium levels are altered in Alzheimer's disease brain and blood but not in cerebrospinal fluid. Acta Neuropathol Commun 2016; 4:119. [PMID: 27842602 PMCID: PMC5109650 DOI: 10.1186/s40478-016-0390-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 10/29/2016] [Indexed: 12/21/2022] Open
Abstract
Loss of intracellular compartmentalization of potassium is a biochemical feature of Alzheimer's disease indicating a loss of membrane integrity and mitochondrial dysfunction. We examined potassium and rubidium (a biological proxy for potassium) in brain tissue, blood fractions and cerebrospinal fluid from Alzheimer's disease and healthy control subjects to investigate the diagnostic potential of these two metal ions. We found that both potassium and rubidium levels were significantly decreased across all intracellular compartments in the Alzheimer's disease brain. Serum from over 1000 participants in the Australian Imaging, Biomarkers and Lifestyle Flagship Study of Ageing (AIBL), showed minor changes according to disease state. Potassium and rubidium levels in erythrocytes and cerebrospinal fluid were not significantly different according to disease state, and rubidium was slightly decreased in Alzheimer's disease patients compared to healthy controls. Our data provides evidence that contrasts the hypothesized disruption of the blood-brain barrier in Alzheimer's disease, with the systemic decrease in cortical potassium and rubidium levels suggesting influx of ions from the blood is minimal and that the observed changes are more likely indicative of an internal energy crisis within the brain. These findings may be the basis for potential diagnostic imaging studies using radioactive potassium and rubidium tracers.
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12
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Abstract
The revolution in cancer genomics has uncovered a variety of clinically relevant mutations in primary brain tumours, creating an urgent need to develop non-invasive imaging biomarkers to assess and integrate this genetic information into the clinical management of patients. Metabolic reprogramming is a central hallmark of cancer, including brain tumours; indeed, many of the molecular pathways implicated in the pathogenesis of brain tumours result in reprogramming of metabolism. This relationship provides the opportunity to devise in vivo metabolic imaging modalities to improve diagnosis, patient stratification, and monitoring of treatment response. Metabolic phenomena, such as the Warburg effect and altered mitochondrial metabolism, can be leveraged to image brain tumours using techniques including PET and MRI. Moreover, genetic alterations, such as mutations affecting isocitrate dehydrogenase, are associated with unique metabolic signatures that can be detected using magnetic resonance spectroscopy. The need to translate our understanding of the molecular features of brain tumours into imaging modalities with clinical utility is growing; metabolic imaging provides a unique platform to achieve this objective. In this Review, we examine the molecular basis for metabolic reprogramming in brain tumours, and examine current non-invasive metabolic imaging strategies that can be used to interrogate these molecular characteristics with the ultimate goal of guiding and improving patient care.
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13
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Abstract
A 64-year-old woman with stage IV breast cancer underwent an FDG and Rb PET brain studies. The PET brain images were fused with MRI brain T1 post-contrast images. The known enhancing left superoposterior frontal brain metastasis is positive on both FDG Rb PET/MRI images. The Rb PET/MRI showed better target-to-noise ratio, but showed nonspecific uptake in the superior sagittal sinus.
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14
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Okita Y, Nonaka M, Shofuda T, Kanematsu D, Yoshioka E, Kodama Y, Mano M, Nakajima S, Kanemura Y. (11)C-methinine uptake correlates with MGMT promoter methylation in nonenhancing gliomas. Clin Neurol Neurosurg 2014; 125:212-6. [PMID: 25178915 DOI: 10.1016/j.clineuro.2014.08.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/29/2014] [Accepted: 08/03/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Several studies have aimed to detect biomarkers in glioma using noninvasive imaging techniques. However, few studies have been able to image 1p/19q deletion by (11)C-methionine positron emission tomography ((11)C-methionine PET) or 2-hydroxyglutarate (2HG) by proton magnetic resonance spectroscopy (MRS). This study examines the correlation between (11)C-methionine uptake and MGMT promoter methylation in grade II and grade III nonenhancing gliomas. PATIENTS AND METHODS Data was collected from 20 patients with grade II and III nonenhancing gliomas who underwent both MRI and (11)C-methionine PET as part of their pre-surgical examination. We examined MGMT promoter methylation by quantitative methylation-specific PCR. RESULTS The mean MGMT promoter methylation for tumors with T/N ratios ≥1.6 was 28.0±26.3, and that for tumors with T/N ratios <1.6 was 0.68±0.89. The MGMT promoter methylation for tumors with T/N ratios ≥1.6 was significantly higher than that for tumors with T/N ratios <1.6 (P<0.05). CONCLUSIONS A higher uptake in (11)C-methionine PET may reflect increased MGMT promoter methylation. (11)C-methionine PET could be a useful tool to detect MGMT promoter methylation in nonenhancing glioma.
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Affiliation(s)
- Yoshiko Okita
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
| | - Masahiro Nonaka
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan.
| | - Tomoko Shofuda
- Division of Stem Cell Research, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
| | - Daisuke Kanematsu
- Division of Regenerative Medicine, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
| | - Ema Yoshioka
- Division of Stem Cell Research, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
| | - Yoshinori Kodama
- Department of Central Laboratory and Surgical Pathology, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
| | - Masayuki Mano
- Department of Central Laboratory and Surgical Pathology, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
| | - Shin Nakajima
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
| | - Yonehiro Kanemura
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan; Division of Regenerative Medicine, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City 540-0006, Japan
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15
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Abstract
18F-DOPA is a radiopharmaceutical with interesting clinical applications and promising performances in the evaluation of the integrity of dopaminergic pathways, brain tumors, NETs (especially MTCs, paragangliomas, and pheochromocytomas), and congenital hyperinsulinism. 18F-DOPA traces a very specific metabolic pathway and has a very precise biodistribution pattern. As for any radiopharmaceutical, the knowledge of the normal distribution of 18F-DOPA, its physiologic variants, and its possible pitfalls is essential for the correct interpretation of PET scans. Moreover, it is important to be aware of the potential false-positive and false-negative episodes that can occur in the various clinical settings.
