Combined Use of Positron Emission Tomography with 18F-fluorodeoxyglucose and 11C-methionine for Preoperative Evaluation of Gliomas Shigeru YAMAGUCHI 1 , Shunsuke TERASAKA 1 , Hiroyuki KOBAYASHI 1 , Takuhito NARITA 1 , Kenji HIRATA 2 , Satoshi SHIGA 2 , Reiko USUI 2 , Shinya TANAKA 3 , Kanako KUBOTA 4 , Junichi MURATA 5 , Katsuyuki ASAOKA 6 1Department of Neurosurgery,Hokkaido University Graduate School of Medicine 2Department of Nuclear Medicine,Hokkaido University Graduate School of Medicine 3Department of Pathology,Hokkaido University Graduate School of Medicine 4Department of Surgical Pathology,Hokkaido University Hospital 5Sapporo Azabu Neurosurgical Hospital 6Department of Neurosurgery,Teine Keijinkai Hospital Keyword: fluorodeoxyglucose , glioma , methionine , positron emission tomography , preoperative evaluation pp.621-628
Published Date 2010/7/10
DOI https://doi.org/10.11477/mf.1436101209
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 Object: The aim of this study was to evaluate the usefulness of combined use of positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) and 11C-methionine (MET) for the preoperative evaluation of gliomas and to investigate the feasibility of PET in glioma surgery.

 Methods: Preoperative FDG (n=25) and/or MET (n=22) PET studies were performed in 26 patients with primary and recurrent adult gliomas. We qualitatively (visual analysis) and quantitatively evaluated the uptake of both tracers in the tumor location. For quantitative analysis, data were analyzed by a region of interest method using the standard uptake value (SUV) and a calculated uptake ratio. We investigated the correlation among the tracer uptake ratios, histological tumor grading and tumor proliferation activity.

 Results: On visual inspection, no patient (0/9) with high uptake of FDG had low grade gliomas and 94% (14/15) had high grade gliomas, while uptake of MET was present in all patients. On quantitative analysis, histological tumor grade was most reflected in FDG uptake ratio compared with contralateral white matter. The tumor/normal brain (T/N) uptake ratio of MET increased stepwise with increasing histological grade but was not significantly different from tumor grade. In comparison of FDG and MET uptake ratio with proliferation activity, a significant correlation was shown for FDG uptake ratio, but not for the T/N ratio of MET.

 Conclusions: MET is useful in detecting and delineating the extent of the tumor,but not in evaluating tumor grade and proliferative activity. The FDG uptake ratio correlates well with tumor grade and proliferative activity. Preoperative PET studies with FDG and MET play complementary roles in the planning of glioma surgery,and integrated information from both tracers helps us to plan the extent of tumor resection.

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