Value of 11 C-methionine PET in imaging brain tumours and metastases
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REVIEW ARTICLE
Value of 11C-methionine PET in imaging brain tumours and metastases Andor W. J. M. Glaudemans & Roelien H. Enting & Mart A. A. M. Heesters & Rudi A. J. O. Dierckx & Ronald W. J. van Rheenen & Annemiek M. E. Walenkamp & Riemer H. J. A. Slart Received: 1 August 2012 / Accepted: 6 November 2012 # Springer-Verlag Berlin Heidelberg 2012
Abstract 11C-methionine (MET) is the most popular amino acid tracer used in PET imaging of brain tumours. Because of its characteristics, MET PET provides a high detection rate of brain tumours and good lesion delineation. This review focuses on the role of MET PET in imaging cerebral gliomas. The Introduction provides a clinical overview of what is important in primary brain tumours, recurrent brain tumours and brain metastases. The indications for radiotherapy and the results and problems arising after chemoradiotherapy in relation to imaging (pseudoprogression or radionecrosis) are discussed. The working mechanism, scan interpretation and quantification possibilities of MET PET are then explained. A literature overview is given of the role of MET PET in primary gliomas (diagnostic accuracy, grading, prognosis, assessment of tumour extent, biopsy and radiotherapy planning), in brain metastases, and in the differentiation between tumour recurrence A. W. J. M. Glaudemans (*) : R. A. J. O. Dierckx : R. W. J. van Rheenen : R. H. J. A. Slart Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO 9700 RB, Groningen, The Netherlands e-mail: [email protected] R. H. Enting Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands M. A. A. M. Heesters Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands R. A. J. O. Dierckx Ghent University, Ghent, Belgium A. M. E. Walenkamp Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
and radiation necrosis. Finally, MET PET is compared to other nuclear imaging possibilities in brain tumour imaging. Keywords 11C-Methionine . MET PET . PET tracers . Cerebral glioma . Brain metastases
Introduction Primary brain tumours Primary brain tumours are a heterogeneous group of tumours. Histological diagnoses include gliomas (in approximately 50 % of cases), meningiomas (about 25 %), other neuroepithelial tumours, lymphomas and nerve sheath tumours [1]. The focus of this review are the gliomas. The clinical outcome in patients with gliomas is determined by age, clinical condition, resectability, staging and histological examination for typing and grading of the tumour [2, 3]. Tumour grade is determined using the WHO grading system which is a malignancy scale with grades from I to IV. Grade I includes tumours with low proliferative potential and the possibility of cure following resection alone. Grade II includes low-grade tumours, and grades III and IV include cytologically ma
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