Comparison of &lt;sup&gt;11&lt;/sup&gt;C-Methionine, &lt;sup&gt;11&lt;/sup&gt;C-Choline, and &lt;sup&gt;18&lt;/sup&gt;F-Fluorodeoxyglucose-PET for Distinguishing Glioma Recurrence from Radiation Necrosis

Takenaka, Shunsuke; Asano, Yoshitaka; Shinoda, Jun; Nomura, Yuichi; Yonezawa, Suguru; Miwa, Kazuhiro; Yano, Hirohito; Iwama, Toru

doi:10.2176/nmc.oa2013-0117

Cited by 103 publications

(74 citation statements)

References 26 publications

(24 reference statements)

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“…It is likely that the infiltrating edge of a high-grade glioma might not yet have disrupted the blood-brain barrier [20,21]. Amino acid tracers such as 11 C-methionine (MET) are the most useful agents for detecting the infiltrating edge of gliomas based on their intensities as well as the tracer uptake volume [22,23]. In our previous study, the 11 C-MET-positive area was larger than the Gd-enhanced area; the latter only accounted for an average of 58.6% of the 11 C-MET-positive area [24].…”

Section: Discussionmentioning

confidence: 99%

Pathological analysis of the surgical margins of resected glioblastomas excised using photodynamic visualization with both 5-aminolevulinic acid and fluorescein sodium

et al. 2017

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During glioma resection, 5-aminolevulinic acid (5-ALA) and fluorescein sodium (Fl-Na) are used for photodynamic tumor visualization. The objective of this study was to evaluate the pathological findings of the boundary zone between the tumor and adjacent normal brain in glioblastoma patients undergoing simultaneous double staining with 5-ALA and Fl-Na during surgery. Eight patients received 5-ALA (20 mg/kg orally) before the induction of general anesthesia, and Fl-Na (20 mg/kg) was administered intravenously before the dural incision was performed. The tumor bulk was removed under the guidance of Fl-Na staining alone using conventional white light. Subsequently, residual tumor was removed under the guidance of both fluorescent agents within functionally safe limits until both were visibly undetectable. Twenty specimens exhibiting different staining intensities of both agents were obtained. The vessel index (VI) was calculated from CD31 immunohistochemistry (IHC) samples. Boundary zone tumor cells were detected by IHC for olig2, and were expressed as the olig2 index (OLI). The VI was significantly higher in Fl-Na-positive areas than in Fl-Na-negative areas (p = 0.0005). In contrast, the OLI was significantly higher in 5-ALA-positive areas than in 5-ALA-negative areas (p = 0.0149). 5-ALA-positive/Fl-Na negative areas were observed in 7 patients. These findings indicate that Fl-Na accumulates in areas with a disrupted blood-brain barrier, and that 5-ALA fluorescence is dependent on tumor cell protoporphyrin IX metabolism. In conclusion, 5-ALA was better for detecting tumor cells in the boundary zone than was Fl-Na. Of note, tumor cells existed outside the fluorescence-stained boundaries of both agents.

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Section: Discussionmentioning

confidence: 99%

Pathological analysis of the surgical margins of resected glioblastomas excised using photodynamic visualization with both 5-aminolevulinic acid and fluorescein sodium

et al. 2017

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“…In a comparative study, 11 C-MET was found to be superior to 18 F-FDG for diagnostic accuracy in distinguishing glioma recurrence from radiation necrosis (95). Similarly, in a prospective comparison with 18 F-FDG PET, 18 F-FDOPA PET had a diagnostic accuracy of 100% for the diagnosis of glioblastoma recurrence versus 92.8% with 18 F-FDG PET (96).…”

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confidence: 89%

PET Imaging in Glioblastoma: Use in Clinical Practice

Verger¹,

Langen²

2017

Glioblastoma

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Positron emission tomography (PET) is a nuclear medicine imaging method with increasing relevance for the diagnosis, prognostication, and monitoring of glioblastomas. PET provides additional insight beyond magnetic resonance imaging (MRI) into the biology of gliomas, which can be used for noninvasive grading, differential diagnosis, delineation of tumor extent, planning of surgery, and radiotherapy and post-treatment monitoring. In clinical practice, two classes of radiotracers have been used predominantly for imaging purposes, namely glucose metabolism tracers and amino acid transport tracers. Both classes of tracers can provide information on grading and prognosis of gliomas, but amino acid tracers, which exhibit lower uptake in normal brain tissue, are better suited for delineation of tumor extent, treatment planning, or follow-up than 18 F-2-fluoro-2-deoxy-D-glucose ( 18 F-FDG). Owing to the progress in PET imaging using radiolabeled amino acids in recent years, the Response Assessment in Neuro-Oncology (RANO) working group, an international effort to develop new standardized response criteria for clinical trials in brain tumors, has recently recommended amino acid PET as an additional tool in the diagnostic assessment of brain tumors. PET Imaging in Glioblastomas 156These developments as well as multimodality imaging should improve the diagnostic assessment of these tumors.

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“…It was already mentioned that focal and high 18 F-FET uptake was suspicious for tumor recurrence, whereas low and homogeneous uptake around the resection cavity was considered benign due to post-treatment alterations of the BBB (73). Furthermore, amino acid PET was assumed to be superior to both 18 F-FCho PET and 18 F-FDG PET for diagnostic accuracy in distinguishing glioma recurrence from RN (6,49,50,83). Using 18 F-FDOPA PET, a sensitivity and specificity of more than 80% to distinguish recurrent GB or recurrent brain metastasis and radiation-related effects was shown (25,84).…”

Section: Amino-acid Petmentioning

confidence: 99%

PET for Therapy Response Assessment in Glioblastoma

et al. 2017

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Glioblastoma (GB) is the most malignant and the most common type of glioma in adults, accounting for 60-70% of all malignant gliomas. Despite the current therapy, the clinical course of GB is usually rapid, with a mean survival time of approximately 1 year. For therapy response assessment in GB, magnetic resonance imaging (MRI) is the method of choice. In 2010, the Response Assessment in Neuro-Oncology (RANO) was introduced, including the tumor size (in 2D) as measured on T2-weighted and Fluid Attenuated Inversion Recovery (FLAIR)-weighted images, in addition to the contrast-enhancing tumor part. Although the RANO criteria addressed some of the limitations of the previous MacDonald criteria for therapy evaluation in high-grade glioma, treatment-related side effects hamper correct response assessment. To address the above-mentioned drawbacks in the follow-up of GB, incorporating changes in tumor biology measured by advanced MRI and positron emission tomography (PET) imaging, which may precede anatomical changes of the tumor volume, is promising. Imaging biomarkers capable of predicting response at an early time point after treatment initiation are the premise of personalized treatment enabling change or GB Treatment Response Using PET 176 discontinuation of therapy to prevent ineffective treatment or adverse events of treatment. In this chapter, an overview of applicable PET tracers for the therapy response assessment in GB and the determination of tumor recurrence versus treatment-related effects is given.

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Comparison of <sup>11</sup>C-Methionine, <sup>11</sup>C-Choline, and <sup>18</sup>F-Fluorodeoxyglucose-PET for Distinguishing Glioma Recurrence from Radiation Necrosis

Cited by 103 publications

References 26 publications

Pathological analysis of the surgical margins of resected glioblastomas excised using photodynamic visualization with both 5-aminolevulinic acid and fluorescein sodium

Pathological analysis of the surgical margins of resected glioblastomas excised using photodynamic visualization with both 5-aminolevulinic acid and fluorescein sodium

PET Imaging in Glioblastoma: Use in Clinical Practice

PET for Therapy Response Assessment in Glioblastoma

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