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Campion A, Iv M. Brain Tumor Imaging: Review of Conventional and Advanced Techniques. Semin Neurol 2023; 43:867-888. [PMID: 37963581 DOI: 10.1055/s-0043-1776765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Approaches to central nervous system (CNS) tumor classification and evaluation have undergone multiple iterations over the past few decades, in large part due to our growing understanding of the influence of genetics on tumor behavior and our refinement of brain tumor imaging techniques. Computed tomography and magnetic resonance imaging (MRI) both play a critical role in the diagnosis and monitoring of brain tumors, although MRI has become especially important due to its superior soft tissue resolution. The purpose of this article will be to briefly review the fundamentals of conventional and advanced techniques used in brain tumor imaging. We will also highlight the applications of these imaging tools in the context of commonly encountered tumors based on the most recently updated 2021 World Health Organization (WHO) classification of CNS tumors framework.
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Affiliation(s)
- Andrew Campion
- Department of Radiology (Neuroradiology), Stanford University, Stanford, California
| | - Michael Iv
- Department of Radiology (Neuroradiology), Stanford University, Stanford, California
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Pang NGT, Batara JMF, Luistro LTC, Mojica CV, Domingo AJC. Value of Thallium-201 SPECT and SPECT/CT Brain Imaging in Differentiating Malignant From Nonmalignant Lesions: A Comparative Case-Series Study With Pathologic and/or Clinical Correlation. Brain Tumor Res Treat 2023; 11:239-245. [PMID: 37953447 PMCID: PMC10641321 DOI: 10.14791/btrt.2023.0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Thallium-201 single-photon emission computed tomography/computed tomography (SPECT/CT) brain scan is an imaging modality which can be done to differentiate between malignant and nonmalignant lesions among patients with nonconclusive findings on conventional neuroimaging. This study describes the results of thallium-201 SPECT/CT brain imaging and relate it to histopathologic and/or clinical findings and evaluate the value of thallium-201 SPECT/CT brain imaging in differentiating malignant from nonmalignant lesions. METHODS This is a retrospective case series study of 10 patients with cerebral lesions who underwent thallium-201 SPECT/CT brain imaging in a hospital in the Philippines from 2010 to 2021. RESULTS A total of 10 patients underwent thallium-201 SPECT/CT brain scan. Six had negative results while 4 had positive results. All of the patients who had positive results were found to have malignancy, whether recurrent or newly diagnosed. All of the patients with negative scan were found to have either an infectious and inflammatory disease and responded to treatment albeit in different degrees. Two of the 10 patients underwent biopsy whose results were consistent with the thallium-201 SPECT/CT brain scan results. CONCLUSION Thallium-201 brain scan combined with SPECT and SPECT/CT has been demonstrated to be useful in distinguishing malignant from nonmalignant lesions and is more cost-effective versus other imaging techniques. The findings in this study support the role of thallium scintigraphy in the diagnosis of patients with brain lesions most significantly when there is a need to differentiate between a malignant and benign condition.
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Affiliation(s)
- Nicole Girlyn T Pang
- Institute for Neurosciences, St. Luke's Medical Center-Quezon City and Global City, Philippines.
| | - Julette Marie F Batara
- Institute for Neurosciences, St. Luke's Medical Center-Quezon City and Global City, Philippines
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Lara Triccia C Luistro
- Department of Nuclear Medicine, St. Luke' Medical Center-Global City, Taguig, Philippines
| | - Christianne V Mojica
- Institute for Neurosciences, St. Luke's Medical Center-Quezon City and Global City, Philippines
| | - Allan Jay C Domingo
- Department of Nuclear Medicine, St. Luke' Medical Center-Global City, Taguig, Philippines
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Tosic L, Thoma M, Voglis S, Hofer AS, Bektas D, Pangalu A, Regli L, Germans MR. Evaluation of patient STress level caused by radiological Investigations in early Postoperative phase After CRANIOtomy (IPAST-CRANIO): protocol of a Swiss prospective cohort study. BMJ Open 2022; 12:e061452. [PMID: 36130762 PMCID: PMC9494566 DOI: 10.1136/bmjopen-2022-061452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Postoperative imaging after neurosurgical interventions is usually performed in the first 72 hours after surgery to provide an accurate assessment of postoperative resection status. Patient frequently report that early postoperative examination after craniotomy for tumour and vascular procedures is associated with distress, exertion, nausea and pain. Delayed postoperative imaging (between 36 and 72 hours postoperatively) may have an advantage regarding psychological and physical stress compared with early imaging. The goal of this study is to evaluate and determine the optimal time frame for postoperative imaging with MRI and CT in terms of medical and neuroradiological implications and patient's subjective stress level. METHODS AND ANALYSIS Data will be prospectively collected from all patients aged 18-80 years who receive postoperative MRI or CT imaging following a craniotomy for resection of a cerebral tumour (benign and malignant) or vascular surgery. Participants have to complete questionnaires containing visual analogue scores (VAS) for headache and nausea, Body Part Discomfort score and a single question addressing subjective preference of timing of postoperative imaging after craniotomy. The primary endpoint of the study is the difference in subjective stress due to imaging studies after craniotomy, measured just before and after postoperative MRI or CT with the above-mentioned instruments. Subjective stress is defined as a combination of the scores VAS pain, VAS nausea and 0.5* Body Part Discomfort core.This study determines whether proper timing of postoperative imaging can improve patient satisfaction and reduce pain, stress and discomfort caused by postoperative imaging. Factors causing additional postoperative stress are likely responsible for delayed recovery of neurosurgical patients. ETHICS AND DISSEMINATION The institutional review board (Kantonale Ethikkommission Zürich) approved this study on 4 August 2020 under case number BASEC 2020-01590. The authors are planning to publish the data of this study in a peer-reviewed paper. After database closure, the data will be exported to the local data repository (Zurich Open Repository and Archive) of the University of Zurich. The sponsor (LR) and the project leader (MR.G) will make the final decision on the publication of the results. The data that support the findings of this study are available on request from the corresponding author LT. The data are not publicly available due to privacy/ethical restrictions. TRIAL REGISTRATION NUMBER NCT05112575; ClinicalTrials.gov.
