Positron emission tomography with injection of methionine as a prognostic factor in glioma

Restricted access

Object. Positron emission tomography with l-[methyl-11C]methionine (MET-PET) provides information on the metabolism of gliomas. The aim of this study was to determine the predictive value of MET-PET in the treatment of patients with gliomas.

Methods. Since 1992, 85 patients with a World Health Organization (WHO) classification—verified glioma underwent PET studies in which MET was injected before (74 cases) or after treatment (11 cases). Analysis of PET data was conducted by the same investigator using two scales: a qualitative visual grading scale and a quantitative scale (ratio between tumor uptake and normal brain uptake, classified on a seven-level scale).

Uptake of MET was present in 98% of gliomas. The investigator judged this uptake to be moderate to very high based on visual inspection (qualitative scale). For all grades of gliomas, a visual grade of 3 was statistically associated with a shorter patient survival period (p < 0.005). The tumor/normal brain uptake ratio was significantly influenced by the histological grade of the tumor. A statistically poor outcome was demonstrated when this ratio was higher than a threshold of 2.2 for a WHO Grade II tumor and 2.8 for WHO Grade III tumor. For Grade II and III tumors, oligodendrogliomas had a higher uptake of MET than astrocytomas.

Conclusions. Uptake of MET was present in 98% of the gliomas studied. A high uptake is statistically associated with a poor survival time. The intensity of MET uptake represents a prognostic factor for WHO Grade II and III tumors considered separately.

Article Information

Address reprint requests to: Olivier De Witte, M.D., Department of Neurosurgery, Hôpital Erasme, U.L.B, 808 Route de Lennik, Brussels, 1070, Belgium. email: odewitte@ ulb.ac.be.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Graph showing Kaplan—Meier survival curves for patients with a visual scale grade below (dotted line) or equal to 3 (solid line). The probability value was 0.0056 according to the log rank test.

  • View in gallery

    Graph showing Kaplan—Meier survival curves for patients with a visual scale grade below (0–2, dotted line) or equal to 3 (only patient in whom a preoperative PET study was performed, solid line). The probability value was 0.0176 according to the log rank test.

  • View in gallery

    Graph showing Kaplan—Meier survival curves for patients with a low-grade glioma (Grade II) and a ratio value below (dotted line) or above the threshold of 2.2 (solid line). The probability value was 0.0114 according to the log rank test.

  • View in gallery

    Graph showing Kaplan—Meier survival curves for patients with a WHO Grade III glioma and a ratio value below (dotted line) or above the threshold of 2.8 (solid line). The probability value was 0.0056 according to the log rank test.

References

  • 1.

    Bergstrom MEricson KHagenfeldt Let al: PET study of methionine accumulation in glioma and normal brain tissue competition with branched chain amino acids. J Comput Assist Tomogr 11:2082131987Bergstrom M Ericson K Hagenfeldt L et al: PET study of methionine accumulation in glioma and normal brain tissue competition with branched chain amino acids. J Comput Assist Tomogr 11:208–213 1987

    • Search Google Scholar
    • Export Citation
  • 2.

    Bustany PChatel MDerlon JMet al: Brain tumor protein synthesis and histological grades: a study by positron emission tomography (PET) with C11-L-Methionine. J Neurooncol 3:3974041986Bustany P Chatel M Derlon JM et al: Brain tumor protein synthesis and histological grades: a study by positron emission tomography (PET) with C11-L-Methionine. J Neurooncol 3:397–404 1986

    • Search Google Scholar
    • Export Citation
  • 3.

    Comar DCartron JMazière Met al: Labeling and metabolism of methionine-methyl-11C. Eur J Nucl Med 1:11141976Comar D Cartron J Mazière M et al: Labeling and metabolism of methionine-methyl-11C. Eur J Nucl Med 1:11–14 1976

    • Search Google Scholar
    • Export Citation
  • 4.

    De Witte OLevivier MViolon Pet al: Prognostic value of positron emission tomography with [18F]fluoro-2-deoxy-D-glucose in the low-grade glioma. Neurosurgery 39:4704771996De Witte O Levivier M Violon P et al: Prognostic value of positron emission tomography with [18F]fluoro-2-deoxy-D-glucose in the low-grade glioma. Neurosurgery 39:470–477 1996

    • Search Google Scholar
    • Export Citation
  • 5.

    Derlon JMBourdet CBustany Pet al: [11C]L-methionine uptake in gliomas. Neurosurgery 25:7207281989Derlon JM Bourdet C Bustany P et al: [11C]L-methionine uptake in gliomas. Neurosurgery 25:720–728 1989

    • Search Google Scholar
    • Export Citation
  • 6.