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Affiliation(s)
- Sotirios Chondrogiannis
- Department of Nuclear Medicine, PET/CT Centre, Santa Maria della Misericordia Hospital, Viale Tre Martiri 140, Rovigo 45100, Italy
| | - Maria Cristina Marzola
- Department of Nuclear Medicine, PET/CT Centre, Santa Maria della Misericordia Hospital, Viale Tre Martiri 140, Rovigo 45100, Italy
| | - Domenico Rubello
- Department of Nuclear Medicine, PET/CT Centre, Santa Maria della Misericordia Hospital, Viale Tre Martiri 140, Rovigo 45100, Italy.
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16
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Schwarzenberg J, Czernin J, Cloughesy TF, Ellingson BM, Pope WB, Grogan T, Elashoff D, Geist C, Silverman DHS, Phelps ME, Chen W. Treatment response evaluation using 18F-FDOPA PET in patients with recurrent malignant glioma on bevacizumab therapy. Clin Cancer Res 2014; 20:3550-9. [PMID: 24687922 DOI: 10.1158/1078-0432.ccr-13-1440] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study compares the value of 3,4-dihydroxy-6-[(18)F]-fluoro-l-phenylalanine ((18)F-FDOPA) positron emission tomography (PET) and MRI in assessing outcome during antiangiogenic treatment in patients with recurrent high-grade gliomas. EXPERIMENTAL DESIGN Thirty patients were prospectively studied with (18)F-FDOPA PET scans immediately before, and two and six weeks after start of bevacizumab therapy. (18)F-FDOPA metabolic tumor volumes (MTV) as well as max and mean standardized uptake values (SUV) within this MTV were obtained. MRI treatment response was assessed at six weeks. The predictive ability of (18)F-FDOPA PET and MRI response assessment were evaluated with regard to progression-free survival (PFS) and overall survival (OS). RESULTS A total of 30, 28, and 24 (18)F-FDOPA PET scans at baseline, two weeks, and six weeks, were available for analysis, respectively. (18)F-FDOPA PET SUVs as well as their changes through therapy were not predictive of outcome. However, MTV parameters such as MTV changes were highly prognostic. Interestingly, absolute MTV at the first follow up scan provides the most significant prediction for increased OS (P < 0.0001) as well as PFS (P = 0.001). This surprising result was scrutinized with cross-validation and simulation analysis. Responders based on (18)F-FDOPA PET data survived 3.5 times longer (12.1 months vs. 3.5 months, median OS, P < 0.001) than nonresponders (17 patients vs. 11 patients, respectively). In comparison, responders based on MRI data lived 1.5 times longer (11.4 months vs 7.7 months, P = 0.03) than nonresponders (22 patients vs. 7 patients, respectively). CONCLUSIONS (18)F-FDOPA PET identifies treatment responders to antiangiogenic therapy as early as two weeks after treatment initiation.
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Affiliation(s)
- Johannes Schwarzenberg
- Authors' Affiliations: Department of Molecular and Medical Pharmacology; Ahmanson Translational Imaging Division; Departments of Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Austria
| | - Johannes Czernin
- Authors' Affiliations: Department of Molecular and Medical Pharmacology; Ahmanson Translational Imaging Division; Departments of
| | | | | | | | - Tristan Grogan
- Medicine Statistics Core, University of California, Los Angeles; and
| | - David Elashoff
- Medicine Statistics Core, University of California, Los Angeles; and
| | - Cheri Geist
- Authors' Affiliations: Department of Molecular and Medical Pharmacology; Ahmanson Translational Imaging Division; Departments of
| | - Daniel H S Silverman
- Authors' Affiliations: Department of Molecular and Medical Pharmacology; Ahmanson Translational Imaging Division; Departments of
| | - Michael E Phelps
- Authors' Affiliations: Department of Molecular and Medical Pharmacology
| | - Wei Chen
- Authors' Affiliations: Department of Molecular and Medical Pharmacology; Ahmanson Translational Imaging Division; Departments of
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17
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Rheims S, Rubi S, Bouvard S, Bernard E, Streichenberger N, Guenot M, Le Bars D, Hammers A, Ryvlin P. Accuracy of distinguishing between dysembryoplastic neuroepithelial tumors and other epileptogenic brain neoplasms with [¹¹C]methionine PET. Neuro Oncol 2014; 16:1417-26. [PMID: 24598358 DOI: 10.1093/neuonc/nou022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dysembryoplastic neuroepithelial tumors (DNTs) represent a prevalent cause of epileptogenic brain tumors, the natural evolution of which is much more benign than that of most gliomas. Previous studies have suggested that [(11)C]methionine positron emission tomography (MET-PET) could help to distinguish DNTs from other epileptogenic brain tumors, and hence optimize the management of patients. Here, we reassessed the diagnostic accuracy of MET-PET for the differentiation between DNT and other epileptogenic brain neoplasms in a larger population. METHODS We conducted a retrospective study of 77 patients with focal epilepsy related to a nonrapidly progressing brain tumor on MRI who underwent MET-PET, including 52 with a definite histopathology. MET-PET data were assessed by a structured visual analysis that distinguished normal, moderately abnormal, and markedly abnormal tumor methionine uptake and by semiquantitative ratio measurements. RESULTS Pathology showed 21 DNTs (40%), 10 gangliogliomas (19%), 19 low-grade gliomas (37%), and 2 high-grade gliomas (4%). MET-PET visual findings significantly differed among the various tumor types (P < .001), as confirmed by semiquantitative analyses (P < .001 for all calculated ratios), regardless of gadolinium enhancement on MRI. All gliomas and gangliogliomas were associated with moderately or markedly increased tumor methionine uptake, whereas 9/21 DNTs had normal methionine uptake. Receiver operating characteristics analysis of the semiquantitative ratios showed an optimal cutoff threshold that distinguished DNTs from other tumor types with 90% specificity and 89% sensitivity. CONCLUSIONS Normal MET-PET findings in patients with an epileptogenic nonrapidly progressing brain tumor are highly suggestive of DNT, whereas a markedly increased tumor methionine uptake makes this diagnosis unlikely.