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Affiliation(s)
- Lazar Tosic
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Marco Thoma
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Stefanos Voglis
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Anna Sophie Hofer
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Delal Bektas
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Athina Pangalu
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Menno R Germans
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
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The new era of bio-molecular imaging with O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) in neurosurgery of gliomas. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00509-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wang S, Cao G, Wang Y, Liao S, Wang Q, Shi J, Li C, Shen D. Review and Prospect: Artificial Intelligence in Advanced Medical Imaging. FRONTIERS IN RADIOLOGY 2021; 1:781868. [PMID: 37492170 PMCID: PMC10365109 DOI: 10.3389/fradi.2021.781868] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/08/2021] [Indexed: 07/27/2023]
Abstract
Artificial intelligence (AI) as an emerging technology is gaining momentum in medical imaging. Recently, deep learning-based AI techniques have been actively investigated in medical imaging, and its potential applications range from data acquisition and image reconstruction to image analysis and understanding. In this review, we focus on the use of deep learning in image reconstruction for advanced medical imaging modalities including magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET). Particularly, recent deep learning-based methods for image reconstruction will be emphasized, in accordance with their methodology designs and performances in handling volumetric imaging data. It is expected that this review can help relevant researchers understand how to adapt AI for medical imaging and which advantages can be achieved with the assistance of AI.
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Affiliation(s)
- Shanshan Wang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen, China
- Pengcheng Laboratrory, Shenzhen, China
| | - Guohua Cao
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Yan Wang
- School of Computer Science, Sichuan University, Chengdu, China
| | - Shu Liao
- Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Qian Wang
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Jun Shi
- School of Communication and Information Engineering, Shanghai University, Shanghai, China
| | - Cheng Li
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen, China
| | - Dinggang Shen
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
- Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
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The value of quantitative pentavalent 99mTc-dimercaptosuccinic acid scan in predicting progression-free survival and overall survival in patients with glioblastoma multiforme. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396920000187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAim:Glioblastoma multiforme (GBM) is the commonest and the most aggressive primary brain tumour. Pentavalent 99mTc-dimercaptosuccinic acid (99mTc (V)-DMSA) has been found to be a tumour-seeking agent. Pre-radiotherapy 99mTc (V)-DMSA positive scan was found to be significantly correlated with poor progression-free survival (PFS) and overall survival (OS). This study aims at evaluating the impact of quantitative 99mTc (V)-DMSA tumour uptake before and after radiotherapy on PFS and OS in patients with GBM.Methods:A prospective study included 40 patients with GBM. Single-photon emission computed tomography studies were done before and after adjuvant radiotherapy and were qualitatively and quantitatively evaluated. The retention index (RI) of the viable tumour was correlated with PFS and OS.Results:The qualitative enhancement of 99mTc (V)-DMSA uptake either positive or negative was significantly correlated with PFS at both early and late images (p-values 0·04 and 0·026, respectively) and OS only in the late image (p-value 0·036). The calculated ion/non-lesion ratios at late images were statistically correlated with PFS and OS (p-values 0·021 and 0·025, respectively). The baseline RI had significant correlation with PFS only (p-value 0·01).Conclusion:The degree of 99mTc (V)-DMSA scan positivity is a poor prognostic factor for PFS and OS in GBM patients.
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Lee SH, Park JS, Kim H, Kim D, Lee SH, Ham WS, Han WK, Choi YD, Yun M. Glycolysis on F-18 FDG PET/CT Is Superior to Amino Acid Metabolism on C-11 Methionine PET/CT in Identifying Advanced Renal Cell Carcinoma at Staging. Cancers (Basel) 2021; 13:cancers13102381. [PMID: 34069168 PMCID: PMC8155930 DOI: 10.3390/cancers13102381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Alteration of metabolism, including glycolysis and glutaminolysis in malignant tumours, has become a hallmark of cancer and related biological aggressiveness. The metabolic signature of each cancer has been actively investigated for potential new drug development. Of the metabolic imaging biomarkers, F-18 fluorodeoxyglucose (FDG) and C-11 methionine positron emission tomography/computed tomography (PET/CT) are widely studied to evaluate the degree of glucose metabolism and amino acid metabolism, respectively. In this prospective study, we found that both F-18 FDG and C-11 methionine uptakes on PET/CT were heterogeneous in renal cell carcinomas, and increased uptake was associated with higher grades of both radiotracers. Additionally, metabolic tumour volume on F-18 FDG PET/CT but not C-11 methionine PET/CT was significant in predicting advanced-stage renal cell carcinoma. These metabolic features derived with PET/CT may help in the development of new drugs targeting glucose and amino acid metabolic pathways. Abstract We evaluated the value of F-18 fluorodeoxyglucose (FDG) and C-11 methionine positron emission tomography/computed tomography (PET/CT) to predict high-Fuhrman grade and advanced-stage tumours in patients with renal cell carcinoma (RCC). Forty patients with RCC underwent F-18 FDG and C-11 methionine PET/CT between September 2016 and September 2018. They were classified into limited (stages I and II, n = 15) or advanced stages (stages III and IV, n = 25) according to pathological staging. Logistic regressions were used to predict the advanced stage using various parameters, including maximum standardised uptake value (SUVmax) and metabolic tumour volume (MTV). Receiver operating characteristic analyses were performed to predict high-grade tumours (Fuhrman 3 and 4). On univariate analysis, tumour size, SUVmax and MTV of F-18 FDG and C-11 methionine, and Fuhrman grades were significant predictors for the advanced stage. On multivariate analysis, F-18 FDG MTV > 21.3 cm3 was the most significant predictor (p < 0.001). The area under the curve for predicting high-grade tumours was 0.830 for F-18 FDG (p < 0.001) and 0.726 for C-11 methionine PET/CT (p = 0.014). In conclusion, glycolysis on F-18 FDG PET/CT and amino acid metabolism on C-11 methionine PET/CT were variable but increased in high-grade RCCs. Increased MTV on F-18 FDG PET/CT is a powerful predictor of advanced-stage tumours.
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Affiliation(s)
- Suk-Hyun Lee
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03772, Korea; (S.-H.L.); (D.K.)
- Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Korea
| | - Jee-Soo Park
- Department of Urology, Urologic Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03772, Korea; (J.-S.P.); (S.-H.L.); (W.-S.H.); (W.-K.H.)
| | - Hyunjeong Kim
- Department of Nuclear Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si 17046, Gyeonggi-do, Korea;
| | - Dongwoo Kim
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03772, Korea; (S.-H.L.); (D.K.)
| | - Seung-Hwan Lee
- Department of Urology, Urologic Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03772, Korea; (J.-S.P.); (S.-H.L.); (W.-S.H.); (W.-K.H.)
| | - Won-Sik Ham
- Department of Urology, Urologic Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03772, Korea; (J.-S.P.); (S.-H.L.); (W.-S.H.); (W.-K.H.)
| | - Woong-Kyu Han
- Department of Urology, Urologic Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03772, Korea; (J.-S.P.); (S.-H.L.); (W.-S.H.); (W.-K.H.)
| | - Young-Deuk Choi
- Department of Urology, Urologic Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03772, Korea; (J.-S.P.); (S.-H.L.); (W.-S.H.); (W.-K.H.)
- Correspondence: (Y.-D.C.); (M.Y.); Tel.: +82-2-2228-2317 (Y.-D.C.); +82-2-2228-2350 (M.Y.)
| | - Mijin Yun
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03772, Korea; (S.-H.L.); (D.K.)
- Correspondence: (Y.-D.C.); (M.Y.); Tel.: +82-2-2228-2317 (Y.-D.C.); +82-2-2228-2350 (M.Y.)
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Zhao W, Yu X, Peng S, Luo Y, Li J, Lu L. Construction of nanomaterials as contrast agents or probes for glioma imaging. J Nanobiotechnology 2021; 19:125. [PMID: 33941206 PMCID: PMC8091158 DOI: 10.1186/s12951-021-00866-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
Malignant glioma remains incurable largely due to the aggressive and infiltrative nature, as well as the existence of blood-brain-barrier (BBB). Precise diagnosis of glioma, which aims to accurately delineate the tumor boundary for guiding surgical resection and provide reliable feedback of the therapeutic outcomes, is the critical step for successful treatment. Numerous imaging modalities have been developed for the efficient diagnosis of tumors from structural or functional aspects. However, the presence of BBB largely hampers the entrance of contrast agents (Cas) or probes into the brain, rendering the imaging performance highly compromised. The development of nanomaterials provides promising strategies for constructing nano-sized Cas or probes for accurate imaging of glioma owing to the BBB crossing ability and other unique advantages of nanomaterials, such as high loading capacity and stimuli-responsive properties. In this review, the recent progress of nanomaterials applied in single modal imaging modality and multimodal imaging for a comprehensive diagnosis is thoroughly summarized. Finally, the prospects and challenges are offered with the hope for its better development.
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Affiliation(s)
- Wei Zhao
- Zhuhai Precision Medical Center, Zhuhai Interventional Medical Center, Zhuhai People's Hospital (Affiliated With Jinan University), Zhuhai, 519000, Guangdong, China
| | - Xiangrong Yu
- Zhuhai Precision Medical Center, Zhuhai Interventional Medical Center, Zhuhai People's Hospital (Affiliated With Jinan University), Zhuhai, 519000, Guangdong, China
| | - Shaojun Peng
- Zhuhai Precision Medical Center, Zhuhai Interventional Medical Center, Zhuhai People's Hospital (Affiliated With Jinan University), Zhuhai, 519000, Guangdong, China
| | - Yu Luo
- School of Chemical Science and Engineering, Tongji University, 1239 Siping Road, Shanghai, China.
| | - Jingchao Li
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, China.
| | - Ligong Lu
- Zhuhai Precision Medical Center, Zhuhai Interventional Medical Center, Zhuhai People's Hospital (Affiliated With Jinan University), Zhuhai, 519000, Guangdong, China.
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Peyraga G, Robaine N, Khalifa J, Cohen-Jonathan-Moyal E, Payoux P, Laprie A. Molecular PET imaging in adaptive radiotherapy: brain. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 62:337-348. [PMID: 30497232 DOI: 10.23736/s1824-4785.18.03116-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Owing to their heterogeneity and radioresistance, the prognosis of primitive brain tumors, which are mainly glial tumors, remains poor. Dose escalation in radioresistant areas is a potential issue for improving local control and overall survival. This review focuses on advances in biological and metabolic imaging of brain tumors that are proving to be essential for defining tumor target volumes in radiation therapy (RT) and for increasing the use of DPRT (dose painting RT) and ART (adaptative RT), to optimize dose in radio-resistant areas. EVIDENCE ACQUISITION Various biological imaging modalities such as PET (hypoxia, glucidic metabolism, protidic metabolism, cellular proliferation, inflammation, cellular membrane synthesis) and MRI (spectroscopy) may be used to identify these areas of radioresistance. The integration of these biological imaging modalities improves the diagnosis, prognosis and treatment of brain tumors. EVIDENCE SYNTHESIS Technological improvements (PET and MRI), the development of research, and intensive cooperation between different departments are necessary before using daily metabolic imaging (PET and MRI) to treat patients with brain tumors. CONCLUSIONS The adaptation of treatment volumes during RT (ART) seems promising, but its development requires improvements in several areas and an interdisciplinary approach involving radiology, nuclear medicine and radiotherapy. We review the literature on biological imaging to outline the perspectives for using DPRT and ART in brain tumors.
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Affiliation(s)
- Guillaume Peyraga
- Department of Radiation Therapy, Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Nesrine Robaine
- Department of Nuclear Medicine, Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Jonathan Khalifa
- Department of Radiation Therapy, Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France.,Paul Sabatier University, Toulouse III, Toulouse, France
| | - Elizabeth Cohen-Jonathan-Moyal
- Department of Radiation Therapy, Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France.,Paul Sabatier University, Toulouse III, Toulouse, France
| | - Pierre Payoux
- Department of Nuclear Medicine, Purpan University Hospital Center, Toulouse, France
| | - Anne Laprie
- Department of Radiation Therapy, Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France - .,Paul Sabatier University, Toulouse III, Toulouse, France
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Magnetic resonance imaging in radiotherapy treatment target volumes definition for brain tumours: a systematic review and meta-analysis. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s1460396917000693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractPurposeThe aim of this study is to establish clinical evidence regarding the use of magnetic resonance imaging (MRI) in target volume definition for radiotherapy treatment planning of brain tumours.MethodsPrimary studies were systematically retrieved from six electronic databases and other sources. Studies included were only those that quantitatively compared computed tomography (CT) and MRI in target volume definition for radiotherapy of brain tumours. Study characteristics and quality were assessed and the data were extracted from eligible studies. Effect estimates for each study was computed as mean percentage difference based on individual patient data where available. The included studies were then combined in meta-analysis using Review Manager (RevMan) software version 5.0.ResultFive studies with a total number of 72 patients were included in this review. The quality of the studies was rated strong. The percentages mean differences of the studies were 7·47, 11·36, 30·70, 41·69 and −24·6% using CT as the baseline. The result of statistical analysis showed small-to-moderate heterogeneity; τ2=36·8; χ2=6·23; df=4 (p=0·18); I2=36%. The overall effect estimate was −1·85 [95% confidence interval (CI); −7·24, 10·94], Z=0·40 (p=0·069>0·5).ConclusionBrain tumour volumes measured using MRI-based method for radiotherapy treatment planning were larger compared with CT defined volumes but the difference lacks statistical significance.
