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CASE REPORT
Year : 2011  |  Volume : 26  |  Issue : 2  |  Page : 91-93  

Comparision of F-18 FDG and C-11 Methionine PET/CT for demonstration of subependymal deposit in a treated case of glioblastoma multiforme


1 Division of PET Imaging, Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
2 Delhi State Cancer Institute, Guru Teg Bahadur Hospital, Shahdara-Delhi, India

Date of Web Publication25-Nov-2011

Correspondence Address:
Madhavi Tripathi
Division of PET Imaging, MIRC, INMAS, Delhi - 54
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.90259

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   Abstract 

A 10-year-boy post-operative, post-radiotherapy case of left temporal glioblastoma multiforme (GBM) was referred for F-18 Flurodeoxyglucose (FDG) Positron emission tomography/Computed Tomography (PET/CT) to rule out residual/recurrent disease 6 months following completion of therapy. The FDG scan 3 months following therapy had not shown evidence of viable residual or metastatic disease. The present scan showed a tiny focus of abnormal FDG accumulation in the region of the trigone of the left lateral ventricle which was best appreciated on the plain PET image. A correlative C-11 methionine study showed a well defined focus of abnormal tracer accumulation in the region of the left trigone. CECT and MRI done subsequently proved it to be a subependymal deposit. This case therefore demonstrates the possibility of subependymal deposits in GBM and the need for this possibility to be entertained during interpretation of the FDG study. It also highlights the advantage of labelled amino acids like C-11 methionine for clearly delineating subependymal deposits apart from the advantage for unequivocal interpretation of the PET study in recurrent brain tumors.

Keywords: C-11 methionine, F-18 FDG, GBM, subependymal deposit


How to cite this article:
Tripathi M, D'Souza M, Bal J, Guliani S, Jain J, Santosh, Sharma R, Mondal A. Comparision of F-18 FDG and C-11 Methionine PET/CT for demonstration of subependymal deposit in a treated case of glioblastoma multiforme. Indian J Nucl Med 2011;26:91-3

How to cite this URL:
Tripathi M, D'Souza M, Bal J, Guliani S, Jain J, Santosh, Sharma R, Mondal A. Comparision of F-18 FDG and C-11 Methionine PET/CT for demonstration of subependymal deposit in a treated case of glioblastoma multiforme. Indian J Nucl Med [serial online] 2011 [cited 2019 Dec 10];26:91-3. Available from: http://www.ijnm.in/text.asp?2011/26/2/91/90259


   Introduction Top


Both F-18 Fluorodeoxyglucose (FDG) and C-11 Methionine PET/CT studies were done in a treated case of glioblastoma multiforme who was sent for evaluation of recurrence. Apart from recurrence at the primary site a subependymal deposit was noted in the trigone of the lateral ventricle which was well demonstrated on the C-11 Methionine study as compared to the F-18 FDG study. This case therefore highlights the important role that C-11 Methionine can play for evaluating not only recurrence but also metastatic deposits which are a possibility in such high grade tumors.


   Case Report Top


A 10-year-boy post-operative, post-radiotherapy case of left temporal glioblastoma multiforme (GBM) was referred for F-18 Flurodeoxyglucose (FDG) Positron emission tomography/Computed Tomography (PET/CT) to rule out residual/recurrent disease 6 months following completion of therapy. The FDG scan 3 months following therapy had not shown evidence of viable residual or metastatic disease. 185 MBq of F-18 FDG was injected intravenously and the patient was rested for one hour followed by the PET/CT acquisition on a Discovery STE 16 camera (GE). Low dose CT was followed by 3D PET emission scan of the brain for 15 minutes. Images were reconstructed by 3D VUE algoritm (GE) and viewed on a Xeleris workstation (GE) using the volumetrix protocol. A tiny focus of abnormal FDG accumulation was noted in the region of the trigone of the left lateral ventricle which was best appreciated on the plain PET image [Figure 1]-arrow.
Figure 1: Coronal, Saggital and Transaxial fused F-18 FDG PET/CT images

