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Comparative evaluation of 11C-methionine and 18F-fluorodeoxyglucose positron emission tomography for distinguishing between primary central nervous system lymphoma and isocitrate dehydrogenase-wildtype glioblastoma

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Abstract

Purpose

Distinguishing between primary central nervous system lymphoma (PCNSL) and isocitrate dehydrogenase (IDH)-wildtype glioblastoma is important for therapeutic decision-making. This study aimed to compare the performance of 11C-methionine (MET) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for distinguishing between these two major malignant brain tumors.

Methods

We retrospectively conducted qualitative and semiquantitative analyses of pre-treatment MET and FDG PET/computed tomography (CT) images of 22 patients with PCNSL and 64 patients with IDH-wildtype glioblastoma. For semiquantitative analysis, we calculated the tumor-to-normal tissue (T/N) ratio by dividing the maximum standardized uptake value (SUV) for the tumor (T) by the average SUV for the normal tissue (N). For performance evaluation, we employed receiver operating characteristic curve analysis and calculated the areas under the curve (AUC) values.

Results

In the qualitative analysis, all PCNSLs and IDH-wildtype glioblastomas were MET-positive, while 95% and 84% of PCNSLs and IDH-wildtype glioblastomas, respectively, were FDG-positive. Eleven patients were excluded from the FDG PET/CT semiquantitative analysis because of hyperglycemia. There was no difference in MET T/N ratio between PCNSL and IDH-wildtype glioblastoma (p = 0.37). FDG T/N ratio was significantly higher in PCNSL than in IDH-wildtype glioblastoma (p < 0.001). The AUC value for distinguishing PCNSL from IDH-wildtype glioblastoma was significantly higher for the FDG T/N ratio (0.871) than for the MET T/N ratio (0.565) (p = 0.0027).

Conclusion

MET PET could detect both PCNSL and IDH-wildtype glioblastoma, but unlike FDG PET, it could not distinguish between these two major malignant brain tumors.

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Data availability

Data will be made available by the corresponding author upon reasonable request.

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Acknowledgements

Not applicable.

Funding

YY is currently receiving a Grant-in-Aid for Scientific Research (KAKENHI) from the Japan Society for the Promotion of Science (grant number 23K07085). For the remaining authors, there are no funding.

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Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan

    Takashi Norikane, Katsuya Mitamura, Yuka Yamamoto, Yuri Manabe, Mitsumasa Murao, Hanae Arai-Okuda & Yoshihiro Nishiyama

  2. Department of Neurological Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kagawa, Japan

    Tetsuhiro Hatakeyama & Keisuke Miyake

Authors
  1. Takashi Norikane
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Contributions

All authors contributed to the concept and design of the study. The study was designed by TN and YY. Material preparation, data collection, and analysis were performed by TN, KM, YM, MM, HAO, TH and KM. The first draft of the manuscript was written by TN and reviewed by YY and YN. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yuka Yamamoto.

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The authors declare no conflicts of interest.

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This study was approved by the Ethics Committee of the Faculty of Medicine, Kagawa University (approval numbers: 2023-146).

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Norikane, T., Mitamura, K., Yamamoto, Y. et al. Comparative evaluation of 11C-methionine and 18F-fluorodeoxyglucose positron emission tomography for distinguishing between primary central nervous system lymphoma and isocitrate dehydrogenase-wildtype glioblastoma. J Neurooncol 166, 195–201 (2024). https://doi.org/10.1007/s11060-023-04534-w

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