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11C-Methionine Positron Emission Tomography/Computed Tomography Versus 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Evaluation of Residual or Recurrent World Health Organization Grades II and III Meningioma After Treatment. J Comput Assist Tomogr 2018; 42:517-521. [PMID: 29613985 DOI: 10.1097/rct.0000000000000729] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to determine the assessment of positron emission tomography-computed tomography using C-methionine (MET PET/CT) for World Health Organization (WHO) grades II and III meningiomas; MET PET/CT was compared with PET/CT using F-fluorodeoxy glucose (FDG PET/CT). METHODS This study was performed in 17 cases with residual and/or recurrent WHO grades II and III meningiomas. Two neuroradiologists reviewed both PET/CT scans. For agreement, the κ coefficient was measured. Difference in tumor-to-normal brain uptake ratios (T/N ratios) between 2 PET/CT scans was analyzed. Correlation between the maximum tumor size and T/N ratio in PET/CT was studied. RESULTS For agreement by both reviewers, the κ coefficient was 0.51 (P < 0.05). The T/N ratio was significantly higher for MET PET/CT (3.24 ± 1.36) than for FDG PET/CT (0.93 ± 0.44) (P < 0.01). C-methionine ratio significantly correlated with tumor size (y = 8.1x + 16.3, n = 22, P < 0.05), but FDG ratio did not CONCLUSIONS: C-methionine PET/CT has superior potential for imaging of WHO grades II and III meningiomas with residual or recurrent tumors compared with FDG PET/CT.
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Hartl BA, Ma HSW, Sridharan S, Hansen KS, Kent MS, Gorin F, Fragoso RC, Marcu L. Label-free fluorescence lifetime spectroscopy detects radiation-induced necrotic changes in live brain in real-time. BIOMEDICAL OPTICS EXPRESS 2018; 9:3559-3580. [PMID: 30338140 PMCID: PMC6191615 DOI: 10.1364/boe.9.003559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/28/2018] [Accepted: 05/22/2018] [Indexed: 05/21/2023]
Abstract
Current clinical imaging modalities do not reliably identify brain tissue regions with necrosis following radiotherapy. This creates challenges for stereotaxic biopsies and surgical-decision making. Time-resolved fluorescence spectroscopy (TRFS) provides a means to rapidly identify necrotic tissue by its distinct autofluorescence signature resulting from tissue breakdown and altered metabolic profiles in regions with radiation damage. Studies conducted in a live animal model of radiation necrosis demonstrated that necrotic tissue is characterized by respective increases of 27% and 108% in average lifetime and redox ratio, when compared with healthy tissue. Moreover, radiation-damaged tissue not visible by MRI but confirmed by histopathology, was detected by TRFS. Current results demonstrate the ability of TRFS to identify radiation-damaged brain tissue in real-time and indicates its potential to assist with surgical guidance and MRI-guided biopsy procedures.
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Affiliation(s)
- Brad A. Hartl
- Department of Biomedical Engineering, University of California, Davis, CA 95616,
USA
| | - Htet S. W. Ma
- Department of Biomedical Engineering, University of California, Davis, CA 95616,
USA
| | - Shamira Sridharan
- Department of Biomedical Engineering, University of California, Davis, CA 95616,
USA
| | - Katherine S. Hansen
- Department of Surgical and Radiological Sciences, University of California Davis School of Veterinary Medicine, Davis, CA 95616,
USA
| | - Michael S. Kent
- Department of Surgical and Radiological Sciences, University of California Davis School of Veterinary Medicine, Davis, CA 95616,
USA
| | - Fredric Gorin
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA 95817,
USA
| | - Ruben C. Fragoso
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA 95817,
USA
| | - Laura Marcu
- Department of Biomedical Engineering, University of California, Davis, CA 95616,
USA
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Schinkelshoek M, Lopci E, Clerici E, Alongi F, Mancosu P, Rodari M, Navarria P, van der Hiel B, Scorsetti M, Chiti A. Impact of 11C-methionine positron emission tomography/computed tomography on radiation therapy planning and prognosis in patients with primary brain tumors. TUMORI JOURNAL 2018. [DOI: 10.1177/1778.19268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Egesta Lopci
- Nuclear Medicine Department, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Filippo Alongi
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Pietro Mancosu
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Marcello Rodari
- Nuclear Medicine Department, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Bernies van der Hiel
- Nuclear Medicine Department, the Netherlands Cancer Institute, Antoni van Leeuwenhoek hospital (NKI-AVL), Amsterdam, the Netherlands
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Arturo Chiti
- Nuclear Medicine Department, Humanitas Research Hospital, Rozzano (MI), Italy
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Ubben T, Kluge A, Abolmaali N, Iannilli E. Explorative analysis of IPA-SPECT data through statistical inference for an automated diagnosis of glioma tumor. Med Phys 2018; 45:1108-1117. [DOI: 10.1002/mp.12770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/30/2017] [Accepted: 01/04/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Timm Ubben
- Department of Otorhinolaryngology; Interdisciplinary Center “Smell & Taste”; TU Dresden; Dresden 01307 Germany
| | | | - Nasreddin Abolmaali
- Department of Radiology; Universitätsklinikum Carl Gustav Carus, TU Dresden; Dresen 01307 Germany
| | - Emilia Iannilli
- Department of Otorhinolaryngology; Interdisciplinary Center “Smell & Taste”; TU Dresden; Dresden 01307 Germany
- National Center for Adaptive Neurotechnologies; Wadsworth Center; NYS Department of Health; Albany NY 12208 USA
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Palanichamy K, Chakravarti A. Diagnostic and Prognostic Significance of Methionine Uptake and Methionine Positron Emission Tomography Imaging in Gliomas. Front Oncol 2017; 7:257. [PMID: 29164057 PMCID: PMC5672012 DOI: 10.3389/fonc.2017.00257] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/13/2017] [Indexed: 12/15/2022] Open
Abstract
The present most common image diagnostic tracer in clinical practice for glioma is 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for brain tumors diagnosis and prognosis. PET is a promising molecular imaging technique, which provides real-time information on the metabolic behavior of the tracer. The diffusive nature of glioblastoma (GBM) and heterogeneity often make the radiographic detection by FDG-PET inaccurate, and there is no gold standard. FDG-PET often leads to several controversies in making clinical decisions due to their uptake by normal surrounding tissues, and pose a challenge in delineating treatment-induced necrosis, edema, inflammation, and pseudoprogression. Thus, it is imperative to find new criteria independent of conventional morphological diagnosis to demarcate normal and tumor tissues. We have provided proof of concept studies for 11C methionine-PET (MET-PET) imaging of gliomas, along with prognostic and diagnostic significance. MET-PET is not widely used in the United States, though clinical trials from Japan and Germany suggesting the diagnostic ability of MET-PET imaging are superior to FDG-PET imaging for brain tumors. A major impediment is the availability of the onsite cyclotron and isotopic carbon chemistry facilities. In this article, we have provided the scientific rationale and advantages of the use of MET-PET as GBM tracers. We extend our discussion on the expected pitfalls of using MET-PET and ways to overcome them by incorporating a translational component of profiling gene status in the methionine metabolic pathway. This translational correlative component to the MET-PET clinical trials can lead to a better understanding of the existing controversies and can enhance our knowledge for future randomization of GBM patients based on their tumor gene signatures to achieve better prognosis and treatment outcome.
