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This study aimed whether the uptake of amino tracer positron emission tomography (PET) can be used as an additional imaging biomarker to estimate the prognosis of glioma. Participants comprised 56 adult patients with newly diagnosed and untreated World Health Organization (WHO) grade II–IV astrocytic glioma who underwent surgical excision and were evaluated by 11C-methionine PET prior to the surgical excision at Osaka City University Hospital from July 2011 to March 2018. Clinical and imaging studies were retrospectively reviewed based on medical records at our institution. Preoperative Karnofsky Performance Status (KPS) only influenced progression-free survival (hazard ratio [HR] 0.20; 95% confidence interval [CI] 0.10–0.41,  p  &lt; 0.0001), whereas histology (anaplastic astrocytoma: HR 5.30, 95% CI 1.23–22.8,  p  = 0.025; glioblastoma: HR 11.52, 95% CI 2.27–58.47,  p  = 0.0032), preoperative KPS ≥ 80 (HR 0.23, 95% CI 0.09–0.62,  p  = 0.004), maximum lesion-to-contralateral normal brain tissue (LN max) ≥ 4.03 (HR 0.24, 95% CI 0.08–0.71,  p  = 0.01), and isocitrate dehydrogenase  (IDH)  status (HR 14.06, 95% CI 1.81–109.2,  p  = 0.011) were factors influencing overall survival (OS) in multivariate Cox regression. OS was shorter in patients with LN max ≥ 4.03 (29.3 months) than in patients with LN max &lt; 4.03 (not reached;  p  = 0.03). OS differed significantly between patients with  IDH  mutant/LN max &lt; 4.03 and patients with  IDH  mutant/LN max ≥ 4.03. LN max using 11C-methionine PET may be used in prognostic markers for newly identified and untreated WHO grade II–IV astrocytic glioma.

Maximum 11C-methionine PET uptake as a prognostic imaging biomarker for newly diagnosed and untreated astrocytic glioma