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Newly Diagnosed Glioma: Diagnosis Using Positron Emission Tomography with Methionine and Fluorothymidine

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Tumors of the Central Nervous System, Volume 2

Part of the book series: Tumors of the Central Nervous System ((TCNS,volume 2))

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Abstract

The purpose of this prospective study was to clarify the individual and combined role of MET-PET and FLT-PET in tumor detection, noninvasive grading, and assessment of the cellular proliferation rate in newly diagnosed histologically verified gliomas of different grades. Sixty-two patients with newly diagnosed gliomas were investigated with MET-PET before surgery. Thirty-six patients were also examined with FLT-PET. MET and FLT uptakes were assessed by the standardized uptake value of the tumor showing the maximum uptake (SUVmax), and the ratio to uptake in the normal brain parenchyma (T/N ratio). All tumors were graded by the WHO grading system using surgical specimens and the proliferation activity of the tumors was determined by measuring the Ki-67 index obtained by immunohistochemical staining. On visual analysis, MET exhibited a slightly higher sensitivity (88.7%) in tumor detection than FLT (86.1%) and both tracers were 100% sensitive for malignant gliomas. Low-grade gliomas that were false negative on MET-PET were also false negative on FLT-PET. Although the difference in the MET SUVmax and T/N ratio between grade II and grade III gliomas was statistically significant (P < 0.05), there was a significant overlap of MET uptake in the tumors. The difference in the MET SUVmax and T/N ratio between grade III and grade IV gliomas was not statistically significant. Low-grade gliomas with oligodendroglial components had relatively high MET uptake compared to grade II astrocytoma. The difference in the FLT SUVmax and T/N ratio between grade III and grade IV gliomas was statistically significant (P < 0.001). However, the difference in the FLT SUVmax and T/N ratio between grade II and grade III gliomas was not statistically significant. Grade III gliomas with non-contrast enhancement on MR images had very low FLT uptake. In 36 patients who underwent PET examination with both tracers, a significant but relatively weak correlation was observed between the individual SUV max of MET and FLT (r = 0.52, P < 0.05) and T/N ratio of MET and FLT (r = 0.49, P < 0.05). FLT SUVmax in the tumor had a higher correlation (r = 0.81, P < 0.001) with the Ki-67 proliferation index than MET SUVmax (r = 0.40, P < 0.05). PET studies using MET and FLT are useful for tumor detection in newly diagnosed gliomas. However, there is no complimentary information in tumor detection with simultaneous measurements of MET- and FLT-PET in low grade gliomas. FLT-PET seems to be superior to MET-PET in noninvasive tumor grading and assessment of proliferation activity in gliomas of different grade.

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Authors and Affiliations

  1. Department of Neurological Surgery, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, 761-0793, Japan

    Nobuyuki Kawai & Takashi Tamiya

  2. Department of Radiology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, 761-0793, Japan

    Yoshihiro Nishiyama

Authors
  1. Nobuyuki Kawai
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  2. Yoshihiro Nishiyama
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  3. Takashi Tamiya
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Correspondence to Nobuyuki Kawai .

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  1. , Kean University, Room 213, Library building, Morris Avenue 1000, Union, 07083, New Jersey, USA

    M.A. Hayat

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Kawai, N., Nishiyama, Y., Tamiya, T. (2011). Newly Diagnosed Glioma: Diagnosis Using Positron Emission Tomography with Methionine and Fluorothymidine. In: Hayat, M. (eds) Tumors of the Central Nervous System, Volume 2. Tumors of the Central Nervous System, vol 2. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0618-7_12

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  • DOI: https://doi.org/10.1007/978-94-007-0618-7_12

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  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-007-0617-0

  • Online ISBN: 978-94-007-0618-7

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