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

Clinical article

Natsuki Shinozaki M.D.1, Yoshio Uchino M.D., Ph.D.2, Kyosan Yoshikawa M.D., Ph.D.3, Tomoo Matsutani M.D., Ph.D.1, Azusa Hasegawa M.D., Ph.D.3, Naokatsu Saeki M.D., Ph.D.1, and Yasuo Iwadate M.D., Ph.D.1,3
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  • 1 Department of Neurological Surgery, Chiba University Graduate School of Medicine;
  • | 2 Chiba Medical Center for Prolonged Traumatic Brain Dysfunction; and
  • | 3 National Institute of Radiological Science, Chiba, Japan
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Object

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.

Methods

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.

Results

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.

Conclusions

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.

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