Simultaneous 11C-methionine position emission tomography/magnetic resonance imaging of suspected primary brain tumors

Deuschl, Cornelius; Göricke, Sophia LSF; Grueneisen, Johannes; Sawicki, Lino Morris; Göbel, Juliane LSF; El Hindy, Nicolai; Wrede, Karsten H. LSF; Binse, Ina LSF; Pöppel, Thorsten D. LSF; Quick, Harald H. LSF; Forsting, Michael LSF; Hense, Jörg LSF; Umutlu, Lale LSF; Schlamann, Marc U. LSF

Introduction
The objective of this study was to assess the diagnostic value of integrated 11C- methionine PET/MRI for suspected primary brain tumors, in comparison to MRI alone.
Material and Methods
Forty-eight consecutive patients with suspected primary brain tumor were prospectively enrolled for an integrated 11C-methionine PET/MRI. Two neuro-radiologists separately evaluated the MRI alone and the integrated PET/MRI data sets regarding most likely diagnosis and diagnostic confidence on a 5-point scale. Reference standard was histopathology or follow-up imaging.
Results
Fifty-one suspicious lesions were detected: 16 high-grade glioma and 25 low-grade glioma. Ten non-malignant cerebral lesions were described by the reference standard. MRI alone and integrated PET/MRI each correctly classified 42 of the 51 lesions (82.4%) as neoplastic lesions (WHO grade II, III and IV) or non-malignant lesions (infectious and neoplastic lesions). Diagnostic confidence for all lesions, low-grade astrocytoma and high-grade astrocytoma (3.7 vs. 4.2, 3,1 vs. 3.8, 4.0 vs. 4,7) were significantly (p < 0.05) better with integrated PET/MRI than in MRI alone.
Conclusions
The present study demonstrates the high potential of integrated 11C-methionine-PET/MRI for the assessment of suspected primary brain tumors. Although integrated methionine PET/MRI does not lead to an improvement of correct diagnoses, diagnostic confidence is significantly improved.

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Deuschl, C., Göricke, S., Grueneisen, J., Sawicki, L.M., Göbel, J., El Hindy, N., Wrede, K.H., Binse, I., Pöppel, T.D., Quick, H.H., Forsting, M., Hense, J., Umutlu, L., Schlamann, M.U., 2016. Simultaneous 11C-methionine position emission tomography/magnetic resonance imaging of suspected primary brain tumors. https://doi.org/10.1371/journal.pone.0167596
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