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18F-Fluoromisonidazole positron emission tomography may differentiate glioblastoma multiforme from less malignant gliomas

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Title: 18F-Fluoromisonidazole positron emission tomography may differentiate glioblastoma multiforme from less malignant gliomas
Authors: Hirata, Kenji Browse this author →KAKEN DB
Terasaka, Shunsuke Browse this author →KAKEN DB
Shiga, Tohru Browse this author →KAKEN DB
Hattori, Naoya Browse this author
Magota, Keiichi Browse this author →KAKEN DB
Kobayashi, Hiroyuki Browse this author
Yamaguchi, Shigeru Browse this author
Houkin, Kiyohiro Browse this author →KAKEN DB
Tanaka, Shinya Browse this author →KAKEN DB
Kuge, Yuji Browse this author →KAKEN DB
Tamaki, Nagara Browse this author →KAKEN DB
Keywords: Glioblastoma multiforme
Hypoxia
Fluoromisonidazole
Fluorodeoxyglucose
Issue Date: May-2012
Publisher: Springer Berlin / Heidelberg
Journal Title: European Journal of Nuclear Medicine and Molecular Imaging
Volume: 39
Issue: 5
Start Page: 760
End Page: 770
Publisher DOI: 10.1007/s00259-011-2037-0
PMID: 22307533
Abstract: Glioblastoma multiforme (GBM) is the most aggressive primary brain tumor and its prognosis is significantly poorer than those of less malignant gliomas. Pathologically, necrosis is one of the most important characteristics that differentiate GBM from lower grade gliomas; therefore, we hypothesized that 18F fluoromisonidazole (FMISO), a radiotracer for hypoxia imaging, accumulates in GBM but not in lower grade gliomas. We aimed to evaluate the diagnostic value of FMISO PET for the differential diagnosis of GBM from lower grade gliomas. Methods: This prospective study included 23 patients with pathologically confirmed gliomas. All the patients underwent FMISO PET and FDG PET within a week. FMISO images were acquired 4 hours after intravenous administration of 400 MBq of FMISO. Tracer uptake in the tumor was visually assessed. Lesion-to-normal tissue ratios and FMISO uptake volume were calculated. Results: Thirteen of the 23 glioma patients were diagnosed as having GBM (grade IV glioma in WHO classification 2007), and the others were diagnosed as having non-GBM (5 grade III and 4 grade II). In visual assessment, all the GBM patients showed FMISO uptake in the tumor greater than that in the surrounding brain tissues, whereas all the non-GBM patients showed FMISO uptake in the tumor equal to that in the surrounding brain tissues (p < 0.001). One GBM patient was excluded from FDG PET study because of hyperglycemia. All the GBM patients and 3 of the 9 (33%) non-GBM patients showed FDG uptake greater than or equal to that in the gray matter. The sensitivity and specificity for diagnosing GBM were 100% and 100% for FMISO, and 100% and 66% for FDG, respectively. The lesion-to-cerebellum ratio of FMISO uptake was higher in GBM patients (2.74±0.60, range: 1.71-3.81) than in non-GBM patients (1.22±0.06, range: 1.09-1.29, p < 0.001) with no overlap between the groups. The lesion-to-gray matter ratio of FDG was also higher in GBM patients (1.46±0.75, range: 0.91-3.79) than in non-GBM patients (1.07±0.62, range: 0.66-2.95, p < 0.05); however, overlap of the ranges did not allow clear differentiation between GBM and non-GBM. Uptake volume of FMISO was larger in GBM (27.18±10.46%, range: 14.02-46.67%) than in non- GBM (6.07±2.50%, range: 2.12-9.22%, p < 0.001). Conclusion: These preliminary data suggest that FMISO PET may distinguish GBM from lower grade gliomas.
Rights: The original publication is available at www.springerlink.com
Type: article (author version)
URI: http://hdl.handle.net/2115/52720
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 平田 健司

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