carbon-11-methionine and Astrocytoma

The relationship between uptake of amino acid tracer with positron emission tomography (PET) and glioma subtypes/gene status is still unclear.. The participants were 68 patients with newly diagnosed and untreated glioma who underwent surgical excision and preoperative [. The mean lesion/contralateral normal brain tissue (L/N) ratio of diffuse astrocytomas was significantly lower than that of anaplastic astrocytomas (P = 0.00155), glioblastoma (P < 0.001), and oligodendrogliomas (P = 0.0157). The mean L/N ratio of IDH mutant gliomas was significantly lower than that of IDH wild-type gliomas (median 1.75 vs. 2.61; P = 0.00162). A mean L/N ratio of 2.05 provided the best sensitivity and specificity for distinguishing between IDH mutant and IDH wild-type gliomas (69.2% and 76.2%, respectively). The mean L/N ratio of TERT promoter mutant gliomas was significantly higher than that of TERT promoter wild-type gliomas (P = 0.0147). Multiple regression analysis showed that pathologic diagnosis was the only influential factor on L/N ratio.. Distinguishing glioma subtypes based on the revised 2016 World Health Organization classification of the central nervous system tumors on the basis of [

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Astrocytoma; Brain Neoplasms; Child; DNA, Neoplasm; Female; Gene Expression Regulation, Neoplastic; Glioma; Humans; Isocitrate Dehydrogenase; Male; Methionine; Middle Aged; Mutation; Neurosurgical Procedures; Oligodendroglioma; Positron-Emission Tomography; Promoter Regions, Genetic; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Telomerase; Young Adult

Radiation therapy is a very useful treatment for central nervous systemS neoplasms. The time range of its complications is very wide; they appear even many years after its completion. These late complications behave clinically and radiologically similar to a relapse; a functional diagnostic study with radioactive isotopes can help to make a therapeutic decision.. A male suddenly presented deficient neurological symptoms in the same site where he received radiation therapy 25 years earlier for a pilocytic astrocytoma. The MRI findings suggested a lacunar stroke but a finding in the perfusion sequence forced us to be more precise in the diagnosis. A PET-CT 11C-methionine was performed which showed an increased uptake compatible with neoplasia. The spontaneous regressive evolution of the symptoms inclined us to take a conservative attitude. Lacunar ictus was confirmed on MRI three months later.. The reappearance of neurological symptoms years after radiotherapy of a brain neoplasm poses a diagnostic dilemma. Current diagnostic techniques are very accurate but present false positives. The various nuclear medicine techniques, in particular PET-CT 11C-methionine, are a diagnostic aid. With the presentation of this case we intend to draw attention to one of the late complications of radiation therapy and the various differential diagnoses. Diagnostic and therapeutic advances have increased the life expectancy of cancer patients, so these late complications are expected to be more frequent.. Ictus lacunar como complicación muy tardía de la radioterapia: valor de las técnicas de medicina nuclear.. Introducción. La radioterapia es un tratamiento de gran utilidad en las neoplasias del sistema nervioso central. El rango temporal de sus complicaciones es muy amplio, ya que aparecen incluso muchos años más tarde de haberla finalizado. Estas complicaciones tardías se comportan clínica y radiológicamente de forma similar a una recidiva; un estudio funcional diagnóstico con isótopos radiactivos puede ayudar a tomar una decisión terapéutica. Caso clínico. Varón que presentó de forma brusca sintomatología neurológica deficitaria en la misma localización donde 25 años antes había recibido radioterapia por un astrocitoma pilocítico. La resonancia magnética sugería un ictus lacunar, pero un hallazgo en la secuencia de perfusión obligaba a ser más preciso en el diagnóstico. Una tomografía por emisión de positrones-tomografía computarizada (PET-TC) con C11-metionina mostró un aumento de captación compatible con neoplasia. La evolución espontánea regresiva de los síntomas inclinó a tomar una actitud conservadora. Una resonancia magnética realizada tres meses más tarde confirmó el ictus lacunar. Conclusiones. La reaparición de síntomas neurológicos años más tarde de la radioterapia de una neoplasia cerebral supone un dilema diagnóstico. Las técnicas diagnósticas actuales son muy precisas, pero presentan falsos positivos. Las distintas técnicas de medicina nuclear, en concreto la PET-TC con C11-metionina, suponen una ayuda diagnóstica. Con este caso se pretende llamar la atención sobre una de las complicaciones tardías de la radioterapia y los distintos diagnósticos diferenciales. Los avances diagnósticos y terapéuticos han aumentado la esperanza de vida de los pacientes oncológicos, con lo que estas complicaciones tardías se prevén más frecuentes.