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Affiliation(s)
- Sylvain Rheims
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Sebastià Rubi
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Sandrine Bouvard
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Emilien Bernard
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Nathalie Streichenberger
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Marc Guenot
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Didier Le Bars
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Alexander Hammers
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
| | - Philippe Ryvlin
- Department of Functional Neurology and Epileptology and Institute of Epilepsies (IDEE) (S.Rh., E.B., P.R.); Department of Pathology (N.S.); Department of Functional Neurosurgery (M.G.); Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France (S.Rh., S.B., P.R.); CERMEP-Imagerie du Vivant, Lyon, France (S.B., D.L.B.); Neurodis Foundation, CERMEP-Imagerie du Vivant, Lyon, France (A.H.); Hospital Clinic de Barcelona, Barcelona, Spain (S.Ru.)
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18
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Lizarraga KJ, Allen-Auerbach M, Czernin J, DeSalles AAF, Yong WH, Phelps ME, Chen W. (18)F-FDOPA PET for differentiating recurrent or progressive brain metastatic tumors from late or delayed radiation injury after radiation treatment. J Nucl Med 2013; 55:30-6. [PMID: 24167081 DOI: 10.2967/jnumed.113.121418] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Brain metastases are frequently treated with radiation. It is critical to distinguish recurrent or progressive brain metastases (RPBM) from late or delayed radiation injury (LDRI). The purpose of this study was to examine the diagnostic accuracy as well as the prognostic power of 6-(18)F-fluoro-l-dopa ((18)F-FDOPA) PET for differentiating RPBM from LDRI. METHODS Thirty-two patients who had 83 previously irradiated brain metastases and who underwent (18)F-FDOPA PET because of an MR imaging-based suggestion of RPBM were studied retrospectively. PET studies were analyzed semiquantitatively (lesion-to-striatum and lesion-to-normal brain tissue ratios based on both maximum and mean standardized uptake values) and visually (4-point scale). The diagnostic accuracy of PET was verified by histopathologic analysis (n = 9) or clinical follow-up (n = 74) on a lesion-by-lesion basis. Receiver operating characteristic curve analysis was used to identify the best diagnostic indices. The power of (18)F-FDOPA PET to predict disease progression was evaluated with the Kaplan-Meier and Cox regression methods. RESULTS The best overall accuracy was achieved by visual scoring, with which a score of 2 or more (lesion uptake greater than or equal to striatum uptake) resulted in a sensitivity of 81.3% and a specificity of 84.3%. Semiquantitative (18)F-FDOPA PET uptake indices based on lesion-to-normal brain tissue ratios were significantly higher for RPBM than for LDRI. Among the various predictors tested, (18)F-FDOPA PET was the strongest predictor of tumor progression (hazard ratio, 6.26; P < 0.001), and the lesion-to-normal brain tissue ratio or visual score was the best discriminator. The mean time to progression was 4.6 times longer for lesions with negative (18)F-FDOPA PET results than for lesions with positive (18)F-FDOPA PET results (76.5 vs. 16.7 mo; P < 0.001). (18)F-FDOPA PET findings tended to predict overall survival. CONCLUSION Metabolic imaging with (18)F-FDOPA PET was useful for differentiating RPBM from LDRI. Semiquantitative indices, particularly lesion-to-normal uptake ratios, could be used. A visual score comparing tumor (18)F-FDOPA uptake and striatum (18)F-FDOPA uptake provided the highest sensitivity and specificity and was predictive of disease progression.
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Affiliation(s)
- Karlo J Lizarraga
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida
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19
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Kadrmas DJ, Hoffman JM. Methodology for quantitative rapid multi-tracer PET tumor characterizations. Am J Cancer Res 2013; 3:757-73. [PMID: 24312149 PMCID: PMC3840410 DOI: 10.7150/thno.5201] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 04/15/2013] [Indexed: 01/18/2023] Open
Abstract
Positron emission tomography (PET) can image a wide variety of functional and physiological parameters in vivo using different radiotracers. As more is learned about the molecular basis for disease and treatment, the potential value of molecular imaging for characterizing and monitoring disease status has increased. Characterizing multiple aspects of tumor physiology by imaging multiple PET tracers in a single patient provides additional complementary information, and there is a significant body of literature supporting the potential value of multi-tracer PET imaging in oncology. However, imaging multiple PET tracers in a single patient presents a number of challenges. A number of techniques are under development for rapidly imaging multiple PET tracers in a single scan, where signal-recovery processing algorithms are employed to recover various imaging endpoints for each tracer. Dynamic imaging is generally used with tracer injections staggered in time, and kinetic constraints are utilized to estimate each tracers' contribution to the multi-tracer imaging signal. This article summarizes past and ongoing work in multi-tracer PET tumor imaging, and then organizes and describes the main algorithmic approaches for achieving multi-tracer PET signal-recovery. While significant advances have been made, the complexity of the approach necessitates protocol design, optimization, and testing for each particular tracer combination and application. Rapid multi-tracer PET techniques have great potential for both research and clinical cancer imaging applications, and continued research in this area is warranted.
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21
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F-18 FDG PET-CT in patients with recurrent glioma: Comparison with contrast enhanced MRI. Eur J Radiol 2012; 81:508-13. [DOI: 10.1016/j.ejrad.2011.01.080] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 01/03/2011] [Indexed: 11/22/2022]
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22
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la Fougère C, Suchorska B, Bartenstein P, Kreth FW, Tonn JC. Molecular imaging of gliomas with PET: opportunities and limitations. Neuro Oncol 2011; 13:806-19. [PMID: 21757446 DOI: 10.1093/neuonc/nor054] [Citation(s) in RCA: 190] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Neuroimaging enables the noninvasive evaluation of glioma and is considered to be one of the key factors for individualized therapy and patient management, since accurate diagnosis and demarcation of viable tumor tissue is required for treatment planning as well as assessment of treatment response. Conventional imaging techniques like MRI and CT reveal morphological information but are of limited value for the assessment of more specific and reproducible information about biology and activity of the tumor. Molecular imaging with PET is increasingly implemented in neuro-oncology, since it provides additional metabolic information of the tumor, both for patient management as well as for evaluation of newly developed therapeutics. Different molecular processes have been proposed to be useful, like glucose consumption, expression of amino acid transporters, proliferation rate, membrane biosynthesis, and hypoxia. Thus, PET might help neuro-oncologists gain further insights into tumor biology by "true molecular imaging" as well as understand treatment-related phenomena. This review describes the method of PET acquisition as well as the tracers used to image biological processes in gliomas. Furthermore, it considers the clinical impact of PET on the use of currently available radiotracers, which were shown to be potentially valuable for discrimination between neoplastic and nonneoplastic tissue, as well as on tumor grading, determinination of treatment response, and providing an outlook toward further developments.
