Skip to main content
SpringerLink
Log in

Evaluation of brain tumor metabolism with [11C]choline PET and 1H-MRS

  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Background: The signal of choline containing compounds (Cho) in proton magnetic resonance spectroscopy (1H-MRS) is elevated in brain tumors. [11C]choline uptake as assessed using positron emission tomography (PET) has also been suggested to be higher in brain tumors than in the normal brain. We examined whether quantitative analysis of choline accumulation and content using these two novel techniques would be helpful in non-invasive, preoperative evaluation of suspected brain tumors and tumor malignancy grade.

Methods: 12 patients with suspected brain tumor were studied using [11C]choline PET, gadolinium enhanced 3-D magnetic resonance imaging and 1H-MRS prior to diagnostic biopsy or resection. Eleven normal subjects served as control subjects for 1H-MRS.

Results: The concentrations of Cho and myoinositol (mI) were higher and the concentration of N-acetyl signal/group (NA) lower in brain tumors than in the corresponding regions of the normal brain. There were no significant differences in metabolite concentrations between low- and high-grade gliomas. In non-tumorous lesions Cho concentrations were lower and NA concentrations higher than in any of the gliomas. Enormously increased lipid peak differentiated lymphomas from all other lesions. The uptake of [11C]choline at PET did not differ between low- and high-grade gliomas. The association between Cho concentration determined in 1H-MRS and [11C]choline uptake measured with PET was not significant.

Conclusion: Both 1H-MRS and [11C]choline PET can be used to estimate proliferative activity of human brain tumors. These methods seem to be helpful in differential diagnosis between lymphomas, non-tumorous lesions and gliomas but are not superior to histopathological methods in estimation of tumor malignancy grade.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bruhn H, Frahm J, Gyngell ML, Merboldt KD, Hänicke W, Sauter R, Hamburger C: Non-invasive differentiation of tumors with use of localized H-1 MR spectroscopy in vivo: initial experience in patients with cerebral tumors. Radiology 172: 541–548, 1989

    Google Scholar 

  2. Usenius JP, Kauppinen RA, Vainio PA, Hernesniemi JA, Vapalahti MP, Paljarvi LA, Soimakallio S: Quantitative metabolite patterns of human brain tumors: detection by 1H NMR spectroscopy in vivo and in vitro. J Comput Assist Tomogr 18: 705–713, 1994

    Google Scholar 

  3. Preul MC, Caramanos Z, Collins DL, Villemure JG, Leblanc R, Olivier A, Pokrupa R, Arnold DL: Accurate, noninvasive diagnosis of human brain tumors by using proton magnetic resonance spectroscopy. Nat Med 2: 323–325, 1996

    Google Scholar 

  4. Friedland RP, Mathis CA, Budinger TF, Moyer BR, Rosen M: Labeled choline and phosphorylcholine: body distribution and brain autoradiography: concise communication. J Nucl Med 24: 812–815, 1983

    Google Scholar 

  5. Roivainen A, Lehikoinen P, Grönroos T, Forsback S, Kähkönen M, Minn H: Blood metabolism of [methyl-11C]choline; implications for in vivo imaging with positron emission tomography. Eur J Nucl Med 27: 25–32, 2000

    Google Scholar 

  6. Hara T, Kosaka N, Kishi H: PET imaging of prostate cancer using carbon-11-choline. J Nucl Med 39: 990–995, 1998

    Google Scholar 

  7. Shinoura N, Nishijima M, Hara T, Haisa T, Yamamoto H, Fujii K, Mitsui I, Kosaka N, Kondo T: Brain tumors: detection with C-11 choline PET. Radiology 202: 497–503, 1997

    Google Scholar 

  8. Hara T, Kosaka N, Shinoura N, Kondo T: PET imaging of brain tumor with [methyl-11C]choline. J Nucl Med 38: 842–847, 1997

    Google Scholar 

  9. Di Chiro G: Positron emission tomography using [18F] fluorodeoxyglucose in brain tumors. A powerful diagnostic and prognostic tool. Invest Radiol 22: 360–371, 1986

