Usefulness of 13N-NH3 PET in the evaluation of brain lesions that are hypometabolic on 18F-FDG PET

Abstract

We investigated the usefulness of (13)N-NH(3) PET in characterizing brain lesions which show hypometabolism on (18)F-FDG PET. (13)N-NH(3) PET was performed in 18 patients with brain lesions (in 14 for initial diagnosis and in 4 for detection of astrocytoma recurrence) that showed hypometabolism compared with normal brain tissue on (18)F-FDG PET. The diagnoses were ten gliomas, one metastatic tumor, one dysembryoplastic neuroepithelial tumor (DNT), and six non-neoplastic lesions (including three cases of radiation necrosis, two cases of encephalitic foci, and one ischemic lesion). Diagnosis was verified by histopathological examination in 13 patients or was established by clinical follow-up and additional investigations in the remainder. Seven of 12 brain tumors (58%, sensitivity) showed increased (13)N-NH(3) uptake despite hypometabolism on (18)F-FDG PET. The three low-grade gliomas, one metastatic tumor, and one DNT showed decreased (13)N-NH(3) uptake. The mean (±SD) uptake ratio of (13)N-NH(3) was significantly higher than that of (18)F-FDG (1.24 ± 0.57 vs. 0.67 ± 0.21, P < 0.01) in the tumors. By contrast, all six non-neoplastic lesions showed decreased (13)N-NH(3) uptake (100% specificity). The mean (±SD) uptake ratio of (18)F-FDG and (13)N-NH(3) in the non-neoplastic lesions was 0.68 ± 0.15 and 0.70 ± 0.19, respectively, and there was no significant difference between them (P > 0.05). The mean (±SD) uptake ratio of (13)N-NH(3) in the tumors was significantly higher than that in the non-neoplastic lesions (1.24 ± 0.53 vs. 0.70 ± 0.19, P < 0.05). The preliminary results of this study suggest that (13)N-NH(3) PET may be helpful to detect and differentiate brain tumors which show hypometabolism on (18)F-FDG PET from non-neoplastic lesions with high specificity, especially for cerebral astrocytomas, but the sensitivity is relatively limited.