Evaluating the Diagnostic Efficacy of 99m Tc-Methionine Single-Photon Emission Computed Tomography-Computed Tomography: A Head-to-Head Comparison with 11 C-Methionine Positron Emission Tomography-Magnetic Resonance Imaging in Glioma Patients.

Background: Amino acid positron emission tomography (PET) imaging plays a significant role in the diagnosis of gliomas and in differentiating tumor recurrence from necrosis. In this study, the authors have evaluated the diagnostic efficacy of [99m Tc]Tc-methionine single-photon emission computed tomography-computed tomography (SPECT-CT) in comparison with [11 C]methionine PET-magnetic resonance imaging (MRI) in delineating tumors. Methods: Thirty-one (primary: 16 and postoperative: 15) patients of confirmed (either MRI or histopathological proven) glioma underwent both [99m Tc]Tc-methionine SPECT-CT and [11 C]methionine PET-MRI. A comparative analysis was performed between SPECT, PET, and MR images to calculate the concordance between the modalities and to evaluate the diagnostic efficacy of the [99m Tc]Tc-methionine SPECT. Results: [99m Tc]Tc-methionine SPECT showed comparable uptake in the tumor lesions in comparison to [11 C]methionine PET. A significant and strong positive correlation was observed between the volume of tumor (Vt) in PET and Vt MR ( p  < 0.004). Likewise, a significant and strong positive correlation was found between Vt SPECT and Vt MR. [99m Tc]-methionine has a sensitivity and specificity of 91% and 75%, respectively, compared with 82% and 100% for [11 C]methionine in postoperative cases to differentiate the tumor recurrence from necrosis. The sensitivity and specificity of [99m Tc]Tc-methionine was 92% and 100%, respectively, compared with 92% and 67% for [11 C]methionine in primary tumors. Conclusion: [99m Tc]Tc-methionine SPECT-CT is as equally good as [11 C]methionine for diagnosing and differentiating it from necrosis especially in high-grade glioma.