Pilot Viability of 11C-MET-PET as a Post-surgery Baseline Scan in High-grade Gliomas
Pilot Viability of 11C-MET-PET as a Post-surgery Baseline Scan in High-grade Gliomas
The tracer 11C-methionine (11 C-MET) is used as a specific cell proliferation tracer which
 shows metabolically active tumordeposities. A healthy brain barely takes up 11C-MET, causing
 the difference between the background and the tumor to be realively high. In addition, there
 is relatively little 11C-MET uptake in inflammatory processes. This makes 11C-MET a very
 suitable positron emission tomography (PET) tracer in order to differentiate between tumor
 progression and therapy changes. The latter is a major clinical problem for which further
 investigation is necessary.

 In order to be able to make this differentiation, a direct post-operative baseline scan is
 required. With regard to the advanced MRI sequences, it is known that it is necessary to
 produce the post-operative baseline scan within 48 hours. After that timeframe, operation
 induced changes start to occur, such as granulation tissue. In that case the interpretation
 of the scan is no longer possible. Immediately postoperatively (<48 hours) 11C-MET has never
 been used before. Therefore, it is unknown whether 11C-MET provides a good baseline scan
 directly after surgery. This pilot will investigate the feasibility of this 11C-MET baseline
 scan and comparison the results with the advanced MRI sequences.
Conventional MRI, advanced MRI and 11C-MET-PET will be conducted on the same day. The
 advanced MRI will consist of diffusion weighted imaging (DWI), perfusion imaging by contrast
 technique (DSC) and spectroscopy (MRS). The post-operative MRI and PET scan will be produced
 within 48 hours after surgery (with the aim that operative effects are not visible on the
 baseline scan). This corresponds to the current practice of conventional MRI follow-up at the
 end of the radiotherapy.

 The comparison with the pre-operative scan is to assess the viability of the post-operative
 scan. It will assessed whether the preoperative tumor uptake will disappear in accordance to
 the resection, as shown by the advanced MRI sequences. In addition, it will be assessed
 whether there are no interfering postoperative effects. The 11C-MET-PET scans will be
 interpreted in comparison with the quantitative results obtained with advanced MRI sequences
 (perfusion / diffusion / oxygenation / spectroscopy). If an immediate postoperative
 11C-MET-PET proves to be feasible, than this will provide a basis for further research. This
 future research consist out of the differentiation between tumor progression and therapy
 change, one of the most urgent clinical dilemmas in neuro-oncology.
Inclusion Criteria:

 -  Patients with suspicion of newly diagnosed high-grade glioma who qualify for the
 standard treatment. Written informed consent

 Exclusion Criteria:

 -  Patients with recurrent high-grade glioma or other brain tumor as a secondary
 diagnosis are excluded.

 -  In addition, all patients who have had previous brain surgery or radiotherapy to the
 brain are also excluded.

 -  Patients with only a biopsy will be excluded. Patients under the age of 18 years will
 not be included.

 -  General exclusion criteria for MRI are exclusion criteria for participation in this
 study. The general MRI exclusion criteria are: not MRI compatible ferromagnetic
 material, pregnancy (or presumption thereof) and claustrophobia.