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Affiliation(s)
- Christian la Fougère
- Department of Nuclear Medicine, University of Munich – Campus Grosshadern, Marchioninistr 15, 81377 Munich, Germany
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23
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Xiangsong Z, Weian C, Dianchao Y, Xiaoyan W, Zhifeng C, Xiongchong S. Usefulness of 13N-NH3 PET in the evaluation of brain lesions that are hypometabolic on 18F-FDG PET. J Neurooncol 2011; 105:103-7. [DOI: 10.1007/s11060-011-0570-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 03/26/2011] [Indexed: 11/30/2022]
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24
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Tripathi M, D’Souza M, Bal J, Guliani S, Jain J, Santosh, Sharma R, Mondal A. Comparision of F-18 FDG and C-11 Methionine PET/CT for demonstration of subependymal deposit in a treated case of glioblastoma multiforme. Indian J Nucl Med 2011; 26:91-3. [PMID: 22174514 PMCID: PMC3237225 DOI: 10.4103/0972-3919.90259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A 10-year-boy post-operative, post-radiotherapy case of left temporal glioblastoma multiforme (GBM) was referred for F-18 Flurodeoxyglucose (FDG) Positron emission tomography/Computed Tomography (PET/CT) to rule out residual/recurrent disease 6 months following completion of therapy. The FDG scan 3 months following therapy had not shown evidence of viable residual or metastatic disease. The present scan showed a tiny focus of abnormal FDG accumulation in the region of the trigone of the left lateral ventricle which was best appreciated on the plain PET image. A correlative C-11 methionine study showed a well defined focus of abnormal tracer accumulation in the region of the left trigone. CECT and MRI done subsequently proved it to be a subependymal deposit. This case therefore demonstrates the possibility of subependymal deposits in GBM and the need for this possibility to be entertained during interpretation of the FDG study. It also highlights the advantage of labelled amino acids like C-11 methionine for clearly delineating subependymal deposits apart from the advantage for unequivocal interpretation of the PET study in recurrent brain tumors.
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Affiliation(s)
- Madhavi Tripathi
- Division of PET Imaging, Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Maria D’Souza
- Division of PET Imaging, Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Jaspriya Bal
- Division of PET Imaging, Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Shefali Guliani
- Division of PET Imaging, Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Jyotika Jain
- Delhi State Cancer Institute, Guru Teg Bahadur Hospital, Shahdara-Delhi, India
| | - Santosh
- Division of PET Imaging, Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Rajnish Sharma
- Division of PET Imaging, Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - A Mondal
- Division of PET Imaging, Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
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Alkonyi B, Chugani HT, Muzik O, Chugani DC, Sundaram SK, Kupsky WJ, Batista CE, Juhász C. Increased L-[1-11 C] leucine uptake in the leptomeningeal angioma of sturge-weber syndrome: a PET study. J Neuroimaging 2011; 22:177-83. [PMID: 21223431 DOI: 10.1111/j.1552-6569.2010.00565.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE We used L-[1-(11) C]leucine (LEU) positron emission tomography (PET) to measure amino acid uptake in children with Sturge-Weber syndrome (SWS), and to relate amino acid uptake measures with glucose metabolism. METHODS LEU and 2-deoxy-2[(18) F]fluoro-D-glucose (FDG) PET were performed in 7 children (age: 5 months-13 years) with unilateral SWS. Asymmetries of LEU uptake in the posterior brain region, underlying the angioma and in frontal cortex, were measured and correlated with glucose hypometabolism. Kinetic analysis of LEU uptake was performed in 4 patients. RESULTS Increased LEU standard uptake value (SUV, mean: 15.1%) was found in the angioma region in 6 patients, and smaller increases in LEU SUV (11.5%) were seen in frontal cortex in 4 of the 6 patients, despite normal glucose metabolism in frontal regions. High LEU SUV was due to both increased tracer transport (3/4 patients) and high protein synthesis rates (2/4). FDG SUV asymmetries in the angioma region were inversely related to LEU SUV asymmetries (r=-.83, P= .042). CONCLUSIONS Increased amino acid uptake in the angioma region and also in less affected frontal regions may provide a marker of pathological mechanisms contributing to chronic brain damage in children with SWS.
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Affiliation(s)
- Bálint Alkonyi
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
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Paldino MJ, Wong TZ, Reardon DA, Friedman HS, Barboriak DP. Prognostic significance of parameters derived from co-registered 18F-fluorodeoxyglucose PET and contrast-enhanced MRI in patients with high-grade glioma. Br J Radiol 2010; 84:327-33. [PMID: 20959370 DOI: 10.1259/bjr/48528504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the prognostic significance of the volume and intensity of abnormal (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) accumulation within areas of contrast enhancement on post-therapeutic volumetric MRI. METHODS A total of 10 patients with Grade III or IV glioma were treated with resection followed by intracavitary radiation therapy with (131)I-labelled antitenascin monoclonal antibody. Patients underwent serial FDG-PET and 1.5 T MR imaging. For each patient, MR and FDG-PET image volumes at each time point were aligned using a rigid-body normalised mutual information algorithm. Contrast-enhancing regions of interest (ROIs) were defined using a semi-automated k-means clustering technique. Activity within the ROI on the co-registered PET scan was calculated as a ratio (mean activity ratio; MAR) to activity in contralateral normal-appearing white matter (NAWM). The PET lesion was defined as the portion of the ROI associated with activity greater than two standard deviations above the mean in NAWM. Survival was assessed using the logrank test. RESULTS Larger contrast-enhancing ROIs were strongly associated with an increased MAR (r = 0.51; p<0.002). Enhancing lesions with an MAR >1.2 were associated with decreased survival (p<0.016). In nine patients who died, the MAR on PET correlated inversely with survival duration (r = -0.43; p<0.01), whereas PET lesion volume did not. CONCLUSION Following intracavitary radiation therapy, the development of contrast-enhancing lesions that are associated with high mean FDG-PET accumulation suggests poor prognosis.