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Affiliation(s)
- Kamalakannan Palanichamy
- Department of Radiation Oncology, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, OH, United States
| | - Arnab Chakravarti
- Department of Radiation Oncology, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, OH, United States
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Toussaint M, Pinel S, Auger F, Durieux N, Thomassin M, Thomas E, Moussaron A, Meng D, Plénat F, Amouroux M, Bastogne T, Frochot C, Tillement O, Lux F, Barberi-Heyob M. Proton MR Spectroscopy and Diffusion MR Imaging Monitoring to Predict Tumor Response to Interstitial Photodynamic Therapy for Glioblastoma. Theranostics 2017; 7:436-451. [PMID: 28255341 PMCID: PMC5327359 DOI: 10.7150/thno.17218] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/12/2016] [Indexed: 01/31/2023] Open
Abstract
Despite recent progress in conventional therapeutic approaches, the vast majority of glioblastoma recur locally, indicating that a more aggressive local therapy is required. Interstitial photodynamic therapy (iPDT) appears as a very promising and complementary approach to conventional therapies. However, an optimal fractionation scheme for iPDT remains the indispensable requirement. To achieve that major goal, we suggested following iPDT tumor response by a non-invasive imaging monitoring. Nude rats bearing intracranial glioblastoma U87MG xenografts were treated by iPDT, just after intravenous injection of AGuIX® nanoparticles, encapsulating PDT and imaging agents. Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS) allowed us an original longitudinal follow-up of post-treatment effects to discriminate early predictive markers. We successfully used conventional MRI, T2 star (T2*), Diffusion Weighted Imaging (DWI) and MRS to extract relevant profiles on tissue cytoarchitectural alterations, local vascular disruption and metabolic information on brain tumor biology, achieving earlier assessment of tumor response. From one day post-iPDT, DWI and MRS allowed us to identify promising markers such as the Apparent Diffusion Coefficient (ADC) values, lipids, choline and myoInositol levels that led us to distinguish iPDT responders from non-responders. All these responses give us warning signs well before the tumor escapes and that the growth would be appreciated.
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Sharma R, D'Souza M, Jaimini A, Hazari PP, Saw S, Pandey S, Singh D, Solanki Y, Kumar N, Mishra AK, Mondal A. A comparison study of (11)C-methionine and (18)F-fluorodeoxyglucose positron emission tomography-computed tomography scans in evaluation of patients with recurrent brain tumors. Indian J Nucl Med 2016; 31:93-102. [PMID: 27095856 PMCID: PMC4815400 DOI: 10.4103/0972-3919.178254] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: 11C-methonine ([11C]-MET) positron emission tomography-computed tomography (PET-CT) is a well-established technique for evaluation of tumor for diagnosis and treatment planning in neurooncology. [11C]-MET reflects amino acid transport and has been shown to be more sensitive than magnetic resonance imaging (MRI) in stereotactic biopsy planning. This study compared fluorodeoxyglucose (FDG) PET-CT and MET PET-CT in the detection of various brain tumors. Materials and Methods: Sixty-four subjects of brain tumor treated by surgery, chemotherapy, and/or radiotherapy were subjected to [18F]-FDG, [11C]-MET, and MRI scan. The lesion was analyzed semiquantitatively using tumor to normal contralateral ratio. The diagnosis was confirmed by surgery, stereotactic biopsy, clinical follow-up, MRI, or CT scans. Results: Tumor recurrence was found in 5 out of 22 patients on [F-18] FDG scan while [11C]-MET was able to detect recurrence in 18 out of 22 patients in low-grade gliomas. Two of these patients were false positive for the presence of recurrence of tumor and later found to be harboring necrosis. Among oligodendroglioma, medulloblastoma and high-grade glioma out of 42 patients 39 were found to be concordant MET and FDG scans. On semiquantitative analysis, mean T/NT ratio was found to be 2.96 ± 0.94 for lesions positive for recurrence of tumors and 1.18 ± 0.74 for lesions negative for recurrence of tumor on [11C]-MET scan. While the ratio for FDG scan on semiquantitative analysis was found to be 2.05 ± 1.04 for lesions positive for recurrence of tumors and 0.52 ± 0.15 for lesions negative for recurrence of tumors. Conclusion: The study highlight that [11C]-MET is superior to [18F]-FDG PET scans to detect recurrence in low-grade glioma. A cut-off value of target to nontarget value of 1.47 is a useful parameter to distinguish benign from malignant lesion on an [11C]-MET Scan. Both [18F]-FDG and [11C]-MET scans were found to be useful in high-grade astrocytoma, oligodendroglioma, and medulloblastoma.
