Determination of brain tumor recurrence using ¹¹ C-methionine positron emission tomography after radiotherapy

We conducted a prospective multicenter trial to compare the usefulness of ¹¹ C-methionine (MET) and ¹⁸ F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for identifying tumor recurrence. Patients with clinically suspected tumor recurrence after radiotherapy underwent both ¹¹ C-MET and ¹⁸ F-FDG PET. When a lesion showed a visually detected uptake of either tracer, it was surgically resected for histopathological analysis. Patients with a lesion negative to both tracers were revaluated by magnetic resonance imaging (MRI) at 3 months after the PET studies. The primary outcome measure was the sensitivity of each tracer in cases with histopathologically confirmed recurrence, as determined by the McNemar test. Sixty-one cases were enrolled, and 56 cases could be evaluated. The 38 cases where the lesions showed uptake of either ¹¹ C-MET or ¹⁸ F-FDG underwent surgery; 32 of these cases were confirmed to be subject to recurrence. Eighteen cases where the lesions showed uptake of neither tracer received follow-up MRI; the lesion size increased in one of these cases. Among the cases with histologically confirmed recurrence, the sensitivities of ¹¹ C-MET PET and ¹⁸ F-FDG PET were 0.97 (32/33, 95% confidence interval [CI]: 0.85-0.99) and 0.48 (16/33, 95% CI: 0.33-0.65), respectively, and the difference was statistically significant (P < .0001). The diagnostic accuracy of ¹¹ C-MET PET was significantly better than that of ¹⁸ F-FDG PET (87.5% vs. 69.6%, P = .033). No examination-related adverse events were observed. The results of the study demonstrated that ¹¹ C-MET PET was superior to ¹⁸ F-FDG PET for discriminating between tumor recurrence and radiation-induced necrosis.