The Role of C-11 Methionine PET for Non-invasive Grading Between Oligodendroglial Tumor and Other Brain Tumors

PURPOSE: Several studies have shown that the prognosis of oligodendroglial tumor is dependent on their histological grade. C-11 methionine (MET) PET imaging is one of sensitive techniques for visualizing primary brain tumors. The aim of this study was to evaluate the relationship between the uptake of MET and histopathologic grading especially based on oligodendroglial tumor versus other brain tumors.METHOD AND MATERIALS: Cerebral uptake of MET was determined in 30 patients with histologically proven gliomas (22 male patients and 9 female patients: meanage,46.9y; range, 14-75y). Grade I, II, III and IV lesions based on WHO grading class were 3,10,9, and 8 lesions, respectively. There were 3 oligodendroglioma (grade II) and 1 anaplastic oligodendroglioma (grade III) in our cases. Ecat Exact HR+ PET scanner and Biograph DUO PET/CT were used for imaging in this study. A semiquantitative methionine uptake ratio (TNR; Tumor to normal tissue ratio) was correlated with tumor grade. RESULTS: There was a significant difference in TNR between grade III and IV lesions, but no significant difference between grade II and III in whole cases. In oligodendroglial tumors, 3 grade II lesions tended to show higher TNR than a grade III lesion. There was a significant difference in TNR between grade II and III lesions except oligodendroglial tumors from the cases. Oligodendroglioma might represent different metabolic demand for MET uptake from the other gliomas. CONCLUSION: MET PET was sensitive for histopathologic grading of gliomas except oligodedroglial tumors. We must pay much attention to primary staging of oligodendroglial tumors using MET PET. CLINICAL RELEVANCE/APPLICATION: Non-invasive grading technique for oligodendroglial tumor and other brain tumors using methionine PET94rd Scientific Assembly and Annual Meetin

Accuracy of methionine-PET in predicting the efficacy of heavy-particle therapy on primary adenoid cystic carcinomas of the head and neck.

BACKGROUND: We evaluated whether or not PET or PET/CT using L-methyl-[11C]-methionine (MET) can allow for the early prediction of local recurrence and metastasis, as well as the prognosis (disease-specific survival), in patients with adenoid cystic carcinoma of the head and neck treated by carbon ion beam radiotherapy. METHODS: This was a retrospective cohort study of sixty-seven patients who underwent a MET-PET or PET/CT study prior to and one month after the completion of carbon ion radiotherapy (CIRT). The minimum follow-up period for survivors was 12 months. The MET accumulation of the tumor was evaluated using the semiquantitative tumor to normal tissue ratio (TNR). A univariate analysis was conducted using the log-rank method, and the Cox model was used in a multivariate survival regression analysis. RESULTS: The average TNR prior to and following treatment was 4.8 (+/-1.5) and 3.0 (+/-1.3), respectively, showing a significant decrease following treatment. In the univariate analysis, a high TNR prior to treatment (TNRpre) was a significant factor for predicting the occurrence of metastasis and the disease-specific survival. A high TNR following treatment (TNRpost) was a significant factor for predicting the development of local recurrence. The residual ratio of TNR changes (TNRratio) seemed to be less useful than the TNRpre. In the multivariate analysis, the TNRpost and tumor size were the factors found to significantly influence the risk of local recurrence. The TNRpre, TNRratio and tumor size were all significant factors influencing the occurrence of metastasis. Regarding the disease-specific survival, the TNRpre and age were the only factors with a significant influence on the outcome. CONCLUSIONS: The TNRpre was a factor that was significantly related to the occurrence of metastasis and the disease-specific survival after CIRT for adenoid cystic carcinoma of the head and neck. The TNRpost was a factor that was significantly related to the development of local recurrence. Thus, MET-PET or PET/CT can be useful for predicting or determining the therapeutic efficacy of CIRT

A Study on the Prognostic Evaluation of carbon ion radiotherapy for Head and Neck adenocarcinoma with C-11 Methionine PET