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Affiliation(s)
- Rajnish Sharma
- Division of Positron Emission Tomography Imaging and Division of Cyclotron and Radiopharmaceutical Sciences, Molecular Imaging and Research Center, INMAS, New Delhi, India
| | - Maria D'Souza
- Division of Positron Emission Tomography Imaging and Division of Cyclotron and Radiopharmaceutical Sciences, Molecular Imaging and Research Center, INMAS, New Delhi, India
| | - Abhinav Jaimini
- Division of Positron Emission Tomography Imaging and Division of Cyclotron and Radiopharmaceutical Sciences, Molecular Imaging and Research Center, INMAS, New Delhi, India
| | - Puja Panwar Hazari
- Division of Positron Emission Tomography Imaging and Division of Cyclotron and Radiopharmaceutical Sciences, Molecular Imaging and Research Center, INMAS, New Delhi, India
| | - Sanjeev Saw
- Division of Positron Emission Tomography Imaging and Division of Cyclotron and Radiopharmaceutical Sciences, Molecular Imaging and Research Center, INMAS, New Delhi, India
| | - Santosh Pandey
- Division of Positron Emission Tomography Imaging and Division of Cyclotron and Radiopharmaceutical Sciences, Molecular Imaging and Research Center, INMAS, New Delhi, India
| | - Dinesh Singh
- Division of Positron Emission Tomography Imaging and Division of Cyclotron and Radiopharmaceutical Sciences, Molecular Imaging and Research Center, INMAS, New Delhi, India
| | - Yachna Solanki
- Division of Positron Emission Tomography Imaging and Division of Cyclotron and Radiopharmaceutical Sciences, Molecular Imaging and Research Center, INMAS, New Delhi, India
| | - Nitin Kumar
- Division of Positron Emission Tomography Imaging and Division of Cyclotron and Radiopharmaceutical Sciences, Molecular Imaging and Research Center, INMAS, New Delhi, India
| | - Anil K Mishra
- Division of Positron Emission Tomography Imaging and Division of Cyclotron and Radiopharmaceutical Sciences, Molecular Imaging and Research Center, INMAS, New Delhi, India
| | - Anupam Mondal
- Division of Positron Emission Tomography Imaging and Division of Cyclotron and Radiopharmaceutical Sciences, Molecular Imaging and Research Center, INMAS, New Delhi, India
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Early [18F]FET-PET in Gliomas after Surgical Resection: Comparison with MRI and Histopathology. PLoS One 2015; 10:e0141153. [PMID: 26502297 PMCID: PMC4621037 DOI: 10.1371/journal.pone.0141153] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/03/2015] [Indexed: 11/19/2022] Open
Abstract
Background The precise definition of the post-operative resection status in high-grade gliomas (HGG) is crucial for further management. We aimed to assess the feasibility of assessment of the resection status with early post-operative positron emission tomography (PET) using [18F]O-(2-[18F]-fluoroethyl)-L-tyrosine ([18F]FET). Methods 25 patients with the suspicion of primary HGG were enrolled. All patients underwent pre-operative [18F]FET-PET and magnetic resonance imaging (MRI). Intra-operatively, resection status was assessed using 5-aminolevulinic acid (5-ALA). Imaging was repeated within 72h after neurosurgery. Post-operative [18F]FET-PET was compared with MRI, intra-operative assessment and clinical follow-up. Results [18F]FET-PET, MRI and intra-operative assessment consistently revealed complete resection in 12/25 (48%) patients and incomplete resection in 6/25 cases (24%). In 7 patients, PET revealed discordant findings. One patient was re-resected. 3/7 experienced tumor recurrence, 3/7 died shortly after brain surgery. Conclusion Early assessment of the resection status in HGG with [18F]FET-PET seems to be feasible.
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19
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Sakane M, Tatsumi M, Kim T, Hori M, Onishi H, Nakamoto A, Eguchi H, Nagano H, Wakasa K, Hatazawa J, Tomiyama N. Correlation between apparent diffusion coefficients on diffusion-weighted MRI and standardized uptake value on FDG-PET/CT in pancreatic adenocarcinoma. Acta Radiol 2015; 56:1034-41. [PMID: 25267921 DOI: 10.1177/0284185114549825] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 08/10/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Diffusion-weighted magnetic resonance imaging (DW-MRI) and 2-deoxy-2-[18F]fluoro-D-glucose-positron emission tomography/computed tomography (PET/CT) is increasingly recognized as important for assessing tumor malignancy in oncology. Apparent diffusion coefficient (ADC) and standardized uptake value (SUV) are negatively correlated in some types of cancer based on tumor aggressiveness. PURPOSE To evaluate relationships between ADC of magnetic resonance imaging and SUV of PET/CT in pancreatic adenocarcinomas. MATERIAL AND METHODS Twenty-nine patients histopathologically diagnosed with pancreatic adenocarcinomas were evaluated. ADC maps were generated from 3 T-MRI using b values (b = 0, 800 s/mm(2)). PET/CT was performed 60 min after intravenous injection of FDG (3.7 MBq/kg). The margins of tumors on DW-MRI and PET/CT were assessed to measure ADC and SUV of tumor appropriately. For tumors considered well-marginated, minimal and mean ADC as well as maximal and mean SUV were measured. The correlation of ADC and SUV were statistically evaluated and survival period stratified on ADC and SUV also evaluated. RESULTS Twenty-two tumors on DW-MRI and 25 on PET/CT were deemed well-marginated. Minimal ADC was significantly and negatively correlated with maximal and mean SUV (r = -0.61, P = 0.0040; r = -0.66, P = 0.0015), and mean ADC also showed significantly and negatively correlation with maximal and mean SUV (r = -0.50, P = 0.024; r = -0.54, P = 0.012). There was no significant difference on overall survival stratified on ADC and SUV. CONCLUSION ADC and SUV were significantly correlated in pancreatic adenocarcinomas, although no significant findings were observed in overall survival.
