Diagnostic value of hybrid 11C-methionine PET/MRI for patients with primary or residual/recurrent gliomas
Jiang Shuangshi1, Liu Xuanli2, Feng Hongyan1, Wang Ke1, Zhou Ying1, Ma Xiaowei3, Han Fang2, Bu Lihong1
1Department of PET Center, Renmin Hospital of Wuhan University, Wuhan 430061, China; 2Department of PET/CT Medical Center, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China; 3PET Image Center, the Second Xiangya Hospital of Central South University, Changsha 410011, China
Abstract：Objective This study aims to investigate the diagnostic value of hybrid 11C-methionine positron emission tomography /magnetic resonance imaging (11C-MET PET/MRI) in patients with suspected primary and residual/recurrent gliomas. Methods A retrospective analysis was conducted. Data were obtained from 65 patients with suspected primary or residual/recurrent glioma who underwent hybrid 11C-MET PET/MRI at the People's Hospital of Wuhan University from June 2019 to December 2022. The patients included 36 males and 29 females, aged 13-71 (40.6±15.2) years. Forty-one patients with suspected primary glioma were included in the primary group, and 24 patients with suspected tumor residual/recurrence after surgery/radiation for glioma were included in the follow-up group. The initial group underwent 11C-MET PET/CT and MRI scans before treatment and the follow-up group 1 month after the end of treatment. Both examinations were completed within the same day, and the cross-modality fusion of PET/CT and MRI was performed. PET and MRI sequences and PET/MRI fusion image features were evaluated. Semi-quantitative PET parameters such as standardized maximum uptake value (SUVmax), target to non-target ratio (T/N), and tumor metabolic volume (MTV) as well as semi-quantitative MRI parameters such as cerebral blood flow (CBF), apparent diffusion coefficient (ADC), and choline/N-acetyl aspartate ratio (Cho/NAA) were analyzed. The sensitivity, specificity, and accuracy of Hybrid 11C-MET PET/MRI, 11C-MET PET/CT, or MRI in the diagnosis of primary gliomas and postoperative residual/recurrent tumors were assessed using the patient's pathological histological diagnosis or the final clinical diagnosis obtained after long-term clinical or imaging follow-up as the gold standard. The image characteristics of MRI, PET, and MRI semi-quantitative parameters were compared between patients with benign and malignant lesions within the primary group, between patients with different pathological types of malignant lesions, and between patients with residual/recurrent tumor and post-treatment changes within the follow-up group. Results (1) For the primary diagnosis group, 11C-MET PET/MRI had higher sensitivity (91.7%) than MRI (66.7%), higher specificity (94.1%) than 11C-MET PET/CT (64.7%), and higher accuracy (92.7%) than 11C-MET PET/CT (75.6%) and MRI (73.2%) for the diagnosis of primary glioma. Moreover, significant differences were found in MR image features such as peritumoral edema, enhancement characteristics, and grading of occupancy effect, semi-quantitative PET parameters such as SUVmax and T/N, semi-quantitative MRI parameters such as arterial spin labeling (ASL) and MR spectroscopy (MRS), CBF, and Cho/NAA, between patients with benign and malignant lesions (all P values<0.05). The differences in MRI features (peritumoral edema, occupancy effects, and enhancement features) were also statistically significant when compared between patients with different pathological types of malignant lesions (all P values<0.05). The differences in MRI features (peritumoral oedema, occupancy effects and enhancement features) were statistically significant when compared between patients with different pathological types of malignant lesions (all P values<0.05). (2) For the repeat group, the sensitivity and accuracy of 11C-MET PET/MRI for the diagnosis of residual/recurrent glioma (100%, 95.8%) were higher than those of 11C-MET PET/CT (86.7%, 79.2%) and MRI (66.7%, 70.8%). The differences between patients with residual/recurrent tumor and post-treatment alterations were statistically significant when comparing PET semi-quantitative parameters such as SUVmax, MTV, and T/N and MRI semi-quantitative parameters such as CBF and Cho/NAA (all P values<0.05). Conclusion Hybrid 11C-MET PET/MRI is of great value in detecting and outlining primary or residual/recurrent glioma lesions with higher diagnostic efficacy than 11C-MET PET/CT or MRI alone.