PURPOSE: Carbon ion radiotherapy (CIRT) has been developed, and a phase I/II CIRT trial has been conducted in patients with adenocarcinoma in the head and neck region. We evaluated whether the L: -methyl [11C]-methionine (MET) uptake could be an early predictor for local recurrence, metastasis, and the prognosis in patients with adenocarcinoma in the head and neck egion.METHODS: Twenty-six patients were prospectively studied by MET-positron emission tomography (PET) before and about 1 month after CIRT. The tumor MET uptake was measured with the semiquantitative tumor to normal tissue ratio (TNR). The tumor TNR and relevant clinical parameters were then evaluated by both univariate and multivariate analyses.RESULTS: The average TNRs before and after the treatment were 6.2 (+/-2.2) and 3.9 (+/-1.7), respectively, and significant differences were observed between them. In a univariate analysis, both local recurrence and metastasis were observed more frequently in the group with a higher TNR before and after the treatment than a lower TNR, and the prognosis was also poor. The cut-off values were 9.3, 4.9, and 5.1 before the treatment and 4.9, 4.2, and 4.3 after the treatment, respectively. In the rate of TNR changes before and after the treatment, metastasis was observed more frequently in the group with lower rates of change, and the prognosis was poor. The cut-off values for metastasis and prognosis determination were 18.0% and 16.9%, respectively. In a multivariate analysis, significant differences were observed for all relationships except for the relationship between the TNR before the treatment and local recurrence. Significant differences were observed for metastasis and prognosis in the rate of TNR changes before and after the treatment. CONCLUSIONS: The determination of treatment effectiveness using TNR in CIRT for head and neck adenocarcinoma is an independent factor for predicting local recurrence, the incidence of metastasis, and the prognosis. MET-PET is therefore considered to be useful for determining the treatment effectiveness in patients with head and neck adenocarcinoma undergoing CIRT

Prediction of tumor recurrence by FDG-PET/CT and MRI for pancreatic cancer

ObjectivesFDG-PET provides quantitative information regarding the tumor glucosemetabolism which is useful for the clinical diagnosis of tumor diseases. Adiffusion weighted image (DWI) by MRI can be useful in detecting malignanciessimilar to FDG-PET imaging. We evaluated the role of the clinical use ofFDG-PET/CT and DWI by MRI in the differential diagnosis of tumor malignancywith suspected pancreatic cancer, and in the prediction of tumor recurrence forpancreatic cancer. Materials and Methods Pre-surgery patients with eitherproven or suspected primary pancreatic cancer underwent a whole body FDG-PET/CTand DWI by MRI. The malignancy or benignancy of excised specimens waspathologically confirmed in all cases. The tumor glucose metabolism wasevaluated with standardized uptake value (SUV) in FDG-PET/CT (Aquiduo; Toshiba)study. After at least 6hours of fasting, each patient was injected with FDG(217.8-372.5MBq, average: 321.6MBq ) 60 min before imaging. DWI acquired with a3.0-T MRI scanner (Signa HDx 3T; GE Healthcare) with an 8 channel TORSO arraycoil (8US TORSOPA). The apparent diffusion coefficient (ADC) were measured withDWI using a spin echo echo-planar sequence, TR=10s; TE=80 ms; b value=400, 800,1200s/mm2. We obtained SUV from the FDG injected dose and patientbody weight, and ADC from DWI with three types of b values. ADC was calculatedusing the Advantage work station 4.2; fanctool2, GE Healthcare, and we used theaverage values for ADC value. The value of each factor for differentialdiagnosis of tumor malignancy was determined by analysis of the area under thereceiver operating characteristic (ROC) curve with suspected pancreatic cancer.Similarly, the predictive value of each factor for 1-year tumor recurrence wasdetermined by analysis of the area under the ROC curve with proven pancreaticcancer. Results On ROC curve analysis for differential diagnosis of tumormalignancy, the areas under the curve of SUV and ADC were 0.855 and 0.830,respectively. On ROC curve analysis for tumor recurrence, the areas under thecurve of SUV and ADC were 0.843 and 0.600, respectively. The 1-year recurrencefree survival rate above the cutoff (SUV>4.3) was markedly different fromthe rate below the cutoff (SUV&#8804;4.3) (100% vs. 67%, p<0.01). ConclusionsFDG-PET/CT and ADC from MRI are helpful in differential diagnosis of tumormalignancy. FDG-PET/CT should be performed in preoperative evaluation ofpancreatic tumor not only for differential diagnosis of tumor malignancy butalso for prediction of tumor recurrence.The 2010 EANM Congres