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Affiliation(s)
- M J Paldino
- Duke University Medical Center, Department of Radiology, Durham, NC 27710, USA.
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Fueger BJ, Czernin J, Cloughesy T, Silverman DH, Geist CL, Walter MA, Schiepers C, Nghiemphu P, Lai A, Phelps ME, Chen W. Correlation of 6-18F-Fluoro-l-Dopa PET Uptake with Proliferation and Tumor Grade in Newly Diagnosed and Recurrent Gliomas. J Nucl Med 2010; 51:1532-8. [DOI: 10.2967/jnumed.110.078592] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kim YH, Oh SW, Lim YJ, Park CK, Lee SH, Kang KW, Jung HW, Chang KH. Differentiating radiation necrosis from tumor recurrence in high-grade gliomas: assessing the efficacy of 18F-FDG PET, 11C-methionine PET and perfusion MRI. Clin Neurol Neurosurg 2010; 112:758-65. [PMID: 20619531 DOI: 10.1016/j.clineuro.2010.06.005] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 05/31/2010] [Accepted: 06/09/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The authors analyzed the characteristics of perfusion magnetic resonance imaging (MRI), (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and (11)C-methionine (MET) PET to compare the efficacies of these modalities in making the distinction between radiation necrosis and tumor recurrence of high-grade glioma. PATIENTS AND METHODS Ten patients were evaluated with dynamic susceptibility contrast perfusion MRI, (11)C-MET PET and (18)F-FDG PET to visualize gadolinium-enhanced lesions during the post-radiation follow-up period. In the perfusion MRI, four regions of interest (ROIs) were identified and average values were calculated. A reference ROI of the same size was defined in the contralateral white matter to obtain the relative cerebral blood volume (rCBV). After coregistering the PET images with the MRI, we measured the maximum uptake values of the lesion and of the contralateral cerebral white matter as reference area to calculate the L(max)/R(max) ratio. RESULTS The rCBV was higher in the recurrence group than in the necrosis group (p=0.010). There was no difference between groups in terms of the L(max)/R(max) ratio as derived from the (18)F-FDG and (11)C-MET PET. CONCLUSION A quantitative rCBV as calculated from a perfusion MRI scan might be superior to the L(max)/R(max) ratio as derived from (18)F-FDG and (11)C-MET PET in order to distinguish a recurrence of high-grade glioma from radiation necrosis.
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Affiliation(s)
- Yong Hwy Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Republic of Korea
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Abstract
Evaluating gliomas, either at diagnosis or at recurrence, is among the historical indications of FDG positron emission tomography (PET) imaging. There is a clear relationship between the tumor grade, patient prognosis, and intensity of uptake. Yet the exact role of FDG PET imaging remains debated. PET and methionine labeled with the short-lived C11 also have been proposed, with the significant advantage of high tumor-to-cortex contrast and distinct bological properties that lead to specific indications. Clinical use of this tracer is hampered by the need for an on-site cyclotron, however. In recent years, the increased availability of fluorinated amino-acid analogs, in particular FET, has open the way to renewed scientific interest in the field of neuro-oncological PET and PET/CT. This article discusses FDG and alternative tracers for diagnosing and characterizing primary brain tumors, detecting their recurrences, helping to guide the radiation therapy, and for evaluating the response to treatments.
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Affiliation(s)
- Roland Hustinx
- Division of Nuclear Medicine, University Hospital of Liège, University of Liège, B35, 4000 Liège I, Belgium.
| | - Pacôme Fosse
- Division of Nuclear Medicine, University Hospital of Liège, University of Liège, B35, 4000 Liège I, Belgium
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30
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Advanced Imaging of Adult Brain Tumors with MRI and PET. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/b978-0-7506-7516-1.00004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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31
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Kadrmas DJ, Rust TC, Hoffman JM. Characterization of Multiple Aspects of Tumor Physiology by Multitracer Positron Emission Tomography. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50084-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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32
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Seibyl JP, Chen W, Silverman DH. 3,4-Dihydroxy-6-[18F]-Fluoro-L-Phenylalanine Positron Emission Tomography in Patients With Central Motor Disorders and in Evaluation of Brain and Other Tumors. Semin Nucl Med 2007; 37:440-50. [DOI: 10.1053/j.semnuclmed.2007.08.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Techniques for human brain imaging have undergone rapid developments in recent years. Technological progress has enabled the assessment of many physiological parameters in vivo that are highly relevant for tumour grading, tissue characterisation, definition of the extent and infiltration of tumours, and planning and monitoring of therapy. In this review, we provide a brief overview of advanced MRI and molecular-tracer techniques that have many potential clinical uses. A broad range of techniques, including dynamic MRI, PET, and single photon emission computed tomography, provide measurements of various features of tumour blood flow and microvasculature. Using PET to measure glucose consumption enables visualisation of tumour metabolism, and magnetic resonance spectroscopy techniques provide complementary information on energy metabolism. Changes in protein and DNA synthesis can be assessed through uptake of labelled amino acids and nucleosides. Advanced imaging techniques can be used to assess tumour malignancy, extent, and infiltration, and might provide diagnostic clues to distinguish between lesion types and between recurrent tumour and necrosis. Stereotactic biopsies should be taken from the most malignant part of tumours, which can be identified by changes in microvascular structure and metabolic activity. Functional and metabolic imaging can improve the planning and monitoring of radiation and chemotherapy and contribute to the development of new therapies.
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Affiliation(s)
- Karl Herholz
- Wolfson Molecular Imaging Centre, University of Manchester, Oxford Road, Manchester, UK.
