Methyl-11C-L-methionine positron emission tomography for radiotherapy planning for recurrent malignant glioma

IF 2.5 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Annals of Nuclear Medicine Pub Date : 2024-02-14 DOI:10.1007/s12149-024-01901-z

Hikaru Niitsu, Nobuyoshi Fukumitsu, Keiichi Tanaka, Masashi Mizumoto, Kei Nakai, Masahide Matsuda, Eiichi Ishikawa, Kentaro Hatano, Tsuyoshi Hashimoto, Satoshi Kamizawa, Hideyuki Sakurai

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引用次数: 0

Abstract

Objective

To investigate differences in uptake regions between methyl-¹¹C-L-methionine positron emission tomography (¹¹C-MET PET) and gadolinium (Gd)-enhanced magnetic resonance imaging (MRI), and their impact on dose distribution, including changing of the threshold for tumor boundaries.

Methods

Twenty consecutive patients with grade 3 or 4 glioma who had recurrence after postoperative radiotherapy (RT) between April 2016 and October 2017 were examined. The study was performed using simulation with the assumption that all patients received RT. The clinical target volume (CTV) was contoured using the Gd-enhanced region (CTV(Gd)), the tumor/normal tissue (T/N) ratios of ¹¹C-MET PET of 1.3 and 2.0 (CTV (T/N 1.3), CTV (T/N 2.0)), and the PET-edge method (CTV(P-E)) for stereotactic RT planning. Differences among CTVs were evaluated. The brain dose at each CTV and the dose at each CTV defined by ¹¹C-MET PET using MRI as the reference were evaluated.

Results

The Jaccard index (JI) for concordance of CTV (Gd) with CTVs using ¹¹C-MET PET was highest for CTV (T/N 2.0), with a value of 0.7. In a comparison of pixel values of MRI and PET, the correlation coefficient for cases with higher JI was significantly greater than that for lower JI cases (0.37 vs. 0.20, P = 0.007). D50% of the brain in RT planning using each CTV differed significantly (P = 0.03) and that using CTV (T/N 1.3) were higher than with use of CTV (Gd). V90% and V95% for each CTV differed in a simulation study for actual treatment using CTV (Gd) (P = 1.0 × 10^–7 and 3.0 × 10^–9, respectively) and those using CTV (T/N 1.3) and CTV (P-E) were lower than with CTV (Gd).

Conclusions

The region of ¹¹C-MET accumulation is not necessarily consistent with and larger than the Gd-enhanced region. A change of the tumor boundary using ¹¹C-MET PET can cause significant changes in doses to the brain and the CTV.

Abstract Image

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甲基-11C-L-蛋氨酸正电子发射断层扫描用于复发性恶性胶质瘤的放疗计划。

目的研究甲基-11C-L-蛋氨酸正电子发射断层扫描（11C-MET PET）和钆（Gd）增强磁共振成像（MRI）摄取区域的差异及其对剂量分布的影响，包括肿瘤边界阈值的变化：研究对象为2016年4月至2017年10月期间连续接受术后放疗（RT）后复发的20例3级或4级胶质瘤患者。研究采用模拟法进行，假设所有患者都接受了 RT。使用钆增强区域（CTV(Gd)）、11C-MET PET 的肿瘤/正常组织（T/N）比值 1.3 和 2.0（CTV (T/N 1.3), CTV (T/N 2.0)）以及 PET 边缘法（CTV(P-E)）绘制了临床靶体积（CTV）轮廓，用于立体定向 RT 规划。评估了不同 CTV 之间的差异。评估了每个 CTV 的脑剂量和以核磁共振成像为参考的 11C-MET PET 定义的每个 CTV 的剂量：用 11C-MET PET 测量 CTV (Gd) 与 CTV 的一致性时，CTV（T/N 2.0）的 Jaccard 指数（JI）最高，为 0.7。在核磁共振成像和 PET 的像素值比较中，JI 较高病例的相关系数明显高于 JI 较低病例（0.37 对 0.20，P = 0.007）。在使用每种 CTV 进行 RT 规划时，大脑的 D50% 有明显差异（P = 0.03），使用 CTV（T/N 1.3）的 D50% 比使用 CTV（Gd）的 D50% 高。在使用CTV（Gd）进行实际治疗的模拟研究中，各CTV的V90%和V95%存在差异（P = 1.0 × 10-7和3.0 × 10-9），使用CTV（T/N 1.3）和CTV（P-E）的V90%和V95%低于使用CTV（Gd）的V90%和V95%：结论：11C-MET聚集区不一定与Gd增强区一致，也不一定大于Gd增强区。使用 11C-MET PET 改变肿瘤边界可导致大脑和 CTV 剂量的显著变化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Nuclear Medicine 医学-核医学

CiteScore

4.90

自引率

7.70%

发文量

111

审稿时长

4-8 weeks

期刊介绍： Annals of Nuclear Medicine is an official journal of the Japanese Society of Nuclear Medicine. It develops the appropriate application of radioactive substances and stable nuclides in the field of medicine. The journal promotes the exchange of ideas and information and research in nuclear medicine and includes the medical application of radionuclides and related subjects. It presents original articles, short communications, reviews and letters to the editor.