Topics: Adult; Astrocytoma; Brain Infarction; Brain Neoplasms; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Methionine; Neoplasm Recurrence, Local; Nuclear Medicine; Positron-Emission Tomography; Radiotherapy; Stroke, Lacunar; Time Factors; Tomography, X-Ray Computed

Positron emission tomography (PET) with 11C-methionine (11C-methionine PET/CT) is a new technique used to evaluate primary central nervous system (CNS) tumors. We describe our experience regarding the first 4 patients with glial tumors and 11C-methionine PET/CT. This is a descriptive, observational and prospective study of 4 patients between 38-50 years of age, with different gliomas (WHO classification). MRI and 11C-methionine PET/CT were performed in all cases. Case 1, gliomatosis cerebri grade II post-radiotherapy. Case 2, oligodendroglioma grade II diagnosed and treated with radiotherapy in 1993. Case 3, glioblastoma grade IV post-radiotherapy + temozolomide. Case 4, anaplastic oligoastrocytoma grade III post-radiotherapy + temozolomide. The pattern of 11C-methionine uptake compared with MRI showed tumor progression in cases 1, 3 and 4, and in case 2 showed uptake although the final diagnosis was pseudoprogression. Unlike 18fluordeoxiglucose PET/TC, 11C-methionine uptake in normal brain tissue and pseudoprogression is low, and gliomas are displayed as metabolically active areas. The 11C-methionine PET/CT provided valuable information on the tumoral behavior and extension, although in one case presented did not differentiate tumor progression from pseudoprogression. 11C-methionine PET/CT could be a useful tool in the study and follow-up to patients with gliomas.

Topics: Adult; Astrocytoma; Brain Neoplasms; Female; Glioma; Gliosarcoma; Humans; Male; Methionine; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prospective Studies; Radiopharmaceuticals; Tomography, X-Ray Computed

The effect of chemotherapy with procarbazine, CCNU, and vincristine in an anaplastic oligoastrocytoma was monitored by repeated positron emission tomography (PET) with C-11-methionine (C-11-MET). Chemotherapy caused a continuous decline of active tumor volume at a rate of approximately 2.4% per day, resulting in complete remission that persisted until the end of follow-up at 3 years. Thus, the authors conclude that C-11-MET PET may be useful for monitoring chemotherapy in gliomas and deserves further study.

Topics: Adult; Astrocytoma; Brain Neoplasms; Cerebral Cortex; Chemotherapy, Adjuvant; Drug Monitoring; Female; Humans; Methionine; Radiopharmaceuticals; Tomography, Emission-Computed; Treatment Outcome

Thallium-201, carbon-11 methionine (MET) and fluorine-18 fluorodeoxyglucose (FDG) have all been used to assess brain tumours. The aim of this study was to determine which of these tracers are of use for evaluating the histological grade and the extent of astrocytoma. 201Tl single-photon emission tomography (SPET), MET positron emission tomography (PET) and FDG PET were all performed in 23 patients (13 men, 10 women) with newly diagnosed astrocytic tumours [seven with astrocytoma (grade II), ten with anaplastic astrocytoma (grade III) and six with glioblastoma (grade IV)]. The 201Tl uptake of the tumours was evaluated by a lesion-to-normal region count ratio. Both MET and FDG uptake of the tumours was evaluated by a semiquantitative analysis using the standardized uptake value. 201Tl uptake was found to increase in rank order with histological grade and was significantly different among the three groups (grade II: 1.51+/-0.36; grade III: 2.58+/-1.50; grade IV: 7. 65+/-3.84). MET uptake in grade II (1.49+/-0.44) was also significantly lower than that in both grade III (3.29+/-1.44) and grade IV (3.20+/-0.92). FDG uptake was not significantly different among the three groups (grade II: 2.90+/-0.45; grade III: 3.86+/-1. 56; grade IV: 3.57+/-0.83). No significant correlation was observed between 201Tl uptake and either MET uptake or FDG uptake. In most patients, the extent of the increased MET uptake was the largest while that of the increased FDG uptake was the smallest. In patients with positive 201Tl uptake, the extent of the 201Tl uptake was equal to or smaller than that of gadolinium enhancement. For evaluation of histological grade of astrocytic tumours. 201Tl is therefore considered to be useful though the 201Tl uptake in some grade III astrocytomas was not different from that in grade II astrocytomas. MET was found to be highly useful for detecting astrocytomas, for differentiating between benign and malignant astrocytomas, and for evaluating the extent of astrocytomas; however, it was not sufficiently useful permit evaluation of the histological grade. FDG was not found to be useful either for evaluating the histological grade or for differentiating between benign and malignant astrocytomas.

