Diagnostic accuracy of 11 C-methionine PET in detecting neuropathologically confirmed recurrent brain tumor after radiat
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ORIGINAL ARTICLE
Diagnostic accuracy of 11C-methionine PET in detecting neuropathologically confirmed recurrent brain tumor after radiation therapy Annika Kits1 · Heather Martin1 · Alejandro Sanchez‑Crespo2 · Anna F. Delgado1,3 Received: 23 October 2017 / Accepted: 18 December 2017 © The Japanese Society of Nuclear Medicine 2017
Abstract Objective This study aims to determine the diagnostic test accuracy (DTA) of 11C-methionine (MET) PET in the discrimination between recurrent tumor and radiation-induced injury in neuropathologically confirmed cases. Methods A retrospective cohort of 30 patients with previously irradiated intracranial tumors (23 gliomas, 6 metastases, and 1 meningioma) was included. All patients underwent a preoperative MET PET and postoperative neuropathological analysis. Maximum and mean standardized uptake values (SUV) were obtained in the lesion, in the contralateral mirror region, and in the contralateral frontal cortex. Lesion-to-background SUV ratios (SUR mirror and SUR cortex) were then calculated. The Mann–Whitney U test was used to evaluate differences in SUV ratios between confirmed recurrent tumor and radiation injury. DTA was determined through receiver operating characteristic (ROC) analysis. Results Twenty-one patients had recurrent tumor and nine had radiation injury. The area under the ROC curve (AUC) was 0.89 for SURmaxmirror and 0.88 for SURmaxcortex. The mean (SD) of SURmaxmirror was 2.37 (0.58) in tumor recurrence and 1.57 (0.40) in radiation necrosis (P ≤ 0.001). The corresponding values for S URmaxcortex were 2.13 (0.50) and 1.45 (0.37) (P = 0.001). Clinically relevant cutoffs were SURmaxmirror ≥ 1.99 giving a specificity of 100% for tumor recurrence with a sensitivity of 76% and SURmaxcortex ≥ 1.58 giving a sensitivity and specificity of 90 and 78%, respectively. Conclusions Based on neuropathologically confirmed cases, the DTA of S URmaxmirror and S URmaxcortex from 11C-methionine PET was high when discriminating recurrent tumor from radiation injury. Keywords Radiation injury · 11C-methionine PET · Radiosurgery · Brain tumor recurrence · Gamma-knife surgery
Background
* Annika Kits [email protected] Heather Martin [email protected] Alejandro Sanchez‑Crespo alejandro.sanchez‑[email protected] Anna F. Delgado anna.falk‑[email protected] 1
Department of Neuroradiology, Karolinska University Hospital, R3:00, Solna, 17176 Stockholm, Sweden
2
Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
3
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
Radiotherapy contributes to the treatment of intracranial tumors, but can lead to radiation-related injury [1]. Lesion growth does not always indicate tumor progression, but may represent reversible radiation injury or permanent radiation necrosis. Differentiation of recurrent brain tumor from radiation-induced injury is often difficult with the conventional magnetic resonance imaging [2, 3]. The previous studies have indicated tha
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