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Osamu Tokumaru, Takaaki Kitano, Hidehiro Takei, Kazue Ogata, Hiroaki Kawazato, Aiko Yasuda, Naoko Nisimaru and Isao Yokoi


Gamma Knife surgery (GKS) is performed to treat patients with functional neurological diseases, but the neurophysiological mechanisms of GKS's biological effects with subnecrotic doses remain largely undefined. The purpose of the present study was to investigate the effects of gamma irradiation on energy metabolism in the rat brain by using 31P nuclear magnetic resonance spectroscopy (31P-NMRS).


The whole brains of Wistar rats were irradiated with a subnecrotic (60-Gy) dose of radiation. One week after the irradiation, brain slices (400 μm thick) were incubated in standard artificial cerebrospinal fluid to undergo 31P-NMRS investigation. Changes in high-energy phosphate, phosphocreatine (PCr), and γ-ATP, as well as inorganic phosphate levels before, during, and after ischemic stress for 64 minutes were measured. Histological findings were also evaluated using light and electron microscopy.

The decrease in the PCr level was significantly slower during ischemia and recovery after reperfusion was significantly faster and greater in the gamma-irradiated rats than in the control animals. The γ-ATP level after ischemia was also higher in the gamma-irradiated rats than in the controls. Neither neuronal damage nor astrocytosis was observed in the irradiated cerebral cortices.


Gamma irradiation with a subnecrotic dose may have neuroprotective effects that maintain a more stable cellular phosphorylation potential after ischemic stress. Such effects of GKS on energy metabolism coupled with neurotransmission (glutamate–glutamine cycling between neurons and astrocytes) may play a role in the treatment of neurological disease.

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Hiroaki Takei, Jun Shinoda, Soko Ikuta, Takashi Maruyama, Yoshihiro Muragaki, Tomohiro Kawasaki, Yuka Ikegame, Makoto Okada, Takeshi Ito, Yoshitaka Asano, Kazutoshi Yokoyama, Noriyuki Nakayama, Hirohito Yano and Toru Iwama


Positron emission tomography (PET) is important in the noninvasive diagnostic imaging of gliomas. There are many PET studies on glioma diagnosis based on the 2007 WHO classification; however, there are no studies on glioma diagnosis using the new classification (the 2016 WHO classification). Here, the authors investigated the relationship between uptake of 11C-methionine (MET), 11C-choline (CHO), and 18F-fluorodeoxyglucose (FDG) on PET imaging and isocitrate dehydrogenase (IDH) status (wild-type [IDH-wt] or mutant [IDH-mut]) in astrocytic and oligodendroglial tumors according to the 2016 WHO classification.


In total, 105 patients with newly diagnosed cerebral gliomas (6 diffuse astrocytomas [DAs] with IDH-wt, 6 DAs with IDH-mut, 7 anaplastic astrocytomas [AAs] with IDH-wt, 24 AAs with IDH-mut, 26 glioblastomas [GBMs] with IDH-wt, 5 GBMs with IDH-mut, 19 oligodendrogliomas [ODs], and 12 anaplastic oligodendrogliomas [AOs]) were included. All OD and AO patients had both IDH-mut and 1p/19q codeletion. The maximum standardized uptake value (SUV) of the tumor/mean SUV of normal cortex (T/N) ratios for MET, CHO, and FDG were calculated, and the mean T/N ratios of DA, AA, and GBM with IDH-wt and IDH-mut were compared. The diagnostic accuracy for distinguishing gliomas with IDH-wt from those with IDH-mut was assessed using receiver operating characteristic (ROC) curve analysis of the mean T/N ratios for the 3 PET tracers.


There were significant differences in the mean T/N ratios for all 3 PET tracers between the IDH-wt and IDH-mut groups of all histological classifications (p < 0.001). Among the 27 gliomas with mean T/N ratios higher than the cutoff values for all 3 PET tracers, 23 (85.2%) were classified into the IDH-wt group using ROC analysis. In DA, there were no significant differences in the T/N ratios for MET, CHO, and FDG between the IDH-wt and IDH-mut groups. In AA, the mean T/N ratios of all 3 PET tracers in the IDH-wt group were significantly higher than those in the IDH-mut group (p < 0.01). In GBM, the mean T/N ratio in the IDH-wt group was significantly higher than that in the IDH-mut group for both MET (p = 0.034) and CHO (p = 0.01). However, there was no significant difference in the ratio for FDG.


PET imaging using MET, CHO, and FDG was suggested to be informative for preoperatively differentiating gliomas according to the 2016 WHO classification, particularly for differentiating IDH-wt and IDH-mut tumors.