Metabolic Assessment of Gliomas Using 11C-Methionine, [18F] Fluorodeoxyglucose, and 11C-Choline Positron-Emission Tomography

T. Kato; J. Shinoda; N. Nakayama; K. Miwa; A. Okumura; H. Yano; S. Yoshimura; T. Maruyama; Y. Muragaki; T. Iwama

doi:10.3174/ajnr.A1008

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Fig 1.
Graph showing the correlation between tracer uptake and tumor grade. *P < .05, †P < .01, ‡P < .001.
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Fig 2.
Left top, Contrast-enhanced, T1-weighted image. Right top, MET PET is superimposed on MR imaging. Left bottom, CHO PET is superimposed on MR imaging. Right bottom, FDG PET is superimposed on MR imaging. A, A 32-year-old woman presented with diffuse astrocytoma. MET T/N ratio = 1.72, CHO T/N ratio = 1.38, and FDG T/N ratio = 0.66. B, A 23-year-old woman presented with oligoastrocytoma. MET T/N ratio = 2.76, CHO T/N ratio = 1.82, and FDG T/N ratio = 0.92. C, A 44-year-old man presented with oligodendroglioma. MET T/N ratio = 3.71, CHO T/N ratio = 2.74, and FDG T/N ratio = 1.07. D, A 62-year-old woman presented with anaplastic astrocytoma. MET T/N ratio = 4.26, CHO T/N ratio = 10.17, and FDG T/N ratio = 1.24. E, A 68-year-old man presented with glioblastoma multiforme. MET T/N ratio = 6.85, CHO T/N ratio = 33.38, and FDG T/N ratio = 2.55.
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Fig 3.
Graph showing the correlation between MET T/N ratio and FDG T/N ratio (r = 0.67; P < .001), CHO T/N ratio and FDG T/N ratio (r = 0.73; P < .001), and MET T/N ratio and CHO T/N ratio (r = 0.75; P < .001) in all of the gliomas.
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Fig 4.
Graph showing the correlation between Mib-1 LI and MET T/N ratio (r = 0.64; P < .001), FDG T/N ratio (r = 0.71; P < .001), and CHO T/N ratio (r = 0.64; P < .001) in ATs.

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Table 1:

Histopathologic results according to WHO classification and MRI findings

WHO Classification	No. of Patients	Age, Mean ± SD, y	Tumor Size, Mean ± SD, cm³	MRI Enhancement^*
WHO Classification	No. of Patients	Age, Mean ± SD, y	Tumor Size, Mean ± SD, cm³	None	Weak	Strong
Grade II
Diffuse astrocytoma	14	37.9 ± 13.4	51.1 ± 44.4	11	1	2
Oligodendroglioma	9	36.8 ± 12.4	65.7 ± 56.7	6	3	0
Oligoastrocytoma	14	38.6 ± 14.1	48.3 ± 41.0	12	1	1
Grade III
Anaplastic astrocytoma	19	43.2 ± 13.6	48.7 ± 23.3	5	8	6
Anaplastic oligodendroglioma	13	50.2 ± 14.8	40.4 ± 27.6	4	2	7
Anaplastic oligoastrocytoma	5	44.2 ± 18.8	35.2 ± 10.2	3	2	0
Grade IV
Glioblastoma multiforme	21	60.0 ± 10.9	43.7 ± 32.7	0	3	18
Total	95	45.9 ± 15.6	47.6 ± 35.6	41	20	34

Note:—MRI indicates MR imaging; WHO, World Health Organization.
* None indicates no enhancement; weak, partial or slight enhancement; strong, obvious enhancement.

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Table 2:

T/N ratio in gliomas

Tumor	Grade II, Mean ± SD	Grade III, Mean ± SD	Grade IV, Mean ± SD
Astrocytic tumor, n	14	19	21
MET	2.24 ± 0.90	3.03 ± 1.02	5.03 ± 1.65
FDG	0.79 ± 0.08	1.27 ± 0.46	1.88 ± 0.78
CHO	2.69 ± 2.04	4.76 ± 3.04	18.35 ± 6.73
Oligodendroglial tumor	9	13
MET	3.95 ± 1.60	4.46 ± 1.55
FDG	1.03 ± 0.40	1.71 ± 1.09
CHO	3.46 ± 2.52	12.71 ± 12.21
Oligoastrocytic tumor	14	5
MET	2.60 ± 0.91	2.83 ± 0.99
FDG	1.00 ± 0.45	0.85 ± 0.15
CHO	3.78 ± 3.36	3.02 ± 1.74

Note:—T/N ratio indicates tumor/normal brain uptake ratio; MET, ¹¹C-methionine; FDG, [¹⁸F] fluorodeoxyglucose; CHO, ¹¹C-choline.

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Table 3:
Summary statistics of ANCOVAs
Variable MET, P FDG, P CHO, P
Size .07 .39 .19
Grade <.005 <.005 <.001
Type <.05 .33 .12
Gd-DTPA enhancement <.05 .30 <.01
Note:—MET indicates ¹¹C-methionine; FDG, [¹⁸F] fluorodeoxyglucose; CHO, ¹¹C-choline; Gd-DTPA, gadopentetate dimeglumine.

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Table 4:

Percentage of T/N ratio more than 2.0 in gliomas

Variable	Grade II (37), n (%)	Grade III (37), n (%)	Grade IV (21), n (%)	Overall (95), n (%)^*
MET	28 (75.7)	34 (91.9)	21 (100.0)	83 (87.4)
FDG	1 (2.7)	6 (16.2)	6 (28.6)	13 (13.7)
CHO	18 (48.6)	29 (78.4)	21 (100.0)	68 (71.6)

Note:—T/N ratio indicates tumor/normal brain uptake ratio; MET, ¹¹C-methionine; FDG, [¹⁸F] fluorodeoxyglucose; CHO, ¹¹C-choline.
* There were significant differences in the percentage of T/N ratio more than 2.0 among 3 tracers by using X² test with Bonferroni correction. (MET/FDG and CHO/FDG: P < .001; MET/CHO: P < .01).

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Table 5:

Correlation between tracer uptake and proliferation index

Variable	Tumor	Mib-1 LI
Variable	Tumor	P	r
MET	Astrocytic tumor	<.001	0.64
	Oligodendroglial tumor	.63	−0.13
	Oligoastrocytic tumor	.84	0.05
	All tumor	<.01	0.31
FDG	Astrocytic tumor	<.001	0.71
	Oligodendroglial tumor	.27	0.29
	Oligoastrocytic tumor	.78	−0.07
	All tumor	<.001	0.42
CHO	Astrocytic tumor	<.001	0.64
	Oligodendroglial tumor	.67	0.11
	Oligoastrocytic tumor	.44	0.19
	All tumor	<.001	0.42

Note:—Proliferation index was measured by Mib-1 labeling index; MET indicates ¹¹C-methionine; FDG, [¹⁸F] fluorodeoxyglucose; CHO, ¹¹C-choline; LI, labeling index. P and r values were calculated by using Spearman correlation coefficients.