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Affiliation(s)
- Makoto Sakane
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mitsuaki Tatsumi
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tonsok Kim
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masatoshi Hori
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiromitsu Onishi
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Nakamoto
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nagano
- Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenichi Wakasa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Jun Hatazawa
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
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Meric K, Killeen RP, Abi-Ghanem AS, Soliman F, Novruzov F, Cakan E, Cayci Z. The use of 18F-FDG PET ratios in the differential diagnosis of common malignant brain tumors. Clin Imaging 2015; 39:970-4. [PMID: 26259864 DOI: 10.1016/j.clinimag.2015.07.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 06/23/2015] [Accepted: 07/06/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study examined the use of positron emission tomography (PET) ratios to improve the diagnostic ability of 18F-FDG PET/computed tomography (CT) in the differentiation of enhancing brain metastases, central nervous system lymphomas, and gliomas. MATERIALS AND METHODS Seventy-six patients with malignant brain tumors and available magnetic resonance imaging and PET/CT examinations were included. RESULTS Among standardized uptake value (SUV)-related parameters tested, tumor maximum SUV to ipsilateral cortex maximum SUV ratio (Tmax:WMimax) and maximum SUV (SUVmax) proved to be the two most valuable parameters for differential diagnosis. CONCLUSION In addition to SUVmax, Tmax:WMimax also seems to provide helpful information for the differential diagnosis of lymphomas from other malignant brain tumors.
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Affiliation(s)
- Kaan Meric
- Department of Radiology, University of Minnesota Medical Center, Fairview, Minneapolis, MN, USA
| | - Ronan P Killeen
- Department of Nuclear Medicine, Weill Cornell Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Alain S Abi-Ghanem
- Department of Nuclear Medicine, Weill Cornell Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Fatima Soliman
- Department of Nuclear Medicine, Weill Cornell Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Fuad Novruzov
- Department of Radiology, Marmara University Medical School, Istanbul, Turkey
| | - Esin Cakan
- Department of Economics, University of New Haven, West Haven, Boston, USA
| | - Zuzan Cayci
- Department of Radiology, University of Minnesota Medical Center, Fairview, Minneapolis, MN, USA.
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Nakajima S, Okada T, Yamamoto A, Kanagaki M, Fushimi Y, Okada T, Arakawa Y, Takagi Y, Miyamoto S, Togashi K. Primary central nervous system lymphoma and glioblastoma: differentiation using dynamic susceptibility-contrast perfusion-weighted imaging, diffusion-weighted imaging, and 18F-fluorodeoxyglucose positron emission tomography. Clin Imaging 2015; 39:390-5. [DOI: 10.1016/j.clinimag.2014.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/19/2014] [Accepted: 12/06/2014] [Indexed: 02/08/2023]
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George N, Gean EG, Nandi A, Frolov B, Zaidi E, Lee H, Brašić JR, Wong DF. Advances in CNS Imaging Agents: Focus on PET and SPECT Tracers in Experimental and Clinical Use. CNS Drugs 2015; 29:313-30. [PMID: 25948171 DOI: 10.1007/s40263-015-0237-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The physiological functioning of the brain is not well-known in current day medicine and the pathologies of many neuropsychiatric disorders are still not yet fully understood. With our aging population and better life expectancies, it has become imperative to find better biomarkers for disease progression as well as receptor target engagements. In the last decade, these major advances in the field of molecular CNS imaging have been made available with tools such as functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS), single photon emission computed tomography (SPECT), and neuroreceptor-targeted positron emission tomography (PET). These tools have given researchers, pharmaceutical companies, and clinical physicians a better method of understanding CNS dysfunctions, and the ability to employ improved therapeutic agents. This review is intended to provide an update on brain imaging agents that are currently used in clinical and translational research toward treatment of CNS disorders. The review begins with amyloid and tau imaging, the former of which has at least three [(18)F] agents that have been recently approved and will soon be available for clinical use for specific indications in the USA and elsewhere. Other prevalent PET and SPECT neurotransmitter system agents, including those newly US FDA-approved imaging agents related to the dopaminergic system, are included. A review of both mature and potentially growing PET imaging agents, including those targeting serotonin and opiate receptor systems, is also provided.
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Affiliation(s)
- Noble George
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Johns Hopkins Medical Institutions, 601 N. Caroline St., JHOC Room 3245, Baltimore, MD, 21287-0807, USA
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Amin A, Mustafa M, Abd El-Hadi E, Monier A, Badwey A, Saad E. Pentavalent technetium-99m-dimercaptosuccinic acid [Tc-99m (V) DMSA] brain SPECT: does it have a place in predicting survival in patients with glioblastoma multiforme? J Neurooncol 2014; 121:303-9. [PMID: 25349131 DOI: 10.1007/s11060-014-1633-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
Pentavalent technetium-99m dimercaptosuccinic acid (Tc-99m (V) DMSA) is reported as a useful tool for detection of residual or recurrent gliomas. We aimed to investigate the prognostic value of Tc-99m (V) DMSA brain SPECT in patients with glioblastoma multiforme (GBM). 40 patients [21 males and 19 females; mean age 48.6 ± 12.2 years] with GBM were included. Tc-99m (V) DMSA brain SPECT was done after surgery and before onset of radiation therapy or chemotherapy (Baseline study), at 4-6 weeks and at 6 months as a follow-up after therapy. The end point of the study was clinical follow-up for 2 years and/or death. 4-6 weeks after therapy, 40 and 60 % had negative and positive Tc-99m (V) DMSA for viable tumor tissues respectively (P = 0.09). At 6 months follow-up, 62.5 % of (V) DMSA negative patients and 12.5 % of the positive subjects were responders (P = 0.001). The median over-all survival (OS) of all patients was 12.3 month [range 5-24 month]. Patients with positive (V) DMSA had worse survival (8.87 month) compared to the negative ones (16.67 month) (P = 0.0001). Multivariate Cox regression analysis showed that Tc-99m (V) DMSA brain SPECT studies at 4-6 weeks and 6-months follow-up were independent prognostic factors for survival [OR 1.069; 95 % CI 1.417-2.174; P = 0.03 and OR 1.055; 95 % CI 0.821-1.186; P = 0.01 respectively]. Stratification of tumors into risk groups based on prognostic parameters may improve outcome by altering or intensifying treatment methods. Technetium-99m dimercaptosuccinic acid brain SPECT may have an additional prognostic role in patients with GBM which needs further evaluation in larger future series.
