PET Imaging of cerebral astrocytoma with 13N-ammonia

We performed this study in order to assess the clinical potential of N-13-ammonia PET in patients with cerebral astrocytoma. Methods: Dynamic N-13-ammonia PET was performed in 25 patients with suspected cerebral gliomas or recurrent cerebral astrocytomas ( 19 male and 6 female patients; age range 18 - 64 years) detected by MRI. The histopathological diagnoses were made for all cases either by biopsy or craniotomy, except for one patient with brain infarction and one patient with brain radiation necrosis confirmed by repeated MRI imaging. PET images were visually inspected, and the tumor-to-white matter count (T/W) ratios and the perfusion index ( PI) of the tumors were determined. Results: Six out of nine cases of low-grade gliomas were detected with N-13-ammonia PET, and three non-astrocytoma low-grade gliomas were not detected with N-13-ammonia PET. All 11 high-grade astrocytomas exhibited markedly increased uptake of N-13-ammonia. The five non-neoplastic lesions exhibited low uptake, low T/W ratios and low PI. The significant differences were observed between high-grade and low-grade gliomas with respect to both the T/W ratios and PI ( T/W ratios: 5.92 +/- 2.27, n=11 vs. 1.66 +/- 0.61, n= 9, P< 0.01; PI: 5.22 +/- 1.67, n= 11 vs. 1.60 +/- 0.54, n= 9, P< 0.01). There were the significant differences between the T/W ratios and PI in low-grade astrocytomas and that in non-neoplastic lesions (T/W ratios: 2.00 +/- 0.42, n= 6 vs. 0.97 +/- 0.11, n= 5, P< 0.01; PI: 1.89 +/- 0.37, n= 6 vs. 0.99 +/- 0.03, n= 5, P< 0.01). Conclusions: There is a substantial uptake of N-13-ammonia in cerebral astrocytomas. N-13-ammonia PET may enable differentiation between low- and high-grade astrocytomas, and has the potential to enable differentiation between low- grade astrocytomas and non-neoplastic lesions.