Topics: Astrocytoma; Brain; Brain Neoplasms; Carbon Radioisotopes; Diagnosis, Differential; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Glioblastoma; Humans; Magnetic Resonance Imaging; Male; Methionine; Middle Aged; Radiopharmaceuticals; Thallium Radioisotopes; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

A 47-year-old woman, who 2.5 years previously had undergone resection of a malignant astrocytoma of the left temporal lobe followed by radiotherapy, was found to have a mass in the left frontal lobe. This showed high uptake of thallium-201 (201Tl) on single-photon emission computed tomography and 11C-methionine on positron-emission tomography, suggesting recurrent tumour. Histological examination of the resected lesion, however, revealed it to be radionecrosis. This case thus illustrates a diagnostic pitfall in the use of these investigations for distinguishing radionecrosis from recurrent malignant glioma.

Topics: Adult; Astrocytoma; Brain; Brain Diseases; Brain Neoplasms; Carbon Radioisotopes; Female; Humans; Methionine; Radiation Injuries; Radiopharmaceuticals; Temporal Lobe; Thallium Radioisotopes; Time Factors; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

A three-dimensional brain imaging protocol with PET and MRI was used to visualize the cortical structure in relation to brain function and glioma infiltration to determine tumor resectability.. Sixteen patients with glioma had a PET scan with 11C-methionine to visualize tumor infiltration. The PET images were co-registered to the patients' own MRI reconstructed to the three-dimensional brain surface images to indicate the gyral structure and the extent of tumor infiltration. Thirteen patients, who bore tumors adjacent to the language or motor cortex, had H2 15O activation study to locate the eloquent cortex. The area of tumor infiltration was superimposed on the brain surface images together with the language and/or motor cortex.. When a tumor was located within a single gyrus without influencing surface cortical gyrus pattern, the motor and language areas were identified morphologically by three-dimensional surface image alone. However, when the tumor caused swelling and deformation of cortical structure, functional mapping with H2(15)O activation technique was essential in locating them correctly. In such cases, the combined mapping of the facial motor area with oral movement and the language area with word repetition was the most useful method to identify the parasylvian structure in the dominant hemisphere. Total or near total resection of low-grade glioma in eight patients and the effective decompression of the active part of the malignant glioma in four patients was completed without causing functional neurological deterioration.. The three-dimensional expression of cortical structure and function combined with PET glioma imaging with 11C-methionine is useful for radical resection of cerebral glioma.

Topics: Adult; Astrocytoma; Brain; Brain Neoplasms; Female; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Methionine; Middle Aged; Oxygen Radioisotopes; Radiopharmaceuticals; Tomography, Emission-Computed; Water

We investigated whether 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) and carbon-11 methionine are suitable tracers to monitor the effects of therapy for low-grade gliomas. Ten patients with low-grade glioma without previous treatment were studied with FDG positron emission tomography. Additionally, l-[methyl-11C]methionine uptake was measured in five subjects before and 1 year after computerized tomography (CT)-guided stereotactic and computer-assisted implantation of iodine-125 seeds. All scans were 3D-matched to CT, isodose volumes were determined, and changes in glucose metabolism and methionine uptake were evaluated in tumour and brain tissue as a function of radiation dose. After 1 year glucose metabolism was not significantly altered up to a radiation dose of 300 Gy, whereas methionine uptake showed a significant dose-dependent decrease. Higher rates of decline were found in tumours with high basal methionine incorporation activity before therapy. These data suggest that measurement of methionine uptake is more suitable than measurement of FDG uptake for monitoring therapeutic effects in low-grade gliomas.

Topics: Adult; Astrocytoma; Brachytherapy; Deoxyglucose; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Glucose; Humans; Iodine Radioisotopes; Male; Methionine; Middle Aged; Supratentorial Neoplasms; Tomography, Emission-Computed

A 37-year-old male with mixed glioma was treated with combined radio- and chemotherapy. The amino acid metabolism of the tumor site and normal brain was followed by positron emission tomography using [11C]methionine ([11C]Met). The accumulation of [11C]Met in the tumor decreased during therapy and slightly increased 7 months after completion of the therapy, but then decreased markedly. However, computed tomography revealed no notable changes. The contralateral gray matter also showed a gradual decrease of [11C]Met accumulation. These findings indicate that reduction of amino acid metabolism in the tumor continues after radiochemotherapy although neuroimaging reveals no further morphological changes. Such therapy also has long-term effects on normal brain tissue.

Topics: Adult; Amino Acids; Astrocytoma; Brain; Brain Neoplasms; Carbon Radioisotopes; Combined Modality Therapy; Humans; Magnetic Resonance Imaging; Male; Methionine; Tomography, Emission-Computed; Tomography, X-Ray Computed