Comparison between endoscopic findings and FDG-PET/CT that shows diffuse gastric uptakes in cancer screening

Purpose: FDG uptakes in the stomach, especially diffuse uptakes often pester nuclear medicine physicians with the interpretation as to whether The purpose of this study is to investigate the necessity of endoscopy after FDG-PET/CT that shows diffuse gastric uptakes in cancer screening. Materials and methods: We studied 50 people who had a check-up for cancer using FDG-PET/CT. All people showed diffuse uptakes in the stomach. Fifteen people were female and thirty-five people were male, and mean age was 57.3pm10.1 (36 to 80). The uptakes of the stomach were higher than of the liver in 32 people, similar to the liver in 12 people, and lower than of the liver in 6 people. Thirty-two people underwent biopsy from the stomach. Pathological findings were categorized into five groups according to the following scale: Group 1: normal tissue or benign lesion without atypical cell; Group 2: benign lesion with atypical cell ; Group 3: borderline lesion; Group 4: suspicion of cancer; Group5: cancer. Results: All people had no gastric cancer. Gastritis was detected in 35 people, ulcer in 2 people, hyperplastic polyp in 2 people, metaplasia in one. Ten people had normal findings. On the value of SUV, there was no significant difference between gastritis (3.65pm0.60SD) and normal findings (3.55pm0.33SD, p=0.619). The specimens from biopsy were Group 1 in 27 people and Group 2 in 8 people. No specimens showed Group 3, Group4, and Group 5. No significant difference was found between Group 1 (3.55pm0.59SD) and Group 2 (3.68pm0.60SD). Helicobacter.pylori was detected in 17 people. No significant difference was found between H.pylori positive group (3.70pm0.46SD) and negative group (3.43pm0.71SD, p=0.198). Conclusion: Our results indicate that an additional endoscopy for detecting gastric cancer does not seem to be necessary after FDG-PET/CT that shows diffuse uptakes in the stomach.The 2009 EANM Congres

Comparison of SUVmax and SUVpeak measuring FDG uptake for robust predictions of patient prognosis of pancreas cancer treated by carbon ion radiotherapy

Purpose: Various parameters are used for measuring tumor glucose metabolic activity with 18F-FDG PETincluding measuring the single maximum pixel value within the slice with highest radioactivity concentration(SUVmax) or placing a fixed ROI in the area of the tumor with the highest level of 18F-FDG uptake (SUVpeak),which it defines as the largest possible mean value of a 1 cm3 spherical VOI positioned within a tumor. SUVmaxis avoided inter-observer variation, but a major drawback of this approach is its susceptibility to noise in thedata. SUVpeak is also removed inter-observer variation, and the averaging of multiple voxels reduces thesusceptibility to noise. In this study we determined which parameter of glucose metabolic activity provided themost robust predictions of patient prognosis of pancreas cancer treated by carbon ion radiotherapy.Materials and Methods: A total of 41 patients (28 males, 13 females; mean age, 65 + 8+- y) with pancreas cancerunderwent 18F-FDG PET/CT scan before carbon ion radiotherapy. The following parameters on thepretreatment scans were measured: maximum standardized uptake value (SUVmax), two types of peak SUV(small: SUVpeak5, large: SUVpeak10), and average SUV (SUVave). SUVpeak5 and SUVpeak10 are measuredusing spherical VOI with radius 5 mm and 10 mm, respectively. SUVave is an average pixel value of the circularROI with radius 5 mm within the slice with the highest radioactivity concentration. Correlation coefficients werecalculated for these parameters, and receiver operating characteristic (ROC) analysis was performed tocompare the prediction performance of each parameter for pancreas patients.Results: Pretreatment SUVmax, SUVpeak5, SUVpeak10, and SUVave averaged 6.6, 6.1, 5.1, and 6.0,respectively. Correlation coefficients between all four parameters, SUVmax and SUVpeak5, SUVmax andSUVpeak10, SUVmax and SUVave, SUVpeak5 and SUVpeak10, SUVpeak5 and SUVave, SUVpeak10 andSUVave, were 0.995, 0.964, 0.994, 0.973, 0.995, and 0.969, respectively. The areas under the ROC curve ofSUVmax, SUVpeak5, SUVpeak10, and SUVave were 0.69, 0.69, 0.92, and 0.70, respectively. ROC curves ofSUVmax, SUVpeak5 and SUVave were closely approximated to each other, but the ROC curve of SUVpeak10was different from others and much better than others.Conclusions: Four FDG-PET uptake parameters were correlated closely. ROC analysis showed thatSUVpeak10 was much better than others for prediction of pancreas patient prognosis. It seemed that relativelylarge sphere for calculating SUVpeak is better than small sphere if the tumor is large enough for setting thesphere within it.Annual Congress of the European Association of Nuclear Medicin