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Xiangsong Z, Changhong L, Weian C, Dong Z. PET Imaging of cerebral astrocytoma with 13N-ammonia. J Neurooncol 2006; 78:145-51. [PMID: 16739028 DOI: 10.1007/s11060-005-9069-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Accepted: 11/03/2005] [Indexed: 12/01/2022]
Abstract
UNLABELLED We performed this study in order to assess the clinical potential of (13)N-ammonia PET in patients with cerebral astrocytoma. METHODS Dynamic 13N-ammonia PET was performed in 25 patients with suspected cerebral gliomas or recurrent cerebral astrocytomas (19 male and 6 female patients; age range 18-64 years) detected by MRI. The histopathological diagnoses were made for all cases either by biopsy or craniotomy, except for one patient with brain infarction and one patient with brain radiation necrosis confirmed by repeated MRI imaging. PET images were visually inspected, and the tumor-to-white matter count (T/W) ratios and the perfusion index (PI) of the tumors were determined. RESULTS Six out of nine cases of low-grade gliomas were detected with 13N-ammonia PET, and three non-astrocytoma low-grade gliomas were not detected with 13N-ammonia PET. All 11 high-grade astrocytomas exhibited markedly increased uptake of 13N-ammonia. The five non-neoplastic lesions exhibited low uptake, low T/W ratios and low PI. The significant differences were observed between high-grade and low-grade gliomas with respect to both the T/W ratios and PI (T/W ratios: 5.92+/-2.27, n=11 vs. 1.66+/-0.61, n=9, P<0.01; PI: 5.22+/-1.67, n=11 vs. 1.60+/-0.54, n=9, P<0.01). There were the significant differences between the T/W ratios and PI in low-grade astrocytomas and that in non-neoplastic lesions (T/W ratios: 2.00+/-0.42, n=6 vs. 0.97+/-0.11, n=5, P<0.01; PI: 1.89+/-0.37, n=6 vs. 0.99+/-0.03, n=5, P<0.01). CONCLUSIONS There is a substantial uptake of 13N-ammonia in cerebral astrocytomas. 13N-ammonia PET may enable differentiation between low- and high-grade astrocytomas, and has the potential to enable differentiation between low-grade astrocytomas and non-neoplastic lesions.
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Affiliation(s)
- Zhang Xiangsong
- Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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35
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Rosenberg DS, Demarquay G, Jouvet A, Le Bars D, Streichenberger N, Sindou M, Kopp N, Mauguière F, Ryvlin P. [11C]-Methionine PET: dysembryoplastic neuroepithelial tumours compared with other epileptogenic brain neoplasms. J Neurol Neurosurg Psychiatry 2005; 76:1686-92. [PMID: 16291894 PMCID: PMC1739454 DOI: 10.1136/jnnp.2004.051607] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Brain tumours responsible for longstanding partial epilepsy are characterised by a high prevalence of dysembryoplastic neuroepithelial tumour (DNT), whose natural evolution is much more benign than that of gliomas. The preoperative diagnosis of DNT, which is not yet feasible on the basis of available clinical and imaging data, would help optimise the therapeutic strategy for this type of tumour. This study tested whether [(11)C]-methionine positron emission tomography (MET-PET) could help to distinguish DNTs from other epileptogenic brain tumours. METHODS Prospective study of 27 patients with partial epilepsy of at least six months duration related to a non-rapidly progressing brain tumour on magnetic resonance imaging (MRI). A structured visual analysis, which distinguished between normal, moderately abnormal, or markedly abnormal tumour methionine uptake, as well as various regions of interest and semiquantitative measurements were conducted. RESULTS Pathological results showed 11 DNTs (41%), 5 gangliogliomas (18%), and 11 gliomas (41%). MET-PET visual findings significantly differed between the various tumour types (p<0.0002), regardless of gadolinium enhancement on MRI, and were confirmed by semiquantitative analysis (p<0.001 for all calculated ratios). All gliomas and gangliogliomas were associated with moderately or markedly increased tumour methionine uptake, whereas 7/11 DNTs had a normal methionine uptake, including all six located in the mesiotemporal structures. No DNT presented with a marked MET-PET abnormality. CONCLUSION Normal MET-PET findings in patient with an epileptogenic and non-rapidly progressing brain tumour are suggestive of DNT, whereas a markedly increased tumour methionine uptake makes this diagnosis unlikely.
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Affiliation(s)
- D S Rosenberg
- Cermep, Hopital Neurologique, 59 Bd Pinel, Lyon 69003, France
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36
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Hustinx R, Pourdehnad M, Kaschten B, Alavi A. PET imaging for differentiating recurrent brain tumor from radiation necrosis. Radiol Clin North Am 2005; 43:35-47. [PMID: 15693646 DOI: 10.1016/j.rcl.2004.09.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The exact incidence of true radiation necrosis is largely unknown. It is probably much less frequent than indicated by MR or CT findings. Differentiating radiation necrosis from recurrent tumor is a diagnostic challenge, however, and has important implications for the patient's management. Even though the first results were published 20 years ago, the total number of case studies using FDG-PET in this indication remains limited. Several reports are also hampered by methodologic limitations. The technique has been largely criticized, notably in articles that themselves were not completely free of methodological flaws. Overall however, FDG-PET seems to be a valuable clinical tool. As a general rule, suspicious lesions on MR imaging that show increased FDG uptake (ie, uptake equal to or great than that in normal cortex) are likely to represent tumor recurrence. Sensitivity is an issue, especially but not exclusively with low-grade gliomas. Although false-positive results may occur, specificity is usually high in routine clinical practice. Coregistration with MR imaging surely improves the diagnostic performances of FDG-PET because it helps delineate the suspicious area. Another important aspect is the prognostic value of FDG uptake, which is now well established. It seems clear that only the combination of FDG with a radiolabeled amino acid analogue (MET or a more recent fluorinated compound) can provide a comprehensive characterization of suspected brain tumor recurrence.
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Affiliation(s)
- Roland Hustinx
- Division of Nuclear Medicine, University Hospital of Liège, Campus Universitaire du Sart Tilman, B35 4000 Sart Tilman, Belgium.
