Association Between Pretreatment 11C-Methionine Positron Emission Tomography Metrics, Histology, and Prognosis in 125 Newly Diagnosed Patients with Adult-Type Diffuse Glioma Based on the World Health Organization 2021Classification

Koichiro Kaneko; Shunichi Koriyama; Shunsuke Tsuzuki; Kenta Masui; Rie Kanasaki; Atsushi Yamamoto; Michinobu Nagao; Yoshihiro Muragaki; Takakazu Kawamata; Shuji Sakai

doi:10.1016/j.wneu.2024.03.164

Association Between Pretreatment ¹¹C-Methionine Positron Emission Tomography Metrics, Histology, and Prognosis in 125 Newly Diagnosed Patients with Adult-Type Diffuse Glioma Based on the World Health Organization 2021Classification

World Neurosurg. 2024 Apr 5:S1878-8750(24)00550-3. doi: 10.1016/j.wneu.2024.03.164. Online ahead of print.

Authors

Affiliations

¹ Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: kaneko.koichiro@twmu.ac.jp.
² Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
³ Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan.
⁴ Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan.

PMID: 38583563
DOI: 10.1016/j.wneu.2024.03.164

Abstract

Objective: To clarify the relationships between ¹¹C-methionine (MET) positron emission tomography (PET) metrics and the histology, genetics, and prognosis of adult-type diffuse glioma (ADG) based on the World Health Organization (WHO) 2021 classification.

Methods: A total of 125 newly diagnosed patients with ADG were enrolled. We compared the maximum standardized uptake value (SUVmax), tumor-to-normal background ratio (TNR), metabolic tumor volume (MTV), and total lesion methionine uptake (TLMU) to the histology and genetics of the patients with ADG. We also evaluated the prognoses of the 93 surgically treated patients.

Results: The patients with isocitrate dehydrogenase wild ADG showed significantly higher MET-PET metrics (P < 0.05 for all parameters), significantly shorter overall survival and progression-free survival (P < 0.0001 for both) than those of the patients with isocitrate dehydrogenase mutant (IDHm) ADG. In the IDHm ADG group, the SUVmax, MTV, and TLMU values were significantly higher in patients with IDHm grade (G) 4 astrocytoma than patients with IDHm G2/3 astrocytoma (P < 0.05 for all), but not than patients with G2-3 oligodendroglioma. The progression-free survival was significantly shorter in the patients with G4 astrocytoma versus the patients with G2/3 astrocytoma and G3 oligodendroglioma (P < 0.05 for both). The SUVmax and TNR values were significantly higher in recurrent patients than nonrecurrent patients (P < 0.01 for both), but no significant differences were found in MTV or TLMU values.

Conclusions: MET-PET metrics well reflect the histological subtype, WHO grade and prognosis of ADG based on the 2021 WHO classification, with the exception of oligodendroglial tumors. Volumetric parameters were not significantly associated with recurrence, unlike the SUVmax and TNR.

Keywords: (11)C-methionine PET/CT; 2021 WHO classification; Adult-type diffuse glioma; Prognosis.