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A correlative C-11 methionine study was done the next day 20 minutes following intravenous injection of 740 MBq of the tracer. A 20 minutes static acquisition of the brain was followed by head CECT. A well-defined focus of abnormal tracer accumulation in the region of the left trigone [Figure 2]-arrow was well-appreciated on the MIP, plain PET and fused PET/CT methionine images. F-18 FDG has been used for evaluation of brain tumors. [1],[2] It is actively transported across the BBB into the cell where it is phosphorylated. F-18 FDG uptake can vary greatly but uptake is high in high grade tumors and their metastases. However, because of the high rate of physiologic glucose metabolism in normal brain tissue the detectability of lesions is restricted. Amino acid PET tracers like C-11 methionine in contrast have high uptake in tumor tissue and low uptake in the normal brain, thus giving better lesion to background ratios. [3],[4] They are transported into the cell via carrier mediated transport processes and transport is upregulated following malignant transformation. [5] In this case because the subependymal deposit was away from the grey matter it could be visualised on F-18 FDG PET, however this deposit was clearly delineated on the C-11 methionine study and correlated well with the CECT and MRI findings [Figure 3]. GBM is the most aggressive type of brain tumor and has a very poor prognosis. The tumor may extend into the meninges or ventricular wall and malignant cells carried in CSF may spread to the spinal cord or cause meningeal gliomatosis. Though various studies in literature have compared F-18 FDG with C-11 methionine for evaluation of gliomas and recurrent brain tumors. [6],[7],[8] Their comparison in metastases such as this subependymal deposit has not been reported. The possibility of subependymal metastases should be kept in mind while reporting the F-18 FDG brain study in GBM and these deposits can be well delineated with amino acid tracer such as C-11 Methionine study.
Figure 2: Coronal, Saggital and Transaxial fused C-11 Methionine PET/CT images

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Figure 3: (a) Axial CECT done subsequently showing the mildly enhancing subependymal nodule and (b) axial flair MR sequence showing the hyperintense subependymal nodule in the trigone of the left lateral ventricle

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   References Top

1.Olivero WC, Dulebohn SC, Lister JR. The use of PET in evaluating patients with primary brain tumors: Is it useful? J Neurol Neurosurg Psychiatry 1995;58:250-2.   Back to cited text no. 1
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2.Delbeke D, Meyerowitz C, Lapidus RL, Maciunas RJ, Jennings MT, Moots PL, et al. Optimal cut-off levels of F-18 Flurodeoxyglucose Uptake in differentiation of low grade from high grade brain tumors with PET. Radiology 1995;195:47-52.  Back to cited text no. 2
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3.Herholz K, Hölzer T, Bauer B, Schröder R, Voges J, Ernestus RI, et al. 11C-Methionine PET for differential diagnosis of low-grade gliomas. Neurology 1998;50:1316-22.   Back to cited text no. 3
    
4.Jager PL, Vaalburg W, Pruim J, de Vries EG, Langen KJ, Piers DA. Radiolabeled amino acids: Basic aspects and clinical applications in oncology. J Nucl Med 2001;42:432-45.   Back to cited text no. 4
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5.Miyagawa T, Oku T, Uehara H, Desai R, Beattie B, Tjuvajev J, et al. "Facilitated" amino acid transport is upragulated in brain tumors. J Cereb Blood Flow Metab 1998;18:500-9.   Back to cited text no. 5
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6.Chung JK, Kim YK, Kim SK, Lee YJ, Paek S, Yeo JS, et al. Usefulness of C-11 Methionine PET in the evaluation of brain lesions that are hypo-or isometabolic on F-18 FDG PET. Eur J Nucl Med Mol Imaging 2002;29:176-82.   Back to cited text no. 6
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7.Roelcke U, Radu EW, Von Ammon K, Hausmann O, Maguire RP, Leenders KL. Alteration of blood-brain barrier in human brain tmors: Comparison of F-18 flurodeoxyglucose, C-11 Methionineand Rubidium-82 using PET. J Neurol Sci 1995;132:20-7.   Back to cited text no. 7
    
8.Pirotte B, Goldman S, Massager N, David P, Wikler D, Vandesteene A, et al. Combined use of F-18-flurodeoxyglucose and C-11 methionine in 45 positron emission tomography guided brain biopsies. J Nucl Med 2004;45:1293-8.  Back to cited text no. 8
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