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Imaging 18F-fluorodeoxy glucose/11C-methionine uptake decoupling for identification of tumor cell infiltration in peritumoral brain edema

  • Clinical Study – Patient Study
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Abstract

Discriminating tumor infiltrative and vasogenic brain edema in malignant gliomas is important although challenging in clinical settings. This study challenged this issue by performing voxel-wise analysis of 18F-fluorodeoxy glucose (FDG) and 11C-methionine positron emission tomography (PET) in peritumoral brain edemas. The authors studied ten malignant glioma and nine meningioma patients with peritumoral brain edema. A voxel-wise analysis of FDG and 11C-methionine PET was performed in order to quantify the correlation between uptake of these tracers in normal brain tissue and peritumoral brain edema. Decoupling score of the uptake of two tracers was calculated as the z-score from the estimated correlation between uptake of the two tracers in normal brain tissue. The decoupling score was also converted into images for visual inspection. Average decoupling score in the peritumoral brain edema was calculated and compared between those obtained from malignant gliomas and meningiomas. FDG and 11C-methionine uptake showed a reproducible linear correlation in normal brain tissue. This correlation was preserved in peritumoral edema of meningioma, but not in that of malignant gliomas. In malignant gliomas, higher 11C-methionine uptake compared to that estimated by the FDG uptake in normal brain tissue was observed, thus suggesting that decoupling was caused by tumor infiltration. Visual inspection of the decoupling score enabled discrimination of tumor infiltrative and vasogenic edema. The average decoupling scores of the peritumoral brain edema in malignant gliomas were significantly higher than those in meningiomas (2.9 vs. 0.7, P = 0.0003). As a conclusion, FDG/11C-methionine uptake decoupling score can be used for the discrimination of tumor infiltrative and vasogenic brain edema. The proposed method also suggests the possibility of accurately detecting tumor infiltration into brain tissues in gliomas, providing significant information for treatment planning and follow-up.

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Abbreviations

ADC:

Apparent diffusion coefficient

DTI:

Diffusion tenor imaging

FA:

Fractional anisotropy

FDG:

18F-fluorodeoxy glucose

MRI:

Magnetic resonance imaging

PET:

Positron emission tomography

ROI:

Region of interest

VOI:

Voxels of interest

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Acknowledgments

This investigation was supported by the Osaka Cancer Research Foundation, the Konica Minolta Imaging Science Foundation, the Osaka Cancer Researcher Training Fund, the Takeda Science Foundation, the Sagawa Foundation for Promotion of Cancer Research and a Grant-in-Aid for Scientific Research from the Ministry of Education, Science and Culture of Japan.

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Authors and Affiliations

  1. Department of Neurosurgery, Osaka University Gradate School of Medicine, 2-2 Yamadoka, Suita, Osaka 565-0871, Japan

    Manabu Kinoshita, Tetsu Goto, Hideyuki Arita, Yoshiko Okita, Naoki Kagawa, Yasunori Fujimoto, Haruhiko Kishima, Youichi Saitoh, Naoya Hashimoto & Toshiki Yoshimine

  2. Nuclear Medicine and Tracer Kinetics, Osaka University Gradate School of Medicine, Suita, Japan

    Kayako Isohashi, Eku Shimosegawa & Jun Hatazawa

  3. Department of Neuromodulation and Neurosurgery, Center for Advanced Science and Innovation, Osaka University, Suita, Japan

    Youichi Saitoh

Authors
  1. Manabu Kinoshita
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  2. Tetsu Goto
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  3. Hideyuki Arita
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  4. Yoshiko Okita
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  5. Kayako Isohashi
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  6. Naoki Kagawa
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  7. Yasunori Fujimoto
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  8. Haruhiko Kishima
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  9. Eku Shimosegawa
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  11. Jun Hatazawa
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  12. Naoya Hashimoto
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  13. Toshiki Yoshimine
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Correspondence to Manabu Kinoshita.

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Kinoshita, M., Goto, T., Arita, H. et al. Imaging 18F-fluorodeoxy glucose/11C-methionine uptake decoupling for identification of tumor cell infiltration in peritumoral brain edema. J Neurooncol 106, 417–425 (2012). https://doi.org/10.1007/s11060-011-0688-0

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  • DOI: https://doi.org/10.1007/s11060-011-0688-0

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