Journal
CANCER
Volume 95, Issue 6, Pages 1376-1386Publisher
WILEY
DOI: 10.1002/cncr.10798
Keywords
brain tumor; tumor metabolism; child; positron emission tomography; 2-[F-18] fluoro-2-deoxy-D-glucose; L-[methyl-C-11] methionine
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BACKGROUND. Positron emission tomography (PET) scans of primary brain tumors were performed in pediatric patients to examine whether metabolic characteristics could be used as an index of clinical aggressiveness. METHODS. Twenty-seven pediatric patients with untreated primary central nervous system neoplasms were studied with PET scans using 2-[F-18] fluoro-2-deoxy-D-glucose (FDG) and/or L-[methyl-C-11] methionine (MET). Metabolic characteristics as assessed with FDG and MET standardized uptake values (SUV) and SUV-to-normal brain ratios were compared with histopathology and selected histochemical features such as proliferation activity (Ki-67(MIB-1)) and apoptotic, vascular, and cell density indices. The median followup time was 43 months. RESULTS. The accumulation of both FDG and MET was significantly higher in high-grade than in low-grade tumors, but a considerable overlap was found. The accumulation of both tracers was associated positively with age. High-grade tumors showed higher proliferative activity and vascularity than the low-grade tumors. In univariate analysis, FDG-PET, MET-PET, and apoptotic index were independent predictors of event-free survival. CONCLUSION. We found that both FDG and MET uptake in pediatric brain tumors are associated with malignancy grade. However, no clear limits of SUVs and SUV-to-normal brain ratios can be set between low-grade and high-grade tumors, which makes the assessment of malignancy grade using metabolic imaging with PET scan difficult in individual cases. Although FDG-PET and MET-PET do not compensate for histopathologic evaluation, they may give valuable additional information especially if invasive procedures to obtain histopathologic samples are not feasible. (C) 2002 American Cancer Society.
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