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11C-methionine PET improves the target volume delineation of meningiomas treated with stereotactic fractionated radiotherapy.

Grosu AL, Weber WA, Astner ST, Adam M, Krause BJ, Schwaiger M, Molls M, Nieder C

Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. anca-ligia.grosu@lrz.tum.de

PURPOSE: To evaluate the role of 11C-methionine positron emission tomography (MET-PET) in target volume delineation for meningiomas and to determine the interobserver variability. METHODS AND MATERIALS: Two independent observers performed treatment planning in 10 patients according to a prospective written protocol. In the first step, they used coregistered computed tomography (CT) and magnetic resonance imaging (MRI). In the second step, MET-PET was added to CT/MRI (image fusion based on mutual information). RESULTS: The correlation between gross tumor volume (GTVs) delineated by the two observers based on CT/MRI was r=0.855 (Spearman's correlation coefficient, p=0.002) and r=0.988 (p=0.000) when MET-PET/CT/MRI were used. The number of patients with agreement in more then 80% of the outlined volume increased with the availability of MET-PET from 1 in 10 to 5 in 10. The median volume of intersection between the regions delineated by two observers increased significantly from 69% (from the composite volume) to 79%, by the addition of MET-PET (p=0.005). The information of MET-PET was useful to delineate GTV in the area of cavernous sinus, orbit, and base of the skull. CONCLUSIONS: The hypothesis-generating findings of potential normal tissue sparing and reduced interobserver variability provide arguments for invasive studies of the correlation between MET-PET images and histologic tumor extension and for prospective trials of target volume delineation with CT/MRI/MET-PET image fusion.

Published 12 September 2006 in Int J Radiat Oncol Biol Phys, 66(2): 339-44.
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