Comparison of11C-Methionine and18F-FDG PET/CT for Staging and Follow-up of Pediatric Lymphoma.
Methionine transport across plasma membranes occurs via the large amino acid transporter, which is overexpressed in malignant cells, leading to tracer accumulation within tumors. We investigated the uptake of11C-methionine (11C-MET) in children and young adults with Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL) and compared the biodistribution of11C-MET PET/CT with that of18F-FDG PET/CT.Methods:Conducted under an investigational new drug authorization, we prospectively enrolled patients with newly diagnosed HL (n= 19) and NHL (n= 2) onto the Institutional Review Board-approved investigation of11C-MET PET/CT. After a minimum 4-h fast, patients received 740 MBq/1.7 m2(maximum, 740 MBq [20 mCi/1.7 m2; maximum, 20 mCi]) of11C-methionine intravenously. PET/CT was performed 5 min after injection from the vertex to thighs at 3 min per bed position. In a separate session, patients received 5.5 MBq/kg (maximum, 485 MBq [0.15 mCi/kg; maximum, 12 mCi]) of18F-FDG with imaging initiated approximately 1 h after radiopharmaceutical administration. All studies were reviewed by consensus of 2 senior imaging specialists. The presence of metabolic activity on baseline studies was compared among 17 nodal groups.Results:Eighteen patients (11 male; median age, 15.2 y; age range, 9.5-22.6 y) comprised the study cohort. All had paired11C-MET PET/CT and18F-FDG PET/CT studies at diagnosis. At baseline, 3 nodal groups demonstrating discordant metabolic activity by both18F-FDG PET/CT and11C-MET PET/CT were Waldeyer's ring, paraaortic region, and the liver. All others were found to have concordant metabolic activity. Normal intense11C-MET uptake in the pancreas and liver reduced sensitivity for disease detection in these regions. At follow-up, 14 of 15 study pairs had concordant results.Conclusion:11C-MET uptake is elevated in most regions involved with lymphoma at diagnosis and follow-up. Its utility in the abdomen is limited by uptake in normal structures.
Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee sue.kaste@stjude.org.|Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.|Department of Radiology, University of Tennessee, School of Health Sciences, Memphis, Tennessee.
Sue C
SC
Kaste
Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.
Scott E
SE
Snyder
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.|Department of Pediatrics, University of Tennessee, School of Health Sciences, Memphis, Tennessee.
Monika L
ML
Metzger
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.|Department of Pediatrics, University of Tennessee, School of Health Sciences, Memphis, Tennessee.
John T
JT
Sandlund
School of Health Studies, University of Memphis, Memphis, Tennessee; and.
Scott C
SC
Howard
Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Matthew
M
Krasin
Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.|Department of Radiology, University of Tennessee, School of Health Sciences, Memphis, Tennessee.
Barry L
BL
Shulkin
D000293:Adolescent; D002648:Child; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D005500:Follow-Up Studies; D006801:Humans; D008223:Lymphoma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008657:Metabolic Clearance Rate; D008715:Methionine / Q000493:pharmacokinetics*; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014018:Tissue Distribution; D055815:Young Adult
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; C086242:carbon-11 methionine; D008715:Methionine
Hodgkin disease; fluorodeoxyglucose; lymphoma; methionine