    Google Scholar 

  10. Delbeke D, Meyerowitz C, Lapidus RL, Maciunas RJ, Jennings MT, Moots PL, Kessler RM: Optimal cutoff levels of F-18 fluorodeoxyglucose uptake in the differentiation of low-grade from high-grade brain tumors with PET. Radiology 195: 47–52, 1995

    Google Scholar 

  11. Herholz K, Holzer T, Bauer B, Schroder R, Voges J, Ernestus RI, Mendoza G, Weber-Luxenburger G, Lottgen J, Thiel A, Wienhard K, Heiss WD: 11C-methionine PET for differential diagnosis of low-grade gliomas. Neurology 50: 1316–1322, 1998

    Google Scholar 

  12. Fulham MJ, Bizzi A, Dietz MJ, Shih HH, Raman R, Sobering GS, Frank JA, Dwyer AJ, Alger JR, Di Chiro G: Mapping of brain tumor metabolites with proton MR spectroscopic imaging: clinical relevance. Radiology 185: 675–686, 1992

    Google Scholar 

  13. Kleihues P, Cavenee WK: Pathology & Genetics of Tumours of the Nervous System. World Health Organization Classification of Tumours. IARC Press, Lyon, France, 2000

    Google Scholar 

  14. Patlak CS, Blasberg RG: Graphical evaluation of bloodto-brain transfer constants from multiple-time uptake data. Generalizations. J Cereb Blood Flow Metab 5: 584–590, 1985

    Google Scholar 

  15. Hatazawa J, Ishiwata K, Masatoshi I, Kameyama M, Kubota K, Ido T, Matsuzawa T, Yoshimoto T, Watanuki S, Seo S: Quantitative evaluation of L-[Methyl-C-11] methionine uptake in tumor using positron emission tomography. J Nucl Med 30: 1809–1813, 1989

    Google Scholar 

  16. Ericson K, Blomqvist G, Bergström M, Eriksson L, Stone-Elander S: Application of a kinetic model on the methionine accumulation in intracranial tumours studied with positron emission tomography. Acta Radiologica 28: 505–509, 1987

    Google Scholar 

  17. Webb PG, Sailasuta N, Kohler SJ, Raidy T, Moats RA, Hurd RE: Automated single-voxel proton MRS: technical development and multisite verification. Mag Reson Med 31: 365–373, 1994

    Google Scholar 

  18. Probe Reconstruction and Quantitation Calculations. GE Medical Systems, Milwaukee, Wisconsin, 1998

  19. Danielsen ER, Henriksen O: Absolute quantitative proton NMR spectroscopy based on the amplitude of the local suppression pulse. Quantification of brain water and metabolites. NMR Biomed 7: 311–318, 1994

    Google Scholar 

  20. Sallinen PK, Haapasalo HK, Visakorpi T, Helen PT, Rantala IS, Isola JJ, Helin HJ: Prognostication of astrocytoma patient survival by Ki-67 (MIB-1),PCNA, and S-phase fraction using archival paraffin-embedded samples. J Pathol 174: 275–282, 1994

    Google Scholar 

  21. Haapasalo HK, Sallinen PK, Helen PT, Rantala IS, Helin HJ, Isola JJ: Comparison of three quantitation methods for PCNA immunostaining: applicability and relation to survival in 83 astrocytic neoplasms. J Pathol 171: 207–214, 1993

    Google Scholar 

  22. Tedeschi G, Lundbom N, Raman R, Bonavita S, Duyn JH, Alger JR, Di Chiro G: Increased choline signal coinciding with malignant degeneration of cerebral gliomas: a serial proton magnetic resonance spectroscopy imaging study. J Neurosurg 87: 516–524, 1997

    Google Scholar 

  23. Hwang JH, Egnaczyk GF, Ballard E, Dunn RS, Holland SK, Ball WS, Jr.: Proton MR spectroscopic characteristics of pediatric pilocytic astrocytomas. AJNR Am J Neuroradiol 19: 535–540, 1998

