Document Detail

Tryptophan PET in pretreatment delineation of newly-diagnosed gliomas: MRI and histopathologic correlates.
MedLine Citation:
PMID:  23299463     Owner:  NLM     Status:  MEDLINE    
Pretreatment delineation of infiltrating glioma volume remains suboptimal with current neuroimaging techniques. Gadolinium-enhanced T1-weighted (T1-Gad) MR images often underestimate the true extent of the tumor, while T2-weighted images preferentially highlight peritumoral edema. Accumulation of α-[(11)C]methyl-L-tryptophan (AMT) on positron emission tomography (PET) has been shown in gliomas. To determine whether increased uptake on AMT-PET would detect tumor-infiltrated brain tissue outside the contrast-enhancing region and differentiate it from peritumoral vasogenic edema, volumes and spatial concordance of T1-Gad and T2 MRI abnormalities as well as AMT-PET abnormalities were analyzed in 28 patients with newly-diagnosed WHO grade II-IV gliomas. AMT-accumulating grade I meningiomas were used to define an AMT uptake cutoff threshold that detects the tumor but excludes peri-meningioma vasogenic edema. Tumor infiltration in AMT-accumulating areas was studied in stereotactically-resected specimens from patients with glioblastoma. In the 28 gliomas, mean AMT-PET-defined tumor volumes were greater than the contrast-enhancing volume, but smaller than T2 abnormalities. Volume of AMT-accumulating tissue outside MRI abnormalities increased with higher tumor proliferative index and was the largest in glioblastomas. Tumor infiltration was confirmed by histopathology from AMT-positive regions outside contrast-enhancing glioblastoma mass, while no or minimal tumor cells were found in AMT-negative specimens. These results demonstrate that increased AMT accumulation on PET detects glioma-infiltrated brain tissue extending beyond the contrast-enhanced tumor mass. While tryptophan uptake is low in peritumoral vasogenic edema, AMT-PET can detect tumor-infiltrated brain outside T2-lesions. Thus, AMT-PET may assist pretreatment delineation of tumor infiltration, particularly in high-grade gliomas.
David O Kamson; Csaba Juhász; Amy Buth; William J Kupsky; Geoffrey R Barger; Pulak K Chakraborty; Otto Muzik; Sandeep Mittal
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2013-01-09
Journal Detail:
Title:  Journal of neuro-oncology     Volume:  112     ISSN:  1573-7373     ISO Abbreviation:  J. Neurooncol.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-27     Completed Date:  2013-09-05     Revised Date:  2014-03-07    
Medline Journal Info:
Nlm Unique ID:  8309335     Medline TA:  J Neurooncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  121-32     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Brain / pathology*,  radionuclide imaging*
Brain Neoplasms / diagnosis*
Carbon Isotopes / diagnostic use
Gadolinium / diagnostic use
Glioma / diagnosis*
Imaging, Three-Dimensional
Magnetic Resonance Imaging
Middle Aged
Positron-Emission Tomography*
Statistics, Nonparametric
Tryptophan / diagnostic use*
Young Adult
Grant Support
P30 CA022453/CA/NCI NIH HHS; R01 CA123451/CA/NCI NIH HHS; R01CA123451/CA/NCI NIH HHS
Reg. No./Substance:
0/Carbon Isotopes; 8DUH1N11BX/Tryptophan; AU0V1LM3JT/Gadolinium

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