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Methionine transport across plasma membranes occurs via the large amino acid transporter, which is overexpressed in malignant cells, leading to tracer accumulation within tumors. We investigated the uptake of 11 C-methionine ( 11 C-MET) in children and young adults with Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL) and compared the biodistribution of 11 C-MET PET/CT with that of 18 F-FDG PET/CT. Methods: Conducted under an investigational new drug authorization, we prospectively enrolled patients with newly diagnosed HL ( n = 19) and NHL ( n = 2) onto the Institutional Review Board-approved investigation of 11 C-MET PET/CT. After a minimum 4-h fast, patients received 740 MBq/1.7 m 2 (maximum, 740 MBq [20 mCi/1.7 m 2 ; maximum, 20 mCi]) of 11 C-methionine intravenously. PET/CT was performed 5 min after injection from the vertex to thighs at 3 min per bed position. In a separate session, patients received 5.5 MBq/kg (maximum, 485 MBq [0.15 mCi/kg; maximum, 12 mCi]) of 18 F-FDG with imaging initiated approximately 1 h after radiopharmaceutical administration. All studies were reviewed by consensus of 2 senior imaging specialists. The presence of metabolic activity on baseline studies was compared among 17 nodal groups. Results: Eighteen patients (11 male; median age, 15.2 y; age range, 9.5-22.6 y) comprised the study cohort. All had paired 11 C-MET PET/CT and 18 F-FDG PET/CT studies at diagnosis. At baseline, 3 nodal groups demonstrating discordant metabolic activity by both 18 F-FDG PET/CT and 11 C-MET PET/CT were Waldeyer's ring, paraaortic region, and the liver. All others were found to have concordant metabolic activity. Normal intense 11 C-MET uptake in the pancreas and liver reduced sensitivity for disease detection in these regions. At follow-up, 14 of 15 study pairs had concordant results. Conclusion:  11 C-MET uptake is elevated in most regions involved with lymphoma at diagnosis and follow-up. Its utility in the abdomen is limited by uptake in normal structures.

Comparison of11C-Methionine and18F-FDG PET/CT for Staging and Follow-up of Pediatric Lymphoma

Comparison of¹¹C-Methionine and¹⁸F-FDG PET/CT for Staging and Follow-up of Pediatric Lymphoma