姜双士, 刘烜利, 冯洪燕, 王科, 周莹, 马晓伟, 韩芳, 卜丽红. 异机融合11C-蛋氨酸PET/MRI在原发性、残留/复发性脑胶质瘤诊断中的应用[J]. 中华解剖与临床杂志, 2023, 28(10): 631-639.
Jiang Shuangshi, Liu Xuanli, Feng Hongyan, Wang Ke, Zhou Ying, Ma Xiaowei, Han Fang, Bu Lihong. Diagnostic value of hybrid 11C-methionine PET/MRI for patients with primary or residual/recurrent gliomas. Chinese Journal of Anatomy and Clinics, 2023, 28(10): 631-639.
宋双双, 王振光. 氨基酸类PET联合MRI在脑胶质瘤诊疗中的应用[J].中华神经医学杂志,2022,21(11):1164-1167. DOI: 10.3760/cma.j.cn115354-20220531-00379Song SS, Wang ZG.Recent advance in amino acid PET combined with MRI in brain gliomas[J].Chin J Neuromed,2022,21(11):1164-1167. DOI: 10.3760/cma.j.cn115354-20220531-00379
[2]
Yang Y, He MZ, Li T, et al.MRI combined with PET-CT of different tracers to improve the accuracy of glioma diagnosis: a systematic review and meta-analysis[J]. Neurosurg Rev, 2019,42(2):185-195. DOI: 10.1007/s10143-017-0906-0
[3]
Mangesius J, Mangesius S, Demetz M, et al.A multi-disciplinary approach to diagnosis and treatment of radionecrosis in malignant gliomas and cerebral metastases[J]. Cancers (Basel), 2022,14(24): 6264. DOI: 10.3390/cancers14246264
[4]
Wen PY, Macdonald DR, Reardon DA, et al.Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group[J]. J Clin Oncol, 2010,28(11):1963-1972. DOI: 10.1200/JCO.2009.26.3541
[5]
黄华驰, 崔惠勤, 陈达桂, 等. 11C-MET PET与MRI异机融合对胶质瘤术后残留复发的诊断价值[J].重庆医学,2021,50(19):3338-3341,3345. DOI: 10.3969/j.issn.1671-8348.2021.19.021Huang HC, Cui HQ, Chen DG, et al.The diagnostic value of the cross-modality fusion of 11C-MET PET and MRI in the evaluation of glioma remnant and recurrence after surgery[J].Chongqing Medicine,2021,50(19):3338-3341,3345. DOI: 10.3969/j.issn.1671-8348.2021.19.021
[6]
中华医学会神经外科学分会. 颅内肿瘤周围水肿药物治疗专家共识(第1版)[J].中华医学杂志,2010,90(1):5-9. DOI: 10.3760/cma.j.issn.0376-2491.2010.01.002chines Society of Nearosurgey. Consensus on the drug treatment of peritumoral brain edema[J]. Natl Med J China,2010,90(1):5-9. DOI: 10.3760/cma.j.issn.0376-2491.2010.01.002
[7]
Baris, MM, Celik, AO, Gezer, NS, et al.Role of mass effect, tumor volume and peritumoral edema volume in the differential diagnosis of primary brain tumor and metastasis[J]. Clin Neurol Neurosurg, 2016, 148: 67-71.doi:10.1016/j.clineuro.2016.07.008
[8]
尼加提&#x 000b7;库都来提, 姚成军, 邱天明, 等. 磁共振波谱与11C-蛋氨酸正电子发射显像联合检查在早期诊断幕上非强化胶质瘤中的应用[J].中国临床神经科学,2017,25(3):252-258. DOI: 10.3969/j.issn.1008-0678.2017.03.002Nijiati Kdlt, Yao CJ, Qiu TM, et al.Combination of magnetic resonance spectroscopy and 11C-methionine PET in early diagnosis of non-enhancing supratentorial glioma[J]. Chinese Journal of Clinical Neurosciences,2017,25(3):252-258. DOI: 10.3969/j.issn.1008-0678.2017.03.002
[9]