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37
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Schaller B. Usefulness of positron emission tomography in diagnosis and treatment follow-up of brain tumors. Neurobiol Dis 2004; 15:437-48. [PMID: 15056451 DOI: 10.1016/j.nbd.2003.11.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2003] [Revised: 10/11/2003] [Accepted: 11/25/2003] [Indexed: 10/26/2022] Open
Abstract
Clinical and experimental use of positron emission tomography (PET) is expanding and allows quantitative assessment of brain tumor's pathophysiology and biochemistry. PET therefore provides different biochemical and molecular information about primary brain tumors when compared to histological methods or neuroradiological studies. Common clinical indications for PET contain primary brain tumor diagnosis and identification of the metabolically most active brain tumor reactions (differentiation of viable tumor tissue from necrosis), prediction of treatment response by measurement of tumor perfusion, or ischemia. The interesting key question remains not only whether the magnitude of biochemical alterations demonstrated by PET reveals prognostic value with respect to survival, but also whether it identifies early disease and differentiates benign from malignant lesions. Moreover, an early identification of treatment success or failure by PET could significantly influence patient management by providing more objective decision criteria for evaluation of specific therapeutic strategies. Specially, as PET represents a novel technology for molecular imaging assays of metabolism and signal transduction to gene expression, reporter gene assays are used to trace the location and temporal level of expression of therapeutic and endogenous genes. PET probes and drugs are being developed together as molecular probes to image the function of targets without disturbing them and in mass amounts to modify the target's function as a drug. Molecular imaging by PET helps to close the gap between in vitro to in vivo integrative biology of disease.
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Affiliation(s)
- B Schaller
- Max Planck-Institute for Neurological Research, Cologne, Germany.
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Kubota K, Yokoyama J, Yamaguchi K, Ono S, Qureshy A, Itoh M, Fukuda H. FDG-PET delayed imaging for the detection of head and neck cancer recurrence after radio-chemotherapy: comparison with MRI/CT. Eur J Nucl Med Mol Imaging 2004; 31:590-5. [PMID: 14722678 DOI: 10.1007/s00259-003-1408-6] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2003] [Accepted: 10/21/2003] [Indexed: 01/04/2023]
Abstract
In advanced head and neck cancer, an organ-sparing approach comprising radiation therapy combined with intra-arterial chemotherapy has become an important technique. However, the high incidence of residual masses after therapy remains a problem. In this study, we prospectively evaluated the use of 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) delayed imaging for the detection of recurrence of head and neck cancer after radio-chemotherapy, and compared the FDG-PET results with those of magnetic resonance imaging (MRI) or computed tomography (CT). Forty-three lesions from 36 patients with head and neck cancer suspected to represent recurrence after radio-chemotherapy (median interval from therapy, 4 months) were studied. PET was performed at 2 h after FDG injection, and evaluated. The results were compared to those of contrast studies with MRI or CT performed within 2 weeks of the PET study, and to histological diagnosis (in all patients suspected of having recurrence) or clinical diagnosis. The lesion-based sensitivity (visual interpretation) and negative predictive value of FDG-PET (88% and 91%, respectively) were higher than those of MRI/CT (75% and 67% respectively). The specificity, accuracy and positive predictive value of FDG-PET (78%, 81% and 70%, respectively) were significantly ( P<0.05) higher than those of MRI/CT (30%, 47% and 39% respectively). Three of six patients with false positive findings had post-therapy inflammation. Receiver operating characteristic (ROC) analysis showed that retrospective evaluation with the standardised uptake ratio yielded the best results (sensitivity 87.5%, specificity 81.5%), followed by visual interpretation and then the tumour/neck muscle ratio. An FDG-PET delayed imaging protocol yielded significantly better results for the detection of recurrence of head and neck cancer after radio-chemotherapy than MRI/CT. Because of the high negative predictive value of FDG-PET (91.3%), if PET is negative, further invasive procedures may be unnecessary.
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Affiliation(s)
- Kazuo Kubota
- Division of Nuclear Medicine, Department of Radiology, International Medical Center of Japan, 1-21-1 Toyama, 162-8655 Shinjuku, Tokyo, Japan.
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Bénard F, Romsa J, Hustinx R. Imaging gliomas with positron emission tomography and single-photon emission computed tomography. Semin Nucl Med 2003; 33:148-62. [PMID: 12756647 DOI: 10.1053/snuc.2003.127304] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Over the last two decades the large volume of research involving various brain tracers has shed invaluable light on the pathophysiology of cerebral neoplasms. Yet the question remains as to how best to incorporate this newly acquired insight into the clinical context. Thallium is the most studied radiotracer with the longest track record. Many, but not all studies, show a relationship between (201)Tl uptake and tumor grade. Due to the overlap between tumor uptake and histologic grades, (201)Tl cannot be used as the sole noninvasive diagnostic or prognostic tool in brain tumor patients. However, it may help differentiating a high-grade tumor recurrence from radiation necrosis. MIBI is theoretically a better imaging agent than (201)Tl but it has not convincingly been shown to differentiate tumors according to grade. MDR-1 gene expression as demonstrated by MIBI does not correlate with chemoresistance in high grade gliomas. Currently, MIBI's clinical role in brain tumor imaging has yet to be defined. IMT, a radio-labeled amino acid analog, may be useful for identifying postoperative tumor recurrence and, in this application, appears to be a cheaper, more widely available tool than positron emission tomography (PET). However, its ability to accurately identify tumor grade is limited. 18 F-2-Fluoro-2-deoxy-d-glucose (FDG) PET predicts tumor grade, and the metabolic activity of brain tumors has a prognostic significance. Whether FDG uptake has an independent prognostic value above that of histology remains debated. FDG-PET is effective in differentiating recurrent tumor from radiation necrosis for high-grade tumors, but has limited value in defining the extent of tumor involvement and recurrence of low-grade lesions. Amino-acid tracers, such as MET, perform better for this purpose and thus play a complementary role to FDG. Given the poor prognosis of patients with gliomas, particularly with high-grade lesions, the overall clinical utility of single photon emission computed tomography (SPECT) and PET in characterizing recurrent lesions remains dependent on the availability of effective treatments. These tools are thus mostly suited to the evaluation of treatment response in experimental protocols designed to improve the patients' outcome.
