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18F-fluoromisonidazole positron emission tomography can predict pathological necrosis of brain tumors

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Please use this identifier to cite or link to this item:http://hdl.handle.net/2115/66417

Title: 18F-fluoromisonidazole positron emission tomography can predict pathological necrosis of brain tumors
Authors: Toyonaga, Takuya Browse this author
Hirata, Kenji Browse this author →KAKEN DB
Yamaguchi, Shigeru Browse this author
Hatanaka, Kanako C. Browse this author
Yuzawa, Sayaka Browse this author
Manabe, Osamu Browse this author →KAKEN DB
Kobayashi, Kentaro Browse this author
Watanabe, Shiro Browse this author
Shiga, Tohru Browse this author →KAKEN DB
Terasaka, Shunsuke Browse this author →KAKEN DB
Kobayashi, Hiroyuki Browse this author
Kuge, Yuji Browse this author →KAKEN DB
Tamaki, Nagara Browse this author →KAKEN DB
Keywords: Necrosis
FMISO PET
Hypoxia
Brain tumor
Biopsy
Histology
Issue Date: Jul-2016
Publisher: Springer
Journal Title: European Journal of Nuclear Medicine and Molecular Imaging
Volume: 43
Issue: 8
Start Page: 1469
End Page: 1476
Publisher DOI: 10.1007/s00259-016-3320-x
PMID: 26841941
Abstract: Purpose: Tumour necrosis is one of the indicators of tumour aggressiveness. 18F-fluoromisonidazole (FMISO) is the most widely used positron emission tomography (PET) tracer to evaluate severe hypoxia in vivo. Because severe hypoxia causes necrosis, we hypothesized that intratumoural necrosis can be detected by FMISO PET in brain tumours regardless of their histopathology. We applied FMISO PET to various types of brain tumours before tumour resection and evaluated the correlation between histopathological necrosis and FMISO uptake. Methods: This study included 59 brain tumour patients who underwent FMISO PET/computed tomography before any treatments. According to the pathological diagnosis, the brain tumours were divided into three groups: astrocytomas (group 1), neuroepithelial tumours except for astrocytomas (group 2), and others (group 3). Two experienced neuropathologists evaluated the presence of necrosis in consensus. FMISO uptake in the tumour was evaluated visually and semi-quantitatively using the tumour-to-normal cerebellum ratio (TNR). Results: In visual analyses, 26/27 cases in the FMISO-positive group presented with necrosis, whereas 28/32 cases in the FMISO-negative group did not show necrosis. Mean TNRs with and without necrosis were 3.49 ± 0.97 and 1.43 ± 0.42 (p < 0.00001) in group 1, 2.91 ± 0.83 and 1.44 ± 0.20 (p < 0.005) in group 2, and 2.63 ± 1.16 and 1.35 ± 0.23 (p < 0.05) in group 3, respectively. Using a cut-off value of TNR=1.67, which was calculated by normal reference regions of interest, we could predict necrosis with sensitivity, specificity, and accuracy of 96.7%, 93.1%, and 94.9%, respectively. Conclusions: FMISO uptake within the lesion indicated the presence of histological micro-necrosis. When we used a TNR of 1.67 as the cut-off value, intratumoural micro-necrosis was sufficiently predictable. Because the presence of necrosis implies a poor prognosis, our results suggest that FMISO PET could provide important information for treatment decisions or surgical strategies of any type of brain tumour.
Rights: The final publication is available at link.springer.com
Type: article (author version)
URI: http://hdl.handle.net/2115/66417
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 豊永 拓哉

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