C-methyl-L-methionine PET Measuring Parameters for the Diagnosis of Tumour Progression Against Radiation-induced Changes in Brain Metastases

Overview

Journal Br J Radiol

Publisher Oxford University Press

Specialty Radiology

Date 2021 Jul 8

PMID 34233489

Citations 5

Authors

Chris W Govaerts

Bart Rj van Dijken

Gilles N Stormezand

Hiske L van der Weide

Michiel Wagemakers

Roelien H Enting

Anouk van der Hoorn

Affiliations

Soon will be listed here.

Abstract

Objectives: Radiation-induced changes (RIC) secondary to focal radiotherapy can imitate tumour progression in brain metastases and make follow-up clinical decision making unreliable. C-methyl-L-methionine-PET (MET-PET) is widely used for the diagnosis of RIC in brain metastases, but minimal literature exists regarding the optimum PET measuring parameter to be used. We analysed the diagnostic performance of different MET-PET measuring parameters in distinguishing between RIC and tumour progression in a retrospective cohort of brain metastasis patients.

Methods: 26 patients with 31 metastatic lesions were included on the basis of having undergone a PET scan due to radiological uncertainty of disease progression. The PET images were analysed and methionine uptake quantified using standardised-uptake-values (SUV) and tumour-to-normal tissue (T/N) ratios, generated as SUV, SUV, SUV, T/N, T/N and T/N. Metabolic-tumour-volume and total-lesion methionine metabolism were also computed. A definitive diagnosis of either RIC or tumour progression was established by clinicoradiological follow-up of least 4 months subsequent to the investigative PET scan.

Results: All MET-PET parameters except metabolic-tumour-volume showed statistically significant differences between tumour progression and lesions with RIC. Receiver-operating-characteristic curve and area-under the-curve analysis demonstrated the highest value of 0.834 for SUV with a corresponding optimum threshold of 3.29. This associated with sensitivity, specificity, positive predictive and negative predictive values of 78.57, 70.59%, 74.32 and 75.25% respectively.

Conclusions: MET-PET is a useful modality for the diagnosis of RIC in brain metastases. SUV was the PET parameter with the greatest diagnostic performance.

Advances In Knowledge: More robust comparisons between SUV and SUV could enhance follow-up treatment planning.

Citing Articles

Joint EANM/EANO/RANO/SNMMI practice guideline/procedure standard for PET imaging of brain metastases: version 1.0.

Verger A, Tolboom N, Cicone F, Chang S, Furtner J, Galldiks N Eur J Nucl Med Mol Imaging. 2025; .

PMID: 39762634 DOI: 10.1007/s00259-024-07038-5.

Simultaneous evaluation of brain metastasis and thoracic cancer using semiconductor C-methionine PET/CT imaging.

Kaneko K, Nagao M, Ueda K, Yamamoto A, Sakai S Ann Nucl Med. 2024; 38(4):278-287.

PMID: 38386272 DOI: 10.1007/s12149-024-01908-6.

Assessing the role of positron emission tomography and bone scintigraphy in imaging of pleuropulmonary blastoma (PPB): A report from the International PPB/DICER1 Registry.

Hagedorn K, Nelson A, Towbin A, Frederickson N, Mallinger P, Lucas Jr J Pediatr Blood Cancer. 2023; 70(11):e30628.

PMID: 37592371 PMC: 10538369. DOI: 10.1002/pbc.30628.

The Role of Molecular Imaging in Patients with Brain Metastases: A Literature Review.

Urso L, Bonatto E, Nieri A, Castello A, Maffione A, Marzola M Cancers (Basel). 2023; 15(7).

PMID: 37046845 PMC: 10093739. DOI: 10.3390/cancers15072184.

[Ga]FAPI-PET/CT for radiation therapy planning in biliary tract, pancreatic ductal adeno-, and adenoidcystic carcinomas.

Guberina N, Kessler L, Pottgen C, Guberina M, Metzenmacher M, Herrmann K Sci Rep. 2022; 12(1):16261.

PMID: 36171444 PMC: 9519639. DOI: 10.1038/s41598-022-20447-6.

References

Sneed P, Mendez J, Vemer-van den Hoek J, Seymour Z, Ma L, Molinaro A . Adverse radiation effect after stereotactic radiosurgery for brain metastases: incidence, time course, and risk factors. J Neurosurg. 2015; 123(2):373-86. DOI: 10.3171/2014.10.JNS141610. View

Minniti G, Clarke E, Lanzetta G, Osti M, Trasimeni G, Bozzao A . Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis. Radiat Oncol. 2011; 6:48. PMC: 3108308. DOI: 10.1186/1748-717X-6-48. View

Dankbaar J, Snijders T, Robe P, Seute T, Eppinga W, Hendrikse J . The use of (18)F-FDG PET to differentiate progressive disease from treatment induced necrosis in high grade glioma. J Neurooncol. 2015; 125(1):167-75. PMC: 4592487. DOI: 10.1007/s11060-015-1883-1. View

