title: Diagnostic accuracy of 11C-methionine PET for differentiation of recurrent brain tumors from radiation necrosis after radiotherapy.
abstract: We evaluated the diagnostic accuracy of PET with l-methyl-(11)C-methionine ((11)C-MET) for the differentiation of recurrent brain tumors from radiation necrosis.
  
  
  METHODS
  Seventy-seven patients who had been previously treated with radiotherapy after primary treatment for metastatic brain tumor (n=51) or glioma (n=26) were studied to clarify the diagnostic performance of (11)C-MET PET in differentiating between recurrent brain tumors and radiation necrosis. A total of 88 PET scans with (11)C-MET were obtained; sometimes more than one scan was obtained when there was an indication of recurrent brain tumor or radiation necrosis. A definitive diagnosis was made on the basis of pathologic examination for recurrent brain tumors and on the basis of pathologic examination or clinical course for radiation necrosis. Several indices characterizing the lesions were determined; these included mean and maximum standardized uptake values (SUV(mean) and SUV(max), respectively) and the ratios of lesion uptake to contralateral normal frontal-lobe gray matter uptake corresponding to the SUV(mean) and the SUV(max) (L/N(mean) and L/N(max), respectively). Receiver-operating-characteristic (ROC) curve analysis was used to determine the optimal index of (11)C-MET PET and cutoff values for the differential diagnosis of tumor recurrence and radiation necrosis.
  
  
  RESULTS
  The values of each index of (11)C-MET PET tended to be higher for tumor recurrence than for radiation necrosis. There were significant differences between tumor recurrence and radiation necrosis in all of the indices except for the L/N(max) for glioma. ROC analysis indicated that the L/N(mean) was the most informative index for differentiating between tumor recurrence and radiation necrosis. An L/N(mean) of greater than 1.41 provided the best sensitivity and specificity for metastatic brain tumor (79% and 75%, respectively), and an L/N(mean) of greater than 1.58 provided the best sensitivity and specificity for glioma (75% and 75%, respectively).
  
  
  CONCLUSIONS
  (11)C-MET PET can provide quantitative values to aid in the differentiation of tumor recurrence from radiation necrosis, although these values do not appear to be absolute indicators. Quantitative analysis of (11)C-MET PET data may be helpful in managing irradiated brain tumors.
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine, Osaka City University, Abeno-ku, Osaka, Japan. terakawa@msic.med.osaka-cu.ac.jp
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Terakawa
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tsuyuguchi
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Iwai
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Higashiyama
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Takami
authors.forename: Kenji
authors.initials: K
authors.lastname: Ohata
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000556:secondary; D002250:Carbon Radioisotopes; D003937:Diagnosis, Differential; D005260:Female; D005910:Glioma / Q000175:diagnosis / Q000556:secondary; D006801:Humans; D008297:Male; D008715:Methionine; D008875:Middle Aged; D009336:Necrosis / Q000175:diagnosis* / Q000209:etiology*; D049268:Positron-Emission Tomography / Q000379:methods*; D012372:ROC Curve; D011878:Radiotherapy / Q000009:adverse effects*; D012680:Sensitivity and Specificity
chemical_list: D002250:Carbon Radioisotopes; D008715:Methionine