    Google Scholar 

  24. Kinoshita Y, Yokota A: Absolute concentrations of metabolites in human brain tumors using in vitro proton magnetic resonance spectroscopy. NMR Biomed 10: 2–12, 1997

    Google Scholar 

  25. Kuhlmann T, Schroter A, Dechent P, Weber F, Rustenbeck H, Fuzesi L, Bruck W, Ehrenreich H, Frahm J: Diagnosis of a multifocal B cell lymphoma with preceding demyelinating central nervous system lesions by single voxel proton MR spectroscopy. J Neurol Neurosurg Psychiatry 70: 259–262, 2001

    Google Scholar 

  26. Ohtani T, Kurihara H, Ishiuchi S, Saito N, Oriuchi N, Inoue T, Sasaki T: Brain tumor imaging with carbon-11 choline: comparison with FDG PET and gadoliumenhanced MR imaging. Eur J Nucl Med 28: 1664–1670, 2001

    Google Scholar 

  27. Utriainen M, Metsähonkala L, Salmi T, Utriainen T, Kalimo H, Pihko H: Metabolic characterization of childhood brain tumors: comparison of 18F-fluorodeoxyglucose and 11C-methionine positron emission tomography. Cancer 95: 1376–1386, 2002

    Google Scholar 

  28. Ogawa T, Shishido F, Kanno I, Inugami A, Fujita H, Murakami M, Shimosegawa E, Ito H, Hatazawa J, Okudera T, Uemura K, Yasui N, Mineura K: Cerebral glioma: evaluation with methionine PET. Radiology 186: 45–53, 1993

    Google Scholar 

  29. Nuutinen J, Leskinen S, Lindholm P, Söderström KO, Någren K, Huhtala S, Minn H: Use of carbon-11 methionine positron emission tomography to assess malignancy grade and predict survival in patients with lymphomas. Eur J Nucl Med 25: 729–735, 1998

    Google Scholar 

  30. Haapasalo H, Sallinen S, Sallinen P, Helen P, Jaaskelainen J, Salmi TT, Paetau A, Paljarvi L, Visakorpi T, Kalimo H: Clinicopathological correlation of cell proliferation, apoptosis and p53 in cerebellar pilocytic astrocytomas. Neuropathol Appl Neurobiol 25: 134–142, 1999

    Google Scholar 

  31. Rhodes RH: Biological evaluation of biopsies from adult cerebral astrocytomas: cell-growth/cell-suicide ratios and their relationship to patient survival. J Neuropathol Exp Neurol 57: 746–757, 1998

    Google Scholar 

  32. Ho DM, Wong TT, Hsu CY, Ting LT, Chiang H: MIB-1 labeling index in nonpilocytic astrocytoma of childhood: a study of 101 cases. Cancer 82: 2459–2466, 1998

    Google Scholar 

  33. Miyagawa T, Oku T, Uehara H, Desai R, Beattie B, Tjuvajev J, Blasberg R: Facilitated amino acid transport is upregulated in brain tumors. J Cereb Blood Flow Metab 18: 500–509, 1998

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Turku PET Centre, University of Turku, Turku

    M. Utriainen & P. Lehikoinen

  2. Department of Pediatrics, University of Turku, Turku

    M. Utriainen

  3. Department of Radiology, University of Turku, Turku

    M. Komu, P. Sonninen & T. Kurki

  4. Department of Neurosurgery, University of Turku, Turku

    V. Vuorinen

  5. Department of Oncology, University of Helsinki, Helsinki, Finland

    T. Utriainen

  6. Turku PET Centre, University of Turku, Turku

    A. Roivainen & H. Minn

  7. Department of Pathology, University of Turku, Turku

    H. Kalimo

Authors
  1. M. Utriainen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Komu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V. Vuorinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Lehikoinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Sonninen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T. Kurki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T. Utriainen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Roivainen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. H. Kalimo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. H. Minn
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Utriainen, M., Komu, M., Vuorinen, V. et al. Evaluation of brain tumor metabolism with [11C]choline PET and 1H-MRS. J Neurooncol 62, 329–338 (2003). https://doi.org/10.1023/A:1023342516925

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1023342516925

Search

Navigation