In vivo imaging of glucose consumption and lactate concentration in human gliomas

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Abstract
Twenty patients with histologically confirmed gliomas were studied with positron emission tomography (PET) and proton magnetic resonance spectroscopy (1H‐MRS). PET with 18F‐2‐fluoro‐2‐deoxy‐D‐glucose (FDG) provided tomograms of the metabolic rate of glucose. MRS images were obtained by combining volume‐selective excitation with phase‐encoded acquisition. With 32 × 32 gradient phase‐encoding steps, an in‐plane resolution of 7 × 7 mm was achieved. From this set of spectra, lactate maps were created and compared with PET maps of glucose metabolism. Maximum glucose metabolic rates within tumors (relative to metabolic rates of glucose in contralateral regions of the brain) were correlated significantly with maximum lactate concentrations (relative to N‐acetyl aspartate peaks in the contralateral part of the brain). In 8 tumors, no lactate was detected, and in 7 of these the maximum glucose metabolic rate was below the median value. The tumor with the highest lactate concentration also had the highest glucose metabolic rate. The topographic relation between glucose metabolic rate and lactate concentration could be analyzed in 9 patients by three‐dimensional alignment of the PET and MRS images. In that analysis, maximum lactate concentrations were often not found in the same location as maximum glucose metabolism, but lactate tended to accumulate in tumor cysts, necrotic areas, and the vicinity of the lateral ventricles. The combination of FDG PET and 1H‐MRS imaging demonstrates details of the spatial relation between the two poles of nonoxidative glycolysis, glucose uptake and lactate deposition. Both methods can be used as diagnostic tools to study an abnormality of energy metabolism that may be an indicator of dedifferentiation and malignancy.