title: ¹¹C-methionine uptake and intraoperative 5-aminolevulinic acid-induced fluorescence as separate index markers of cell density in glioma: a stereotactic image-histological analysis.
abstract: BACKGROUND
  The extent of tumor resection is acknowledged as 1 of the prognostic factors for glioma. 5-Aminolevulinic acid (5-ALA)-induced fluorescence guidance and neuronavigation integrated with (11) C-methionine positron emission tomography (PET) are widely utilized under the expectation of improving the extent of resection. These 2 novel approaches are beneficial for glioma resections, and the combination of these approaches appears rational. However, biological characteristics reflecting 5-ALA-induced fluorescence and (11) C-methionine uptake have not been clearly elucidated, and studies about the relationship between 5-ALA-induced fluorescence and (11) C-methionine uptake have been limited. The present study aimed to clarify this issue.
  
  
  METHODS
  Data from 11 consecutive patients harboring astrocytic tumors were analyzed: 2 grade II and 2 grade III, and 7 grade IV tumors were included. Thirty samples from these patients were obtained from the relative periphery of each tumor. Relationships among histology, 5-ALA-induced fluorescence and (11) C-methionine uptake were analyzed by stereotactic sampling and image analysis.
  
  
  RESULTS
  Uptake of (11) C-methionine correlated with cell density (R(2) = 0.322, P = .0059). Cell density was higher in fluorescence-positive areas than in negative areas (2760 ± 1080 vs 1450 ± 1380/mm(2) , P = .0132). Although both (11) C-methionine uptake and fluorescence seemed to correlate with cell density, no significant difference in (11) C-methionine uptake was seen between fluorescence-positive and -negative areas (P = .367). Multiple linear regression analysis revealed (11) C-methionine uptake and 5-ALA-induced fluorescence as independent indices for tumor cell density.
  
  
  CONCLUSIONS
  These results indicate that 5-ALA fluorescence and (11) C-methionine PET image are separate index markers for cytoreduction surgery of gliomas.
authors.affiliation: Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Arita
authors.forename: Manabu
authors.initials: M
authors.lastname: Kinoshita
authors.forename: Naoki
authors.initials: N
authors.lastname: Kagawa
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kishima
authors.forename: Naoya
authors.initials: N
authors.lastname: Hashimoto
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yoshimine
mesh_terms: D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid; D001932:Brain Neoplasms / Q000737:chemistry / Q000378:metabolism / Q000473:pathology*; D002250:Carbon Radioisotopes; D002452:Cell Count; D049109:Cell Proliferation; D005260:Female; D005453:Fluorescence; D005910:Glioma / Q000737:chemistry / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D019394:Ki-67 Antigen / Q000032:analysis; D008279:Magnetic Resonance Imaging; D008297:Male; D008715:Methionine; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011524:Protoporphyrins / Q000032:analysis; D012044:Regression Analysis
chemical_list: D002250:Carbon Radioisotopes; D019394:Ki-67 Antigen; D011524:Protoporphyrins; D000622:Aminolevulinic Acid; D008715:Methionine; C028025:protoporphyrin IX