title: 1-11C-acetate versus 18F-FDG PET in detection of meningioma and monitoring the effect of gamma-knife radiosurgery.
abstract: This study aimed to define the potential of 1-(11)C-acetate PET, compared with (18)F-FDG, in detecting meningiomas and monitoring the effect of gamma-knife radiosurgery.
  
  
  METHODS
  Twenty-two patients with the neuroradiologic diagnosis of meningioma were examined by 1-(11)C-acetate and (18)F-FDG PET on the same day. There were 12 cases of histopathologically proven meningioma (8 grade I, 2 grade II, and 2 grade III), 1 of tuberculous granuloma, and 1 of degenerative tissue. 1-(11)C-acetate PET scans of fasting patients were obtained 10 min after intravenous administration of 740 MBq of 1-(11)C-acetate. (18)F-FDG PET was performed at 2 h after 1-(11)C-acetate scanning. The PET images were evaluated by a qualitative method and semiquantitative analysis using standardized uptake value and tumor-to-cortex ratio.
  
  
  RESULTS
  The (18)F-FDG PET study revealed a hypometabolic focus in 17 meningiomas (8 grade I, 1 grade II, and 8 unknown grade) and hypermetabolism in 1 grade II and 2 grade III meningiomas. High uptake of 1-(11)C-acetate was observed in all 20 meningiomas, in contrast to the low uptake in surrounding normal brain tissue, allowing a clearer demarcation of the tumor boundary than that provided by (18)F-FDG. Dissociation of regional accumulation of 1-(11)C-acetate and (18)F-FDG within the tumor was also noted on the coregistered images. The standardized uptake value for 1-(11)C-acetate was not different from that for (18)F-FDG (mean +/- SD, 3.16 +/- 1.75 vs. 3.22 +/- 1.50, P = 0.601), but the tumor-to-cortex ratio for 1-(11)C-acetate was higher than that for (18)F-FDG (3.46 +/- 1.38 vs. 0.93 +/- 1.08, P < 0.005). (18)F-FDG was able to differentiate grade I from grade II-III meningiomas, whereas 1-(11)C-acetate was unable to do so. Tuberculous granuloma had a high 1-(11)C-acetate and (18)F-FDG uptake similar to that of grade II/III meningioma. Five patients received 1-(11)C-acetate and (18)F-FDG PET before and after gamma-knife surgery. 1-(11)C-acetate performed better than did (18)F-FDG in monitoring the response of tumor metabolism to radiosurgery.
  
  
  CONCLUSIONS
  1-(11)C-acetate was found to be useful for detecting meningiomas and evaluating the extent of meningiomas and potentially useful for monitoring tumor response to radiosurgery. However, 1-(11)C-acetate was not useful for evaluating the tumor grade. (18)F-FDG was found to be less useful than 1-(11)C-acetate for evaluating the extent of meningiomas and the response to radiosurgical treatment but may be useful for differentiating benign from malignant meningiomas. (18)F-FDG and 1-(11)C-acetate are complementary for assessing diverse cell metabolism of meningioma.
authors.affiliation: Department of Nuclear Medicine, National PET/Cyclotron Center, Taipei Veterans General Hospital, Taipei, Taiwan. rsliu@vghtpe.gov.tw
authors.forename: Ren-Shyan
authors.initials: RS
authors.lastname: Liu
authors.forename: Chen-Pei
authors.initials: CP
authors.lastname: Chang
authors.forename: Wen-You
authors.initials: WY
authors.lastname: Guo
authors.forename: David H C
authors.initials: DH
authors.lastname: Pan
authors.forename: Donald Ming-Tak
authors.initials: DM
authors.lastname: Ho
authors.forename: Chi-Wei
authors.initials: CW
authors.lastname: Chang
authors.forename: Bang-Hung
authors.initials: BH
authors.lastname: Yang
authors.forename: Liang-Chi
authors.initials: LC
authors.lastname: Wu
authors.forename: Shin-Hwa
authors.initials: SH
authors.lastname: Yeh
mesh_terms: D000085:Acetates / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001692:Biological Transport; D002244:Carbon / Q000378:metabolism; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008579:Meningioma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D016634:Radiosurgery; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000085:Acetates; C438206:carbon-11 acetate; D019788:Fluorodeoxyglucose F18; D002244:Carbon