Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb;44(1):587-597.
doi: 10.1007/s10143-020-01258-7. Epub 2020 Feb 15.

Met-PET uptake index for total tumor resection: identification of 11C-methionine uptake index as a goal for total tumor resection including infiltrating tumor cells in glioblastoma

Akihiro Inoue  1 , Takanori Ohnishi  2 , Shohei Kohno  3 , Shiro Ohue  4 , Masahiro Nishikawa  3 , Satoshi Suehiro  3 , Shirabe Matsumoto  3 , Saya Ozaki  3 , Mana Fukushima  5 , Mie Kurata  6 , Riko Kitazawa  5 , Seiji Shigekawa  3 , Hideaki Watanabe  3 , Takeharu Kunieda  3
Affiliations

Met-PET uptake index for total tumor resection: identification of 11C-methionine uptake index as a goal for total tumor resection including infiltrating tumor cells in glioblastoma

Akihiro Inoue et al. Neurosurg Rev. 2021 Feb.

Abstract

Glioblastoma multiforme (GBM) is largely due to glioma stem cells (GSCs) that escape from total resection of gadolinium (Gd)-enhanced tumor on MRI. The aim of this study is to identify the imaging requirements for maximum resection of GBM with infiltrating GSCs. We investigated the relationship of tumor imaging volume between MRI and 11C-methionine (Met)-PET and also the relationship between Met uptake index and tumor activity. In ten patients, tumor-to-contralateral normal brain tissue ratio (TNR) was calculated to evaluate metabolic activity of Met uptake areas which were divided into five subareas by the degrees of TNR. In each GBM, tumor tissue was obtained from subareas showing the positive Met uptake. Immunohistochemistry was performed to examine the tumor proliferative activity and existence of GSCs. In all patients, the volume of Met uptake area at TNR ≦ 1.4 was larger than that of the Gd-enhanced area. The Met uptake area at TNR 1.4 beyond the Gd-enhanced tumor was much wider in high invasiveness-type GBMs than in those of low invasiveness type, and survival was much shorter in the former than the latter types. Immunohistochemistry revealed the existence of GSCs in the area showing Met uptake at TNR 1.4 and no Gd enhancement. Areas at TNR > 1.4 included active tumor cells with relatively high Ki-67 labeling index. In addition, it was demonstrated that GSCs could exist beyond the border of Gd-enhanced tumor. Therefore, to obtain maximum resection of GBMs, including infiltrating GSCs, aggressive surgical excision that includes the Met-positive area at TNR 1.4 should be considered.

Keywords: Glioblastoma; Methionine; Positron emission tomography; Surgical planning; Total resection.

PubMed Disclaimer

References

    1. Arbizu J, Tejada S, Marti-Climent JM, Diez-Valle R, Prieto E, Quincoces G, Vigil C, Idoate MA, Zubieta JL, Peñuelas I, Richter JA (2012) Quantitative volumetric analysis of gliomas with sequential MRI and 11C-methionine PET assessment: patterns of integration in therapy planning. Eur J Nucl Med Mol Imaging 39(5):771–781 - DOI
    1. Della Puppa A, Lombardi G, Rossetto M, Rustemi O, Berti F, Cecchin D, Gardiman MP, Rolma G, Persano L, Zagonel V, Scienza R (2017) Outcome of patients affected by newly diagnosed glioblastoma undergoing surgery assisted by 5-aminolevulinic acid guided resection followed by BCNU wafers implantation: a 3-year follow-up. J Neuro-Oncol 131(2):331–340 - DOI
    1. Donovan LK, Potter NE, Warr T, Pilkington GJ (2012) A prominin-1-rich pediatric glioblastoma: biologic behavior is determined by oxygen tension-modulated CD133 expression but not accompanied by underlying molecular profiles. Transl Oncol 5(3):141–154 - DOI
    1. Galldiks N, Ullrich R, Schroeter M, Fink GR, Jacobs AH, Kracht LW (2010) Volumetry of [(11)C]-methionine PET uptake and MRI contrast enhancement in patients with recurrent glioblastoma multiforme. Eur J Nucl Med Mol Imaging 37(1):84–92 - DOI
    1. Giese A, Kucinski T, Knopp U, Goldbrunner R, Hamel W, Mehdorn HM, Tonn JC, Hilt D, Westphal M (2004) Pattern of recurrence following local chemotherapy with biodegradable carmustine (BCNU) implants in patients with glioblastoma. J Neuro-Oncol 66(3):351–360 - DOI

LinkOut - more resources