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Is [1-¹¹C]Putrescine Useful as a Brain Tumor Marker?

Departments of Neurosurgery and Psychiatry, New York University School of Medicine, New York, New York
Department of Chemistry, Brookhaven National Laboratory, Upton, New York

Correspondence: For reprints contact: Emile M. Hiesiger, MD, Dept. of Neurosurgery, New York University School of Medicine, 530 First Ave., New York, NY 10016.

ABSTRACT

Our experience with ¹¹C-putrescine underscores the difficulty of finding a selective brain tumor tracer, uniquely incorporated by neoplastic glia or metastatic cells within brain, but not by the proliferating, nontransformed cells which constitute a normal pathophysiological reaction to various disease processes. Thirty-three patients with 36 lesions were studied with ¹¹C-putrescine to determine the specificity of labeled putrescine for tumor tissue. The uptake of ¹¹C-putrescine was correlated with local cerebral glucose metabolic rate in various lesions, including different types of tumors, to assess the relationship between ¹¹C-putrescine uptake and tumor biology. Carbon-11-putrescine uptake was similar in malignant tumor and benign, non-neoplastic lesions with blood-brain barrier breakdown, illustrating the lack of tumor specificity of this tracer. Carbon-11-putrescine was not well incorporated into poorly enhancing lesions, regardless of their pathology, emphasizing the requirement of a disrupted blood-brain barrier for ¹¹C-putrescine uptake. The ratio of ¹¹C concentration within lesions, compared to that in a region of interest in the contralateral brain, weakly correlated with an analogous ratio for local cerebral glucose metabolic rate in various lesions. Physiological processes not unique to tumors are associated with polyamine active transport and metabolism and contribute to the lack of tumor specificity of ¹¹C-putrescine. Carbon-11-putrescine appear to have less diagnostic utility than ¹⁸FDG in brain tumors. The potential of ¹¹C-putrescine for evaluating the effect of antineoplastic therapy and providing prognostic information on brain tumors remains to be investigated.

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