Diagnostic Accuracy of 11C-Methionine PET for Differentiation of Recurrent Brain Tumors from Radiation Necrosis After Radiotherapy
Open Access
- 15 April 2008
- journal article
- Published by Society of Nuclear Medicine in Journal of Nuclear Medicine
- Vol. 49 (5), 694-699
- https://doi.org/10.2967/jnumed.107.048082
Abstract
We evaluated the diagnostic accuracy of PET with l-methyl-11C-methionine (11C-MET) for the differentiation of recurrent brain tumors from radiation necrosis. Methods: Seventy-seven patients who had been previously treated with radiotherapy after primary treatment for metastatic brain tumor (n = 51) or glioma (n = 26) were studied to clarify the diagnostic performance of 11C-MET PET in differentiating between recurrent brain tumors and radiation necrosis. A total of 88 PET scans with 11C-MET were obtained; sometimes more than one scan was obtained when there was an indication of recurrent brain tumor or radiation necrosis. A definitive diagnosis was made on the basis of pathologic examination for recurrent brain tumors and on the basis of pathologic examination or clinical course for radiation necrosis. Several indices characterizing the lesions were determined; these included mean and maximum standardized uptake values (SUVmean and SUVmax, respectively) and the ratios of lesion uptake to contralateral normal frontal-lobe gray matter uptake corresponding to the SUVmean and the SUVmax (L/Nmean and L/Nmax, respectively). Receiver-operating-characteristic (ROC) curve analysis was used to determine the optimal index of 11C-MET PET and cutoff values for the differential diagnosis of tumor recurrence and radiation necrosis. Results: The values of each index of 11C-MET PET tended to be higher for tumor recurrence than for radiation necrosis. There were significant differences between tumor recurrence and radiation necrosis in all of the indices except for the L/Nmax for glioma. ROC analysis indicated that the L/Nmean was the most informative index for differentiating between tumor recurrence and radiation necrosis. An L/Nmean of greater than 1.41 provided the best sensitivity and specificity for metastatic brain tumor (79% and 75%, respectively), and an L/Nmean of greater than 1.58 provided the best sensitivity and specificity for glioma (75% and 75%, respectively). Conclusion: 11C-MET PET can provide quantitative values to aid in the differentiation of tumor recurrence from radiation necrosis, although these values do not appear to be absolute indicators. Quantitative analysis of 11C-MET PET data may be helpful in managing irradiated brain tumors.Keywords
This publication has 26 references indexed in Scilit:
- Clinical Applications of PET in Brain TumorsJournal of Nuclear Medicine, 2007
- Differentiation of the Radiation-Induced Necrosis and Tumor Recurrence after Gamma Knife Radiosurgery for Brain Metastases: Importance of Multi-Voxel Proton MRSmin - Minimally Invasive Neurosurgery, 2005
- Diagnostic value of thallium-201 chloride single-photon emission computerized tomography in differentiating tumor recurrence from radiation injury after gamma knife surgery for metastatic brain tumorsJournal of Neurosurgery, 2005
- Methionine positron emission tomography for differentiation of recurrent brain tumor and radiation necrosis after stereotactic radiosurgery —In malignant glioma—Annals of Nuclear Medicine, 2004
- Outcome and Cost of Craniotomy Performed to Treat Tumors in Regional Academic Referral CentersNeurosurgery, 2003
- Correlations between Magnetic Resonance Spectroscopy and Image-guided Histopathology, with Special Attention to Radiation NecrosisNeurosurgery, 2002
- Differentiation of radiation necrosis from tumor progression using proton magnetic resonance spectroscopyNeuroradiology, 2002
- Stereotactic radiosurgery VIII. The classification of postradiation reactionsBritish Journal Of Neurosurgery, 1999
- Design and evaluation of HEADTOME-IV, a whole-body positron emission tomographIEEE Transactions on Nuclear Science, 1989
- Brain radiation lesions: MR imaging.Radiology, 1986