Comparison between SUVmax and SUVpeak of FDG uptake in pancreas cancer:Bland-Altman plot analysis

Adoption of metabolic imaging with F-18-FDG in staging and follow up of cancers needs tumor metabolism parameters like standardized uptake value (SUV). SUVmax,the value of the single voxel with the maximum intensity, avoids inter-observer differences, but a major drawback of SUVmax is its susceptibility to noise in the data. SUVpeak defined as the largest possible mean value of a 1 cm3 spherical VOI positioned within a tumor removes inter-observer variation and reduces the susceptibility to noise. In this study we compared SUVpeak against SUVmax of glucose metabolic activity of pancreas cancer, and assessed how much the SUVpeak was likely to differ from SUVmax using Bland-Altman plot.Method:A total of 53 patients (35 males, 18 females; mean age, 67+-8 y) with pancreas cancer underwent F-18-FDG PET/CT scan in pre-and post-carbon ion radiotherapy. All patients were followed more than 1 year after treatment. The following parameters were measured: maximum standardized uptake value (SUVmax) and peak SUVs (SUVpeak6, SUVpeak10, SUVpeak15). SUVpeak6, SUVpeak10 and SUVpeak15 are measured using spherical VOI with radius 6 mm, 10 mm and 15 mm, respectively, where the volume of spherical VOI of SUVpeak6 is almost 1 cm3. The overall survival was estimated using the Kaplan-Meier method with SUVs as prognostic variables. Bland-Altman plots were used to evaluate difference between SUVmax and SUVpeak in pre-and post-treatment scan.Results: Cutoff values for each SUV were defined by ROC analysis, and the probability of survival was significantly lower with increasing FDG uptake measured by all the kinds of SUVs in both pre-and post-treatment.Significant correlations were observed between SUVmax and SUVpeak6, SUVpeak10 or SUVpeak15 in both pre-and post-treatment. However, proportional bias was observed between SUVmax and SUVpeak6, SUVpeak10 or SUVpeak15 in both pre-and post-treatment as revealed by the Bland-Altman plot analysis. The Bland-Altman analysis illustrated that the 95% limits of agreement is smaller between SUVmax and SUVpeak6 (range: pre 0.25, post 0.16) than between SUVmax and SUVpeak10 (range: pre 0.40, post 0.23), and is also smaller between SUVmax and SUVpeak10 than between SUVmax and SUVpeak15 (rang: 0.62, post 0.35). Conclusions: SUVmax and SUVpeak were statistically significant prognostic variables for overall survival estimated using the Kaplan-Meire method. SUVmax as FDG-PET uptake parameter was correlated closely to SUVpeak, but there was proportional bias between SUVmax and SUVpeak. The smaller the sphere\u27s radius of SUVpeak the smaller the 95% limits of agreement is.EANM\u2713 - Annual Congress of the European Association of Nuclear Medicin