Surgical target selection in cerebral glioma surgery: linking methionine (MET) PET image fusion and neuronavigation.
OBJECTIVE
The objective of this study was to investigate the histological correlate of (11)C-methionine (MET) PET uptake of brain gliomas by image fusion for navigated surgery.


METHODS
Twenty-seven patients (18 male, 9 female; mean age 42 years; range 11-77 years; 8 low-grade and 11 high-grade astrocytomas or mixed gliomas, 8 oligodendrogliomas) underwent MET PET studies preoperatively.


RESULTS
MET PET tumor uptake was detected in 26 of 27 patients (96.3%). The quantitative MET tumor standardized uptake value (SUV) ratio was significantly higher in malignant gliomas and oligodendrogliomas than in low-grade gliomas (2.76/2.62 vs. 1.67, p=0.03). Generally, qualitative visual grading of MET uptake revealed 2 main patterns: focal MET uptake in 12 and uniform global MET uptake in 11 patients. Focal uptake corresponded to malignant glioma histology in 66.7%, and uniform global uptake to oligodendroglial histology in 72.7%. In oligodendrogliomas, global MET uptake constituted 81.5% (range 53.8-135%) of the MRI T(1) tumor volume on average and was limited to the MRI FLAIR tumor volume in 86% (7/8) of patients. Tissue samples of focal MET uptake areas correlated with histological anaplasia in 66.6% (8/12 glioma patients), although 62.5% (5/8 patients) lacked MRI contrast enhancement.


CONCLUSIONS
MET PET image fusion may facilitate the targeting of anaplastic foci in homogeneous MRI non-enhancing gliomas for biopsy, may identify oligodendroglial histology preoperatively as well as characterize biologically active tumor volumes within MRI T(1)/FLAIR tumor areas of candidate patients for resection.
Department of Neurosurgery, Medical University of Vienna, Vienna, Austria. Karl.Roessler@lkhf.at
K
K
Roessler
B
B
Gatterbauer
A
A
Becherer
M
M
Paul
K
K
Kletter
D
D
Prayer
R
R
Hoeftberger
J
J
Hainfellner
S
S
Asenbaum
E
E
Knosp
D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D002250:Carbon Radioisotopes; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D008297:Male; D008715:Methionine / Q000378:metabolism; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D009837:Oligodendroglioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000295:instrumentation / Q000379:methods; D012680:Sensitivity and Specificity
D002250:Carbon Radioisotopes; D008715:Methionine