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Prognostic value of volume-based measurements on 11C-methionine PET in glioma patients

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

11C-methionine (MET) PET is an established diagnostic tool for glioma. Studies have suggested that MET uptake intensity in the tumor is a useful index for predicting patient outcome. Because MET uptake is known to reflect tumor expansion more accurately than MRI, we aimed to elucidate the association between volume-based tumor measurements and patient prognosis.

Methods

The study population comprised 52 patients with newly diagnosed glioma who underwent PET scanning 20 min after injection of 370 MBq MET. The tumor was contoured using a threshold of 1.3 times the activity of the contralateral normal cortex. Metabolic tumor volume (MTV) was defined as the total volume within the boundary. Total lesion methionine uptake (TLMU) was defined as MTV times the mean standardized uptake value (SUVmean) within the boundary. The tumor-to-normal ratio (TNR), calculated as the maximum standardized uptake value (SUVmax) divided by the contralateral reference value, was also recorded. All patients underwent surgery (biopsy or tumor resection) targeting the tissue with high MET uptake. The Kaplan-Meier method was used to estimate the predictive value of each measurement.

Results

Grade II tumor was diagnosed in 12 patients (3 diffuse astrocytoma, 2 oligodendroglioma, and 7 oligoastrocytoma), grade III in 18 patients (8 anaplastic astrocytoma, 6 anaplastic oligodendroglioma, and 4 anaplastic oligoastrocytoma), and grade IV in 22 patients (all glioblastoma). TNR, MTV and TLMU were 3.1 ± 1.2, 51.6 ± 49.9 ml and 147.7 ± 153.3 ml, respectively. None of the three measurements was able to categorize the glioma patients in terms of survival when all patients were analyzed. However, when only patients with astrocytic tumor (N = 33) were analyzed (i.e., when those with oligodendroglial components were excluded), MTV and TLMU successfully predicted patient outcome with higher values associated with a poorer prognosis (P < 0.05 and P < 0.01, respectively), while the predictive ability of TNR did not reach statistical significance (P = NS).

Conclusion

MTV and TLMU may be useful for predicting outcome in patients with astrocytic tumor.

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Acknowledgments

We thank Eriko Suzuki, Keiichi Magota, and Reiko Usui for their technical assistance.

Conflicts of interest

Funds were provided by the Translational Research Network Program of the Ministry of Education, Culture, Sports, Science and Technology (2014). Author K.H. has received a SNMMI Wagner-Torizuka Fellowship (2013/2015), Hokkaido University in conjunction with the HIROKO International Academic Exchange Foundation (2012), and Bayer Best Research Award of the Japan Radiological Society (2014).

Compliance with ethical standards

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Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Source of funding

Translational Research Network Program of Ministry of Education, Culture, Sports, Science and Technology (2014); SNMMI Wagner-Torizuka Fellowship (2013/2015); Hokkaido University HIROKO’s Fund for Academic Exchange (2012) Bayer Best Research Award of the Japan Radiological Society (2014).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-Ku, Sapporo, Hokkaido, Japan, 060-8638

    Kentaro Kobayashi, Kenji Hirata, Osamu Manabe, Tohru Shiga & Nagara Tamaki

  2. Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Shigeru Yamaguchi, Shunsuke Terasaka & Hiroyuki Kobayashi

  3. Department of Molecular Imaging, Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Naoya Hattori

  4. Department of Cancer Pathology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Shinya Tanaka

  5. Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Kenji Hirata

  6. Central Institute of Isotope Science, Hokkaido University, Sapporo, Japan

    Yuji Kuge

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  1. Kentaro Kobayashi
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Correspondence to Kenji Hirata.

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Kobayashi, K., Hirata, K., Yamaguchi, S. et al. Prognostic value of volume-based measurements on 11C-methionine PET in glioma patients. Eur J Nucl Med Mol Imaging 42, 1071–1080 (2015). https://doi.org/10.1007/s00259-015-3046-1

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