    Goldman SLevivier MPirotte Bet al: Regional methionine and glucose uptake in high-grade gliomas: a comparative study on PET-guided stereotactic biopsy. J Nucl Med 38:145914621997Goldman S Levivier M Pirotte B et al: Regional methionine and glucose uptake in high-grade gliomas: a comparative study on PET-guided stereotactic biopsy. J Nucl Med 38:1459–1462 1997

    • Search Google Scholar
    • Export Citation
  • 7.

    Herholz KHölzer TBauer Bet al: 11C-methionine PET for differential diagnosis of low-grade gliomas. Neurology 50:131613221998Herholz K Hölzer T Bauer B et al: 11C-methionine PET for differential diagnosis of low-grade gliomas. Neurology 50:1316–1322 1998

    • Search Google Scholar
    • Export Citation
  • 8.

    Hildebrand JDelecluse F: Malignant glioma in Staquet M (ed): Randomized Trials in Cancer: A Critical Review by Sites. New York: Raven Press1986 pp 583604Hildebrand J Delecluse F: Malignant glioma in Staquet M (ed): Randomized Trials in Cancer: A Critical Review by Sites. N ew York: Raven Press 1986 pp 583–604

    • Search Google Scholar
    • Export Citation
  • 9.

    Inoue TShibasaki TOriuchi Net al: 18F alpha-methyl tyrosine PET studies in patients with brain tumors. J Nucl Med 40:3994051999Inoue T Shibasaki T Oriuchi N et al: 18F alpha-methyl tyrosine PET studies in patients with brain tumors. J Nucl Med 40:399–405 1999

    • Search Google Scholar
    • Export Citation
  • 10.

    Kaschten B: Contribution à l'étude du Métabolisme et de la Croissance des Tumeurs Cérébrales. Définitions d'indices Pronostiques. Academic Thesis, University of LiegeBelgium1997 pp 159162Kaschten B: Contribution à l'étude du Métabolisme et de la Croissance des Tumeurs Cérébrales. Définitions d'indices Pronostiques. A cademic Thesis University of Liege Belgium 1997 pp 159–162

    • Search Google Scholar
    • Export Citation
  • 11.

    Kaschten BStevenaert ASadzot Bet al: Preoperative evaluation of 54 gliomas by PET with fluorine-18-fluorodeoxyglucose and/or carbon-11-methionine. J Nucl Med 39:7787851998Kaschten B Stevenaert A Sadzot B et al: Preoperative evaluation of 54 gliomas by PET with fluorine-18-fluorodeoxyglucose and/or carbon-11-methionine. J Nucl Med 39:778–785 1998

    • Search Google Scholar
    • Export Citation
  • 12.

    Keles GEAnderson BBerger MS: The effect of extent of resection on time to tumor progression and survival in patients with glioblastoma multiforme of the cerebral hemisphere. Surg Neurol 52:3713791999Keles GE Anderson B Berger MS: The effect of extent of resection on time to tumor progression and survival in patients with glioblastoma multiforme of the cerebral hemisphere. Surg Neurol 52:371–379 1999

    • Search Google Scholar
    • Export Citation
  • 13.

    Kleihues PBurger PCScheithauer BW: The new WHO classification of brain tumours. Brain Pathol 3:2552681993Kleihues P Burger PC Scheithauer BW: The new WHO classification of brain tumours. Brain Pathol 3:255–268 1993

    • Search Google Scholar
    • Export Citation
  • 14.

    Langen KJBonnie RMühlensiepen Het al: 3-(123I)iodo-α-methyl-L-tyrosine transport and 4F2 antigen expression in human glioma cells. Nucl Med Biol 28:5112001Langen KJ Bonnie R Mühlensiepen H et al: 3-(123I)iodo-α-methyl-L-tyrosine transport and 4F2 antigen expression in human glioma cells. Nucl Med Biol 28:5–11 2001

    • Search Google Scholar
    • Export Citation
  • 15.

    Levivier MGoldman SBidaut LMet al: Positron emission tomography-guided stereotactic brain biopsy. Neurosurgery 31:7927971992Levivier M Goldman S Bidaut LM et al: Positron emission tomography-guided stereotactic brain biopsy. Neurosurgery 31:792–797 1992

    • Search Google Scholar
    • Export Citation
  • 16.

