Abstract
The purpose of this study was to investigate the value of C-11 methionine (MET) positron emission tomography (PET)/computed tomography (CT) in patients with intracranial germinoma (IG). We conducted a retrospective analysis of 21 consecutive patients with pathologically confirmed IGs and eight patients with intracranial non-germinomas (INGs) located in a similar region. Clinical characteristics, imaging findings, and tumor markers such as α-fetoprotein (AFP) and β-human chorionic gonadotropin (HCG) were used as clinical variables. Maximum standardized uptake value (SUVmax), tumor-to-normal tissue (T/N) ratio, and visual scoring of tumor were used as MET PET parameters. All IGs were well visualized on MET PET with a three-grade visual scoring system. In addition, SUVmax of IGs was higher than that of INGs (P = 0.005). Pre-treatment (Pre-Tx) T/N ratio was significantly correlated with pre-Tx serum HCG (P = 0.031). Moreover, MET PET parameters showed significant associations with tumor location, sex, KRAS variant, and symptoms. MET PET/CT could be a useful diagnostic tool in patients suspected of having IGs. In addition, the MET avidity of tumor is a potential surrogate biomarker of HCG, which has been used as a diagnostic marker for IGs. Tumor MET parameters also had significant differences according to tumor locations, sex, symptoms, and KRAS mutation. However, MET avidity of tumors had no significant prognostic value.
Highlights
Intracranial germinomas (IGs) originate from totipotent germ cells and usually occur in children and young adults [1, 2]
All IGs were well visualized on MET positron emission tomography (PET) with a three-grade visual scoring system
MET PET/computed tomography (CT) could be a useful diagnostic tool in patients suspected of having IGs
Summary
Intracranial germinomas (IGs) originate from totipotent germ cells and usually occur in children and young adults [1, 2]. IGs are potentially malignant in behavior, and can infiltrate normal brain tissue as well as spread through the whole of the central nervous system (CNS) [4] These lesions are highly sensitive to radiotherapy or/and chemotherapy, and are potentially curable without complete surgical resection [5,6,7]. Given that these tumors have a highly favorable treatment response and delayed treatment can cause more severe neurologic complications, early and accurate diagnosis is essential for better clinical outcomes in patients with IGs. Clinical diagnosis and staging of IGs are based on symptoms, tumor markers such as α-fetoprotein (AFP) or β-human chorionic gonadotropin (HCG) in serum and cerebrospinal fluid (CSF), and brain and spinal magnetic resonance imaging (MRI) [8]. An additional biomarker reflecting the tumor characteristics would improve diagnosis and management of these tumors
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