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Diagnosis of recurrent glioma and antiangiogenic treatment response by 11C-Methionine PET
Diagnóstico de recurrencia de un glioma y respuesta al tratamiento antiangiogénico mediante PET con 11C-metionina
J.R. García
, M. Baquero, P. Bassa, M. Soler, M. Moragas, E. Riera
Corresponding author
Unidad PET, CETIR-ERESA, Esplugues, Barcelona, Spain
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Imagen RM secuencia Flair, Imagen de fusión PET/RM por software (SPM8). Imagen PET con 11C-metionina.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La RM pone de manifiesto una lesión redondeada en la rodilla del cuerpo calloso, de 22<span class="elsevierStyleHsp" style=""></span>x<span class="elsevierStyleHsp" style=""></span>18, con edema vasogénico frontal anterior contiguo bilateral, que sugiere recidiva local.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El estudio PET con 11C-metionina muestra un comportamiento hipermetabólico de esta lesión (relación SUV lesión/fondo 5,6/1,6) que confirma la recidiva tumoral. La cuantificación se realiza mediante la relación entre el grado de captación de la lesión (SUV máximo) y el fondo de sustancia gris del lóbulo contralateral sano (SUV medio).</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Figura 1-B: estudio tras tratamiento con bevacizumab. Imagen RM secuencia T1. Imagen RM secuencia Flair, Imagen de fusión PET/RM por software (SPM8). Imagen PET con 11C-metionina.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La RM pone de manifiesto un aumento del tamaño de la lesión localizada en la rodilla del cuerpo calloso (27<span class="elsevierStyleHsp" style=""></span>x<span class="elsevierStyleHsp" style=""></span>24) con similar extensión del edema perilesional.</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El estudio PET con 11C-metionina muestra la resolución de la actividad metabólica en la lesión, confirmando la respuesta al tratamiento antiangiogénico, por lo que se continúa la terapia, sin signos posteriores que sugieran recidiva.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.R. García, M. Baquero, P. Bassa, M. Soler, M. Moragas, E. Riera" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J.R." "apellidos" => "García" ] 1 => array:2 [ "nombre" => "M." 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"apellidos" => "Riera" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2253808915000932" "doi" => "10.1016/j.remnie.2015.09.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000932?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X15000530?idApp=UINPBA00004N" "url" => "/2253654X/0000003400000006/v1_201510300043/S2253654X15000530/v1_201510300043/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2253808915000944" "issn" => "22538089" "doi" => "10.1016/j.remnie.2015.09.003" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "721" "copyright" => "Elsevier España, S.L.U. and SEMNIM" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2015;34:400-11" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 88 "formatos" => array:2 [ "HTML" => 60 "PDF" => 28 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special collaboration</span>" "titulo" => "XXXV SEMNIM Congress. Highlights" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "400" "paginaFinal" => "411" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "XXXV Congreso de la SEMNIM. Conferencia Resumen" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0035" "etiqueta" => "Fig. 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 2346 "Ancho" => 3252 "Tamanyo" => 620104 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">FDG-PET and amyloid (florbetapir) in progressive primary logopenic aphasia. The number of amyloid-positive cases was high, thereby confirming its relationship with Alzheimer disease. 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García, M. Baquero, P. Bassa, M. Soler, M. Moragas, E. Riera" "autores" => array:6 [ 0 => array:4 [ "nombre" => "J.R." "apellidos" => "García" "email" => array:1 [ 0 => "jrgarcia@cetir.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Baquero" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Bassa" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Soler" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Moragas" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Riera" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad PET, CETIR-ERESA, Esplugues, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico de recurrencia de un glioma y respuesta al tratamiento antiangiogénico mediante PET con <span class="elsevierStyleSup">11</span>C-metionina" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2375 "Ancho" => 3250 "Tamanyo" => 518779 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Imaging study after Stupp treatment: T1-weighted and Flair sequences MR imaging. PET/MR imaging fusion by means of software (SPM8). PET imaging with <span class="elsevierStyleSup">11</span>C-Methionine. MR shows a rounded lesion located at the genu of corpus callosum measuring 22<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>18, with adjacent bilateral frontal angiogenic edema, consistent with local recurrence. PET with <span class="elsevierStyleSup">11</span>C-Methionine shows hypermetabolic lesion (SUV target/background ratio is 5.6/1.6), thus confirming tumor recurrence. Quantification was achieved through relationship between uptake avidity of the lesion (SUV maximum) and background of gray substance of the healthy contralateral lobe (SUV mean). (B) Imaging study after Bevacizumab treatment: T1-weighted and Flair sequences MR imaging. PET/MR imaging fusion by means of software (SPM8). PET imaging with <span class="elsevierStyleSup">11</span>C-Methionine. MR shows an increase of size at the lesion located at the genu of corpus callosum (27<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>24), with similar perilesional edema spread. The PET study with <span class="elsevierStyleSup">11</span>C-Methionine shows normalization of previous metabolic activity in lesion, thus confirming response to antiangiogenic treatment, and therapy was carried on with no further suspicious signs of recurrence in our patient.