Grosu A, Astner S, Riedel E, Nieder C, Wiedenmann N, Heinemann F . An interindividual comparison of O-(2-[18F]fluoroethyl)-L-tyrosine (FET)- and L-[methyl-11C]methionine (MET)-PET in patients with brain gliomas and metastases. Int J Radiat Oncol Biol Phys. 2011; 81(4):1049-58. DOI: 10.1016/j.ijrobp.2010.07.002. View

Aide N, Lasnon C, Veit-Haibach P, Sera T, Sattler B, Boellaard R . EANM/EARL harmonization strategies in PET quantification: from daily practice to multicentre oncological studies. Eur J Nucl Med Mol Imaging. 2017; 44(Suppl 1):17-31. PMC: 5541084. DOI: 10.1007/s00259-017-3740-2. View

Valiente M, Ahluwalia M, Boire A, Brastianos P, Goldberg S, Lee E . The Evolving Landscape of Brain Metastasis. Trends Cancer. 2018; 4(3):176-196. PMC: 6602095. DOI: 10.1016/j.trecan.2018.01.003. View

Thust S, van den Bent M, Smits M . Pseudoprogression of brain tumors. J Magn Reson Imaging. 2018; . PMC: 6175399. DOI: 10.1002/jmri.26171. View

Okamoto S, Shiga T, Hattori N, Kubo N, Takei T, Katoh N . Semiquantitative analysis of C-11 methionine PET may distinguish brain tumor recurrence from radiation necrosis even in small lesions. Ann Nucl Med. 2010; 25(3):213-20. DOI: 10.1007/s12149-010-0450-2. View

Lin N, Lee E, Aoyama H, Barani I, Barboriak D, Baumert B . Response assessment criteria for brain metastases: proposal from the RANO group. Lancet Oncol. 2015; 16(6):e270-8. DOI: 10.1016/S1470-2045(15)70057-4. View

10.

Tabouret E, Chinot O, Metellus P, Tallet A, Viens P, Goncalves A . Recent trends in epidemiology of brain metastases: an overview. Anticancer Res. 2012; 32(11):4655-62. View

11.

Brahm C, den Hollander M, Enting R, de Groot J, Solouki A, den Dunnen W . Serial FLT PET imaging to discriminate between true progression and pseudoprogression in patients with newly diagnosed glioblastoma: a long-term follow-up study. Eur J Nucl Med Mol Imaging. 2018; 45(13):2404-2412. PMC: 6208814. DOI: 10.1007/s00259-018-4090-4. View

12.

Chao S, Ahluwalia M, Barnett G, Stevens G, Murphy E, Stockham A . Challenges with the diagnosis and treatment of cerebral radiation necrosis. Int J Radiat Oncol Biol Phys. 2013; 87(3):449-57. DOI: 10.1016/j.ijrobp.2013.05.015. View

13.

Ellingson B, Chung C, Pope W, Boxerman J, Kaufmann T . Pseudoprogression, radionecrosis, inflammation or true tumor progression? challenges associated with glioblastoma response assessment in an evolving therapeutic landscape. J Neurooncol. 2017; 134(3):495-504. PMC: 7893814. DOI: 10.1007/s11060-017-2375-2. View

14.

Lizarraga K, Allen-Auerbach M, Czernin J, DeSalles A, Yong W, Phelps M . (18)F-FDOPA PET for differentiating recurrent or progressive brain metastatic tumors from late or delayed radiation injury after radiation treatment. J Nucl Med. 2013; 55(1):30-6. DOI: 10.2967/jnumed.113.121418. View

15.

Brandsma D, Stalpers L, Taal W, Sminia P, van den Bent M . Clinical features, mechanisms, and management of pseudoprogression in malignant gliomas. Lancet Oncol. 2008; 9(5):453-61. DOI: 10.1016/S1470-2045(08)70125-6. View

16.

Minamimoto R, Saginoya T, Kondo C, Tomura N, Ito K, Matsuo Y . Differentiation of Brain Tumor Recurrence from Post-Radiotherapy Necrosis with 11C-Methionine PET: Visual Assessment versus Quantitative Assessment. PLoS One. 2015; 10(7):e0132515. PMC: 4500444. DOI: 10.1371/journal.pone.0132515. View

17.

Singh Achrol A, Rennert R, Anders C, Soffietti R, Ahluwalia M, Nayak L . Brain metastases. Nat Rev Dis Primers. 2019; 5(1):5. DOI: 10.1038/s41572-018-0055-y. View

18.

Ceccon G, Lohmann P, Stoffels G, Judov N, Filss C, Rapp M . Dynamic O-(2-18F-fluoroethyl)-L-tyrosine positron emission tomography differentiates brain metastasis recurrence from radiation injury after radiotherapy. Neuro Oncol. 2016; 19(2):281-288. PMC: 5463967. DOI: 10.1093/neuonc/now149. View

19.

Hardesty D, Nakaji P . The Current and Future Treatment of Brain Metastases. Front Surg. 2016; 3:30. PMC: 4879329. DOI: 10.3389/fsurg.2016.00030. View

20.

Galldiks N, Langen K, Albert N, Chamberlain M, Soffietti R, Kim M . PET imaging in patients with brain metastasis-report of the RANO/PET group. Neuro Oncol. 2019; 21(5):585-595. PMC: 6502495. DOI: 10.1093/neuonc/noz003. View