11C-Methionine PET for Identification of Pediatric High-Grade Glioma Recurrence

Differentiating tumor recurrence or progression from pseudoprogression during surveillance of pediatric high-grade gliomas (PHGGs) using MRI, the primary imaging modality for evaluation of brain tumors, can be challenging. The aim of this study was to evaluate whether C-11-methionine PET, a molecular imaging technique that detects functionally active tumors, is useful for further evaluating MRI changes concerning for tumor recurrence during routine surveillance. Methods: Using C-11-methionine PET during follow-up visits, we evaluated 27 lesions in 26 patients with new or worsening MRI abnormalities for whom tumor recurrence was of concern. We performed quantitative and qualitative assessments of both C-11-methionine PET and MRI data to predict the presence of tumor recurrence. Further, to assess for an association with overall survival (OS), we plotted the time from development of the imaging changes against survival. Results: Qualitative evaluation of C-11-methionine PET achieved 100% sensitivity, 60% specificity, and 93% accuracy to correctly predict the presence of tumors in 27 new or worsening MRI abnormalities. Qualitative MRI evaluation achieved sensitivity ranging from 86% to 95%, specificity ranging from 40% to 60%, and accuracy ranging from 85% to 89%. The interobserver agreement for C-11-methionine PET assessment was 100%, whereas the interobserver agreement was only 50% for MRI (P < 0.01). Quantitative MRI and C-11-methionine PET evaluation using receiver-operating characteristics demonstrated higher specificity (80%) than did qualitative evaluations (40%-60%). Postcontrast enhancement volume, metabolic tumor volume, tumor-to-brain ratio, and presence of tumor as determined by consensus MRI assessment were inversely associated with OS. Conclusion: C-11-methionine PET has slightly higher sensitivity and accuracy for correctly predicting tumor recurrence, with excellent inter observer agreement, than does MRI. Quantitative C-11-methionine PET can also predict OS. These findings suggest that C-11-methionine PET can be useful for further evaluation of MRI changes during surveillance of previously treated PHGGs.

Automated summary

This study evaluated the role of C-11-methionine PET in assessing MRI changes in PHGGs patients, to differentiate tumor recurrence from pseudoprogression. The results showed that C-11-methionine PET had slightly higher sensitivity and accuracy in correctly predicting tumor existence, with good interobserver agreement. The study also found that quantitative C-11-methionine PET can predict overall survival.