Discrimination between low-grade oligodendrogliomas and diffuse astrocytoma with the aid of 11C-methionine positron emission tomography

Clinical article

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The diagnostic usefulness of 11C-methionine PET scans in gliomas is still controversial. The authors investigated the clinical significance of 11C-methionine PET findings in preoperative diagnosis of histological type and grade.


The tissue uptake of 11C-methionine was assessed using PET in 70 patients with histologically confirmed intracerebral gliomas. The ratio of maximum standard uptake values in tumor areas to the mean standard uptake values in the contralateral normal brain tissue (tumor/normal tissue [T/N] ratio) was calculated and correlated with tumor type, histological grade, contrast enhancement on MR imaging, Ki 67 labeling index, and 1p/19q status.


The T/N ratio was significantly increased as tumor grade advanced in astrocytic tumors (WHO Grade II vs Grade III, p = 0.0011; Grade III vs Grade IV, p = 0.0007). Among Grade II gliomas, the mean T/N ratio was significantly higher in oligodendroglial tumors than in diffuse astrocytomas (DAs) (p < 0.0001). All T/N ratios for oligodendroglial tumors were ≥ 1.46, and those for DA were consistently < 1.46, with the exception of 2 cases of gemistocytic astrocytoma. The Ki 67 labeling index significantly correlated with T/N ratio in astrocytic tumors, but not in oligodendrogliomas. Oligodendroglial tumors without 1p/19q deletion had a significantly higher T/N ratio than those with the codeletion. In combination with Gd-enhanced MR imaging, 67% of nonenhanced tumors with a T/N ratio of ≥ 1.46 were proved to be Grade II oligodendrogliomas.


These results clearly show that 11C-methionine PET T/N ratios in Grade II oligodendrogliomas were higher than those in DAs independently of their proliferative activity. This information contributes to preoperative differential diagnoses of histological type, especially in suspected low-grade gliomas.

Abbreviations used in this paper: DA = diffuse astrocytoma; FISH = fluorescence in situ hybridization; LI = labeling index; ROI = region of interest; SUV = standard uptake value; T/N = tumor/normal tissue.

Article Information

Address correspondence to: Yasuo Iwadate, M.D., Ph.D., Department of Neurological Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. email: iwadatey@faculty.chiba-u.jp.

Please include this information when citing this paper: published online January 7, 2011; DOI: 10.3171/2010.11.JNS10553.

© AANS, except where prohibited by US copyright law.



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    Scatter diagram of methionine SUVs for T/N ratios in astrocytic tumors. The mean SUV T/N ratio was 1.06 ± 0.26 for Grade II astrocytoma, 2.43 ± 0.96 for anaplastic astrocytoma (Grade III), and 3.81 ± 1.08 for glioblastoma (Grade IV). The T/N ratio increased significantly in proportion to advancing tumor grade (p = 0.0011 between Grades II and III, p = 0.0007 between Grades III and IV; Fisher protected least significant difference analysis).

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    Scatter diagram of methionine SUVs for T/N ratios in oligodendrogliomas. The mean SUV T/N ratio was 2.38 ± 0.74 for Grade II oligodendrogliomas and 2.86 ± 1.24 for anaplastic oligodendrogliomas (Grade III). There was no significant difference between Grades II and III (p = 0.101, unpaired t-test).

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    Representative images obtained in patients with DA (images were obtained in a different patient in each row). Axial MR images demonstrate nonenhancing tumors (A, D, and G) with signal-hyperintense areas on T2-weighted imaging (B, E, and H). The 11C-methionine PET scans (C, F, and I) show relatively low uptake levels in the tumor areas.

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    Representative images obtained in patients with Grade II oligodendroglial tumor (images were obtained in a different patient in each row). Axial MR images demonstrate nonenhancing tumors (A, D, and G) with signal-hyperintense areas on T2-weighted imaging (B, E, and H), resembling the imaging features for DA (see Fig. 3). In contrast, 11C-methionine PET scans (C, F, and I) show high uptake levels in the tumor areas.

  • View in gallery

    Scatter diagram demonstrating differences in methionine SUVs of the T/N ratio depending on histological type as either Grade II astrocytoma or oligodendroglioma. The mean SUV T/N ratio was significantly higher in Grade II oligodendrogliomas than in Grade II astrocytoma (2.38 ± 0.74 and 1.06 ± 0.26, respectively; p < 0.0001, unpaired t-test). The horizontal line shows a cutoff threshold of 1.46 for the T/N ratio. All oligodendroglial tumors exist above this line, whereas all nongemistocytic DAs are under this threshold.

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    Correlation of the methionine SUVs for T/N ratios with Ki 67 LI. Left: The T/N ratio shows a positive correlation with Ki 67 in 20 astrocytic tumors (p = 0.0129). Right: The T/N ratio shows no correlation with Ki 67 LI in 19 oligodendrogliomas (p = 0.18).

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    Scatter diagram demonstrating differences in methionine SUVs of T/N ratio depending on 1p/19q status in oligodendrogliomas. The mean SUV T/N ratio was significantly higher in oligodendroglial tumors without 1p/19q deletion than in those with 1p/19q deletion (3.25 ± 0.79 and 2.35 ± 0.78, respectively; p = 0.0173, unpaired t-test).


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