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Affiliation(s)
- François Bénard
- Department of Nuclear Medicine and Radiation Biology, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
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40
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Trampal C, Engler H. [PET in neurology and psychiatry. II]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2002; 21:439-55; quiz 456-60. [PMID: 12425894 DOI: 10.1016/s0212-6982(02)72123-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- C Trampal
- Uppsala University PET Centre. Uppsala. Sweden.
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41
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Enhanced Accuracy in Differential Diagnosis of Radiation Necrosis by Positron Emission Tomography-Magnetic Resonance Imaging Coregistration: Technical Case Report. Neurosurgery 2000. [DOI: 10.1097/00006123-200001000-00051] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Low WC, Duan WM, Keene CD, Ni HT, Westerman MA. Immunobiology of Neural Xenotransplantation. NEUROMETHODS 2000. [DOI: 10.1007/978-1-59259-690-4_23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Thiel A, Pietrzyk U, Sturm V, Herholz K, Hövels M, Schröder R. Enhanced Accuracy in Differential Diagnosis of Radiation Necrosis by Positron Emission Tomography-Magnetic Resonance Imaging Coregistration: Technical Case Report. Neurosurgery 2000. [DOI: 10.1093/neurosurgery/46.1.232] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Volker Sturm
- Department of Functional and Stereotactic Neurosurgery Cologne, Germany
| | - Karl Herholz
- Max-Planck-Institute for Neurological Research
- Department of Neurology Cologne, Germany
| | - Moritz Hövels
- Department of Functional and Stereotactic Neurosurgery Cologne, Germany
| | - Roland Schröder
- Department of Institute for Pathology University of Cologne, Cologne, Germany
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Abstract
Neuronal damage in the CNS after excitotoxic injury is correlated with blood-brain barrier (BBB) breakdown. We have used a glutamate analog injection model and genetically altered mice to investigate the relationship between these two processes in the hippocampus. Our results show that BBB dysfunction occurs too late to initiate neurodegeneration. In addition, plasma infused directly into the hippocampus is not toxic and does not affect excitotoxin-induced neuronal death. To test plasma protein recruitment in neuronal degeneration, we used plasminogen-deficient (plg(-/-)) mice, which are resistant to excitotoxin-induced degeneration. Plasminogen is produced in the hippocampus and is also present at high levels in plasma, allowing us to determine the contribution of each source to cell death. Intrahippocampal delivery of plasminogen to plg(-/-) mice restored degeneration to wild-type levels, but intravenous delivery of plasminogen did not. Finally, although the neurons in plg(-/-) mice do not die after excitotoxin injection, BBB breakdown occurs to a similar extent as in wild-type mice, indicating that neuronal death is not necessary for BBB breakdown. These results indicate that excitotoxin-induced neuronal death and BBB breakdown are separable events in the hippocampus.
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Otte A, Roelcke U, von Ammon K, Hausmann O, Maguire RP, Missimer J, Müller-Brand J, Radü EW, Leenders KL. Crossed cerebellar diaschisis and brain tumor biochemistry studied with positron emission tomography, [18F]fluorodeoxyglucose and [11C]methionine. J Neurol Sci 1998; 156:73-7. [PMID: 9559990 DOI: 10.1016/s0022-510x(98)00019-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cerebral gliomas may cause a reduction of glucose metabolism in the cerebellum contralateral to the tumor side (crossed cerebellar diaschisis, CCD). We investigated whether CCD is related to tumor localization, histological grade, size and tumor biochemistry. Cerebellar glucose metabolism was measured in 44 glioma patients and 15 healthy subjects using positron emission tomography and [18F]fluorodeoxyglucose (FDG). CCD was determined by calculating an asymmetry index of cerebellar glucose metabolism. Further, the tumor uptake of FDG and [11C]methionine (MET) was also assessed, and was expressed as ratio of normalized tracer uptake in tumor over contralateral cortex (T/C). Frontal lobe tumors were associated with highest CCD values. For these tumors, CCD was higher in malignant (-11.8+/-9.9%) than in low-grade (-4.3+/-4.1%) gliomas (P=0.010). In addition, frontal lobe tumors showed increasing CCD values with increasing size. In tumors of the parietal or temporal lobe, CCD was less marked or absent. T/C ratios of tumor tracer uptake were higher in malignant than in low-grade gliomas, but were not correlated with CCD. Our data indicate that the magnitude of CCD is mainly determined by tumor localization and size, the latter being associated with tumor grade. These findings raise the question whether CCD provides a measure of expansion or progression particularly in low-grade tumors of the frontal lobe.
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Affiliation(s)
- A Otte
- PET Program, Paul Scherrer Institute, Villigen, Switzerland
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Abstract
Most mechanisms of drugs which are used in brain tumor chemotherapy are well characterized: alkylation of DNA components (nitrosoureas), binding with tubulin protein resulting in metaphase arrest (vincristine), chromatid breaks and chromosome translocations (procarbazine), or inhibition of ribonucleotide reductase (hydroxyurea) [1]. These drugs exert their effects mainly during certain cell cycle phases of proliferating cells, particularly when DNA is synthesized. From this it can be assumed that the efficacy of these drugs depends on the fraction of proliferating cells. Thus it would be of great importance to estimate the proliferation rate of brain tumors which could guide chemotherapy in individual patients. Positron emission tomography (PET) measures quantitatively the in vivo tissue uptake of tracer substances. In tumors, the uptake appears to be altered in a characteristic way determined by biochemical properties of tumor tissue. Some aspects of brain tumor metabolism which are theoretically related to proliferation have been investigated with PET. In the following, the literature is reviewed with regard to: 1) tracer substances whose uptake has been thought to reflect tumor malignancy (11C-methionine, 18F-fluoro-deoxyglucose), and 2) tracers which theoretically could reflect mechanisms specifically related to DNA synthesis (11C-putrescine, ligands for peripheral benzodiazepine receptors).
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Affiliation(s)
- U Roelcke
- PET-Program, Paul Scherrer Institute, Villigen, Switzerland
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