Nakajima R, Kimura K, Abe K, et al.(11)C-methionine PET/CT findings in benign brain disease[J]. Jpn J Radiol, 2017,35(6):279-288. DOI: 10.1007/s11604-017-0638-7
[10]
郭鹏, 袁晓婷, 魏相磊. 氢质子磁共振波谱对脑膜瘤、脑胶质瘤及脑转移瘤的鉴别诊断价值[J].中国实用医刊,2021,48(24):72-75. DOI: 10.3760/cma.j.cn115689-20210929-03342Guo P, Yuan XT, Wei XL.Differential diagnosis value of hydrogen proton magnetic resonance spectroscopy for meningioma, glioma and brain metastases[J].Chinese Journal of Practical Medicine,2021,48(24):72-75. DOI: 10.3760/cma.j.cn115689-20210929-03342
[11]
Ningning D, Haopeng P, Xuefei D, et al.Perfusion imaging of brain gliomas using arterial spin labeling: correlation with histopathological vascular density in MRI-guided biopsies[J]. Neuroradiology, 2017, 59(1): 51-59.DOI:10.1007/s00234-016-1756-0
[12]
杜常月, 苗娜, 齐旭红, 等. 磁敏感加权成像及3D-ASL在各级脑胶质瘤分级中的价值[J]. 磁共振成像, 2019, 10(9): 645-649.DOI:10.12015/issn.1674-8034.2019.09.002Du CY, Miao N, Qi XH, et al.The value of SWI and 3D-ASL in grading of gliomas[J]. Chin J Magn Reson Imaging, 2019, 10(9): 645-649.DOI:10.12015/issn.1674-8034.2019.09.002
[13]
王子文, 段阳, 杨本强, 等. 氢质子磁共振波谱鉴别恶性胶质瘤与单发性脑转移瘤的价值[J].中国临床实用医学,2017,8(1):33-37. DOI: 10.3760/cma.j.issn.1673-8799.2017.01.009Wang ZW, Duan Y, Yang BQ, et al.The value of 1H-MRS in identification of malignant glioma and solitary brain metastases[J].China Clinical Practical Medicine,2017,8(1):33-37. DOI: 10.3760/cma.j.issn.1673-8799.2017.01.009
[14]
Tian XJ, Wang YZ, Qi M, et al.Diagnostic value of PET with different radiotracers and MRI for recurrent glioma: a Bayesian network meta-analysis[J]. BMJ Open, 2023,13(3):e062555. DOI: 10.1136/bmjopen-2022-062555
[15]
Glaudemans AW, Enting RH, Heesters MA, et al.Value of 11C-methionine PET in imaging brain tumours and metastases[J]. Eur J Nucl Med Mol Imaging, 2013,40(4):615-635. DOI: 10.1007/s00259-012-2295-5
[16]
高玉杰, 周妮娜, 李囡, 等. 11C-MET PET/CT诊断脑胶质瘤术后复发残留的初步研究[J].实用肿瘤杂志,2021,36(2):154-159. DOI: 10.13267/j.cnki.syzlzz.2021.032Gao YJ, Zhou NN, Li N, et al.A preliminary study of 11C-methionine PET/CT in diagnosis of recurrence or residue after glioma surgery[J].Journal of Practical Oncology,2021,36(2):154-159. DOI: 10.13267/j.cnki.syzlzz.2021.032
[17]
Tripathi M, Sharma R, Varshney R, et al.Comparison of F-18 FDG and C-11 methionine PET/CT for the evaluation of recurrent primary brain tumors[J]. Clin Nucl Med, 2012,37(2):158-163. DOI: 10.1097/RLU.0b013e318238f51a
[18]
Deuschl C, Kirchner J, Poeppel TD, et al.11C-MET PET/MRI for detection of recurrent glioma[J]. Eur J Nucl Med Mol Imaging, 2018,45(4):593-601. DOI: 10.1007/s00259-017-3916-9
[19]
D'Souza MM, Sharma R, Jaimini A, et al. 11C-MET PET/CT and advanced MRI in the evaluation of tumor recurrence in high-grade gliomas[J]. Clin Nucl Med, 2014,39(9):791-798. DOI: 10.1097/RLU.0000000000000532.
2023, Vol. 28 