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 60-year-old woman with history of multifocal glioblastoma surgically resected and treated with chemotherapy and radiotherapy, presented MR findings suspected of tumor recurrence. A PET with <span class="elsevierStyleSup">11</span>C-Methionine was performed, which showed high metabolic activity within the MR lesion, thus confirming a tumor recurrence (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Nowadays, it is widely accepted that the first therapeutic modality of glioma requires tumor resection as extensive as possible, followed by radiotherapy with neo-adjuvant, concomitant and adjuvant chemotherapy (Temozolomide-Temodal; Stupp protocol), with survival rates ranging from 10% to 40% by 2 years.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">At present, there are also second-line treatments available for recurrent gliomas, including antiangiogenic therapies and targeted therapy based on genomic differentiation (methylated O-6-methylguanine-DNA methyltransferase gene promoter MGMT, epidermal growth factor receptor EGFR, IDH1 gene, 1p/19q deletion).</p><p id="par0020" class="elsevierStylePara elsevierViewall">A high amount of vascular epithelial growth factor-A (VEGF-A) is found in gliomas, due to their high proliferation rate. In 2009, the Food and Drug Administration approved the use of Bevacizumab (Avastin), a monoclonal antibody against the vascular endothelial growth factor, for the treatment of recurrent glioblastoma.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In our case, the MR study performed for monitoring of Bevacizumab therapy showed persistence of lesion, and even increasing size. Since tumor progression was suspected, a subsequent PET study with <span class="elsevierStyleSup">11</span>C-Methionine was repeated, which showed normalization of previous metabolic activity seen in lesion, thus confirming good response to antiangiogenic therapy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Multiparametric MR is the first-line technique for the diagnosis of gliomas, as well as for post-treatment evaluation: early study after surgery and sequentially after chemo/radiotherapy. However, MR changes do not allow differentiating between radionecrosis and tumor recurrence in many cases. Changes in brain–blood barrier status secondary to antiangiogenic therapy may result in false-progression MR images (pseudo-progression).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">PET with <span class="elsevierStyleSup">11</span>C-Methionine is indicated to differentiate between tumor recurrence, which is shown by high tracer uptake, and radionecrosis, shown by absent metabolic activity. <span class="elsevierStyleSup">11</span>C-Metionine uptake in malignancy is dependent on the increase in transport and metabolism of aminoacids in tumor tissue, independently of the disruption of the blood–brain barrier, thus with a potential usefulness for the evaluation of response to antiangiogenic therapies.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">This case illustrates the usefulness of PET with <span class="elsevierStyleSup">11</span>C-Metionine for the detection of recurrent glioma, as well as its usefulness for the evaluation of treatment response to new second-line agents.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-03-06" "fechaAceptado" => "2015-04-15" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García JR, Baquero M, Bassa P, Soler M, Moragas M, Riera E. Diagnóstico de recurrencia de un glioma y respuesta al tratamiento antiangiogénico mediante PET con 11C-metionina. Rev Esp Med Nucl Imagen Mol. 2015. <span class="elsevierStyleInterRef" id="intr0005" href="doi:10.1016/j.remn.2015.04.001">http://dx.doi.org/10.1016/j.remn.2015.04.001</span></p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2375 "Ancho" => 3250 "Tamanyo" => 518779 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Imaging study after Stupp treatment: T1-weighted and Flair sequences MR imaging. PET/MR imaging fusion by means of software (SPM8). PET imaging with <span class="elsevierStyleSup">11</span>C-Methionine. MR shows a rounded lesion located at the genu of corpus callosum measuring 22<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>18, with adjacent bilateral frontal angiogenic edema, consistent with local recurrence. PET with <span class="elsevierStyleSup">11</span>C-Methionine shows hypermetabolic lesion (SUV target/background ratio is 5.6/1.6), thus confirming tumor recurrence. Quantification was achieved through relationship between uptake avidity of the lesion (SUV maximum) and background of gray substance of the healthy contralateral lobe (SUV mean). (B) Imaging study after Bevacizumab treatment: T1-weighted and Flair sequences MR imaging. PET/MR imaging fusion by means of software (SPM8). PET imaging with <span class="elsevierStyleSup">11</span>C-Methionine. MR shows an increase of size at the lesion located at the genu of corpus callosum (27<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>24), with similar perilesional edema spread. The PET study with <span class="elsevierStyleSup">11</span>C-Methionine shows normalization of previous metabolic activity in lesion, thus confirming response to antiangiogenic treatment, and therapy was carried on with no further suspicious signs of recurrence in our patient.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemoradiotherapy in malignant glioma: standard of care and future directions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Stupp" 1 => "M.E. Hegi" 2 => "M.R. Gilbert" 3 => "A. Chakravarti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2007" "volumen" => "10" "paginaInicial" => "4127" "paginaFinal" => "4136" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bevacizumab and recurrent malignant gliomas: a European perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W. Wick" 1 => "M. Weller" 2 => "M. van den Bent" 3 => "R. Stupp" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2010" "volumen" => "20" "paginaInicial" => "e188" "paginaFinal" => "e189" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuroimaging in brain tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Arbizu" 1 => "P.D. Domínguez" 2 => "R. Diez-Valle" 3 => "C. Vigil" 4 => "R. García-Eulate" 5 => "J.L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2018 February | 2 | 0 | 2 |
| 2018 January | 6 | 0 | 6 |
| 2017 December | 5 | 0 | 5 |
| 2017 November | 11 | 1 | 12 |
| 2017 February | 1 | 0 | 1 |
| 2016 October | 0 | 3 | 3 |
| 2016 September | 0 | 4 | 4 |
| 2016 July | 0 | 1 | 1 |
| 2016 May | 0 | 1 | 1 |
| 2016 April | 0 | 1 | 1 |
| 2016 February | 0 | 3 | 3 |
| 2016 January | 0 | 1 | 1 |
| 2015 November | 0 | 2 | 2 |
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