    Levivier MGoldman SPirotte Bet al: Diagnostic yield of stereotactic brain biopsy guided by positron emission tomography with [18F]fluorodeoxyglucose. J Neurosurg 82:4454521995Levivier M Goldman S Pirotte B et al: Diagnostic yield of stereotactic brain biopsy guided by positron emission tomography with [18F]fluorodeoxyglucose. J Neurosurg 82:445–452 1995

    • Search Google Scholar
    • Export Citation
  • 17.

    Mineura KSasajima TKowada Met al: [Changes in the (11C-methyl)-L-methionine uptake index in gliomas following radiotherapy.] Gan No Rinsho 35:110111041989 (Jpn)Mineura K Sasajima T Kowada M et al: [Changes in the (11C-methyl)-L-methionine uptake index in gliomas following radiotherapy.] Gan No Rinsho 35:1101–1104 1989 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 18.

    Mineura KSasajima TSuda Yet al: Amino acid study of cerebral gliomas using positron emission tomography—analysis of (11C-methyl)-L-methionine uptake index. Neurol Med Chir 30:99710021990Mineura K Sasajima T Suda Y et al: Amino acid study of cerebral gliomas using positron emission tomography—analysis of (11C-methyl)-L-methionine uptake index. Neurol Med Chir 30:997–1002 1990

    • Search Google Scholar
    • Export Citation
  • 19.

    Ogawa TKanno IShishido Fet al: Clinical value of PET with 18F-fluorodeoxyglucose and L-methyl-11C-methionine for diagnosis of recurrent brain tumor and radiation injury. Acta Radiol 32:1972021991Ogawa T Kanno I Shishido F et al: Clinical value of PET with 18F-fluorodeoxyglucose and L-methyl-11C-methionine for diagnosis of recurrent brain tumor and radiation injury. Acta Radiol 32:197–202 1991

    • Search Google Scholar
    • Export Citation
  • 20.

    Ogawa TShishido FKanno Iet al: Cerebral glioma evaluation with methionine PET. Radiology 186:45531993Ogawa T Shishido F Kanno I et al: Cerebral glioma evaluation with methionine PET. Radiology 186:45–53 1993

    • Search Google Scholar
    • Export Citation
  • 21.

    Pardridge WM: Brain metabolism a perspective from the blood—brain barrier. Physiol Rev 63:148115351983Pardridge WM: Brain metabolism a perspective from the blood—brain barrier. Physiol Rev 63:1481–1535 1983

    • Search Google Scholar
    • Export Citation
  • 22.

    Plate KH: Mechanisms of angiogenesis in the brain. J Neuropathol Exp Neurol 58:3133201999Plate KH: Mechanisms of angiogenesis in the brain. J Neuropathol Exp Neurol 58:313–320 1999

    • Search Google Scholar
    • Export Citation
  • 23.

    Plate KHRisau W: Angiogenesis in malignant gliomas. Glia 15:3393471995Plate KH Risau W: Angiogenesis in malignant gliomas. Glia 15:339–347 1995

    • Search Google Scholar
    • Export Citation
  • 24.

    Sato KKameyama MKayama Tet al: Serial positron emission tomography imaging of changes in amino acid metabolism in low grade astrocytoma after radio- and chemotherapy—case report. Neurol Med Chir 35:8088121995Sato K Kameyama M Kayama T et al: Serial positron emission tomography imaging of changes in amino acid metabolism in low grade astrocytoma after radio- and chemotherapy—case report. Neurol Med Chir 35:808–812 1995

    • Search Google Scholar
    • Export Citation
  • 25.

    Theurillat JPHainfellner JMaddalena Aet al: Early induction of angiogenetic signals in gliomas of GFAP-v-src transgenic mice. Am J Pathol 154:5815901999Theurillat JP Hainfellner J Maddalena A et al: Early induction of angiogenetic signals in gliomas of GFAP-v-src transgenic mice. Am J Pathol 154:581–590 1999

    • Search Google Scholar
    • Export Citation
  • 26.

    Tovi MThuomas KABergstrom Ket al: Tumour delineation with magnetic resonance imaging in gliomas. A comparison with positron emission tomography and computed tomography. Acta Radiol Suppl 369:1611631986Tovi M Thuomas KA Bergstrom K et al: Tumour delineation with magnetic resonance imaging in gliomas. A comparison with positron emission tomography and computed tomography. Acta Radiol Suppl 369:161–163 1986

    • Search Google Scholar
    • Export Citation

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 255 255 8
Full Text Views 161 161 0
PDF Downloads 95 95 0
EPUB Downloads 0 0 0

PubMed

Google Scholar