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From the Klinik für Neurologie (Drs. Herholz, Hölzer, Weber-Luxenburger, and Heiss), Institut für Pathologie (Dr. Schröder), Klinik für Stereotaxie und funktionelle Neurochirurgie(Dr. Voges), and Klinik für allgemeine Neurochirurgie (Dr. Ernestus), Universität zu Köln; and the Max-Planck-Institut für Neurologische Forschung (Drs. Bauer, Mendoza, Löttgen, Thiel, Wienhard, and Heiss), Köln, Germany.
Address correspondence and reprint requests to Dr. W.-D. Heiss, Max-Planck-Institut für Neurologische Forschung, Gleuelerstr. 50, D-50931 Köln, Germany.
Management of low-grade gliomas continues to be a challenging task, because CT and MRI do not always differentiate from nontumoral lesions. Furthermore, tumor extent and aggressiveness often remain unclear because of a lack of contrast enhancement. Previous studies indicated that large neutral amino acid tracers accumulate in most brain tumors, including low-grade gliomas, probably because of changes of endothelial and blood-brain barrier function. We describe 11C-methionine uptake measured with PET in a series of 196 consecutive patients, most of whom were studied because of suspected low-grade gliomas. Uptake in the most active lesion area, relative to contralateral side, was significantly different among high-grade gliomas, low-grade gliomas, and chronic or subacute nontumoral lesions, and this difference was independent from contrast enhancement in CT or MRI. Corticosteroids had no significant effect on methionine uptake in low-grade gliomas but reduced uptake moderately in high-grade gliomas. Differentiation between gliomas and nontumoral lesions by a simple threshold was correct in 79%. Recurrent or residual tumors had a higher uptake than primary gliomas. In conclusion, the high sensitivity of 11C-methionine uptake for functional endothelial or blood-brain barrier changes suggests that this tracer is particularly useful for evaluation and follow-up of low-grade gliomas.
Received March 7, 1997. Accepted in final form December 17, 1997.
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