Analysis of progression and recurrence of meningioma using 11 C-methionine PET
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ORIGINAL ARTICLE
Analysis of progression and recurrence of meningioma using 11C-methionine PET Hidetoshi Ikeda • Naohiro Tsuyuguchi • Noritsugu Kunihiro • Kenichi Ishibashi • Takeo Goto • Kenji Ohata
Received: 31 January 2013 / Accepted: 16 June 2013 Ó The Japanese Society of Nuclear Medicine 2013
Abstract Objective The recurrence rate of meningioma after surgery is high, and progression is often observed. The risk factors for recurrence and progression are not clear. We evaluated the risk factors for recurrence and progression in meningioma using 11C-methionine (MET) positron emission tomography (PET). Methods Thirty-seven patients (mean follow-up, 80 months) with an intracranial meningioma were enrolled. MET PET was performed before treatment between 1995 and 2010, and patients were followed up in an out-patient clinic. Surgery was performed in 33 patients, and a waitand-see approach was taken in four patients. We evaluated the extent of tumor resection, location, WHO grade, Ki-67 labeling index, and lesion to normal ratio (LN ratio) of MET uptake. Results Six of the surgical cases had a recurrence, and two of the observation-only patients had tumor progression. A high LN ratio of MET uptake was a significant risk factor for recurrence and progression with univariate analysis. The area under the curve of receiver operating characteristic curve for the LN ratio of MET uptake was 0.754, and the optimal cutoff value was 3.18 (sensitivity 63 %, specificity 79 %). With multivariate analysis, a high LN ratio of MET uptake, non-gross total resection, and a high WHO grade were significant risk factors for progression and recurrence.
H. Ikeda (&) N. Tsuyuguchi N. Kunihiro K. Ishibashi T. Goto K. Ohata Department of Neurosurgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan e-mail: [email protected]
Conclusion A high LN ratio of MET uptake was a risk factor for tumor progression and recurrence. The advantage of MET PET is that it is not invasive and can easily be used to evaluate the whole tumor. Keywords 11C-methionine PET Meningioma Riskfactor of recurrence and progression Multivariable analysis ROC analysis
Introduction Meningioma is the most common primary brain tumor in adults. The frequency of meningioma among all types of brain tumors is 26.4 % in Japan [1] and 34.4 % in the United States. Many histopathological subtypes exist. Most meningiomas are benign, but World Health Organization (WHO) grade II and grade III meningiomas, which exhibit aggressive clinical behavior, are found in 10 % of patients with meningioma. We usually perform surgery for symptomatic cases or cases with large tumors. For small and asymptomatic cases, a wait-and-see approach is taken. However, gross total resection (GTR) is difficult in some surgical cases because of the tumor location and invasion into the brain tissue and the venous sinus. The residual tumor often recurs with malignancy, making the patient’s prognosis poor. Meningiomas that are only obs
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