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Affiliation(s)
- Amr Amin
- Nuclear Medicine Department, Faculty of Medicine, Cairo University, 32, Soliman Abaza St. Al-Mohandeseen, Giza, Egypt,
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Nakazawa H, Mori Y, Komori M, Shibamoto Y, Tsugawa T, Kobayashi T, Hashizume C. Validation of accuracy in image co-registration with computed tomography and magnetic resonance imaging in Gamma Knife radiosurgery. JOURNAL OF RADIATION RESEARCH 2014; 55:924-933. [PMID: 24781505 PMCID: PMC4202285 DOI: 10.1093/jrr/rru027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 03/23/2014] [Accepted: 03/24/2014] [Indexed: 06/03/2023]
Abstract
The latest version of Leksell GammaPlan (LGP) is equipped with Digital Imaging and Communication in Medicine (DICOM) image-processing functions including image co-registration. Diagnostic magnetic resonance imaging (MRI) taken prior to Gamma Knife treatment is available for virtual treatment pre-planning. On the treatment day, actual dose planning is completed on stereotactic MRI or computed tomography (CT) (with a frame) after co-registration with the diagnostic MRI and in association with the virtual dose distributions. This study assesses the accuracy of image co-registration in a phantom study and evaluates its usefulness in clinical cases. Images of three kinds of phantoms and 11 patients are evaluated. In the phantom study, co-registration errors of the 3D coordinates were measured in overall stereotactic space and compared between stereotactic CT and diagnostic CT, stereotactic MRI and diagnostic MRI, stereotactic CT and diagnostic MRI, and stereotactic MRI and diagnostic MRI co-registered with stereotactic CT. In the clinical study, target contours were compared between stereotactic MRI and diagnostic MRI co-registered with stereotactic CT. The mean errors of coordinates between images were < 1 mm in all measurement areas in both the phantom and clinical patient studies. The co-registration function implemented in LGP has sufficient geometrical accuracy to assure appropriate dose planning in clinical use.
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Affiliation(s)
- Hisato Nakazawa
- Department of Radiological Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Yoshimasa Mori
- Department of Radiology and Radiation Oncology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Masataka Komori
- Department of Radiological Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Takahiko Tsugawa
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Tatsuya Kobayashi
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Chisa Hashizume
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
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Palumbo B, Buresta T, Nuvoli S, Spanu A, Schillaci O, Fravolini ML, Palumbo I. SPECT and PET serve as molecular imaging techniques and in vivo biomarkers for brain metastases. Int J Mol Sci 2014; 15:9878-93. [PMID: 24897023 PMCID: PMC4100127 DOI: 10.3390/ijms15069878] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 12/28/2022] Open
Abstract
Nuclear medicine techniques (single photon emission computerized tomography, SPECT, and positron emission tomography, PET) represent molecular imaging tools, able to provide in vivo biomarkers of different diseases. To investigate brain tumours and metastases many different radiopharmaceuticals imaged by SPECT and PET can be used. In this review the main and most promising radiopharmaceuticals available to detect brain metastases are reported. Furthermore the diagnostic contribution of the combination of SPECT and PET data with radiological findings (magnetic resonance imaging, MRI) is discussed.
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Affiliation(s)
- Barbara Palumbo
- Section of Nuclear Medicine and Health Physics, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia 06100, Italy.
| | - Tommaso Buresta
- Section of Nuclear Medicine and Health Physics, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia 06100, Italy.
| | - Susanna Nuvoli
- Section of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of Sassari, Sassari 07100, Italy.
| | - Angela Spanu
- Section of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of Sassari, Sassari 07100, Italy.
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma 00133, Italy.
| | | | - Isabella Palumbo
- Section of Radiotherapy Department of Surgical and Biomedical Sciences, University of Perugia, Perugia 06100, Italy.
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5-(2-[18 F]Fluoroethyl)-4-Methylthiazole Probe For Positron Emission Tomography Of The Central Nervous System. Chem Heterocycl Compd (N Y) 2014. [DOI: 10.1007/s10593-014-1477-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Deng SM, Zhang B, Wu YW, Zhang W, Chen YY. Detection of glioma recurrence by ¹¹C-methionine positron emission tomography and dynamic susceptibility contrast-enhanced magnetic resonance imaging: a meta-analysis. Nucl Med Commun 2014; 34:758-66. [PMID: 23670103 DOI: 10.1097/mnm.0b013e328361f598] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to compare the diagnostic value of ¹¹C-methionine (¹¹C-MET) PET and dynamic susceptibility contrast-enhanced (DSCE) MRI in detecting glioma recurrence by meta-analysis. MATERIALS AND METHODS Databases such as PubMed (MEDLINE included), EMBASE, Science Direct, Springerlink, EBSCO, and Cochrane Database of Systematic Review were searched for relevant original articles on the detection of recurrent glioma using DSCE MRI or ¹¹C-MET PET with or without computed tomography. No restriction was imposed over the types and grades of glioma. The included studies were assessed for methodological quality. Results from histopathological analysis and/or close clinical and/or radiological follow-up for at least 3 months were used as the reference standard. The data were extracted by two reviewers independently to analyze the sensitivity, specificity, summary receiver-operating characteristic curve, area under the curve, and heterogeneity. RESULTS The present study analyzed a total of 17 selected articles including different types and grades of glioma and showed that ¹¹C-MET PET and DSCE MRI had comparable sensitivity (0.870 and 0.884, respectively), specificity (0.813 and 0.853, respectively), positive likelihood ratio (4.355 and 5.806, respectively), negative likelihood ratio (0.192 and 0.134, respectively), and diagnostic odds ratio (21.857 and 41.918, respectively) without statistically significant differences, except for the fact that DSCE MRI displayed higher area under the curve and Q* index compared with ¹¹C-MET PET (P<0.05). CONCLUSION Both ¹¹C-MET PET and DSCE MRI are accurate tools for detecting glioma recurrence. Although DSCE MRI seems to be superior to ¹¹C-MET PET, the latter can also be used to assess glioma recurrence when the former is not available.
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Affiliation(s)
- Sheng-Ming Deng
- Department of aNuclear Medicine, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
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Sedlacik J, Reitz M, Bolar DS, Adalsteinsson E, Schmidt NO, Fiehler J. Correlation of oxygenation and perfusion sensitive MRI with invasive micro probe measurements in healthy mice brain. Z Med Phys 2014; 25:77-85. [PMID: 24636672 DOI: 10.1016/j.zemedi.2014.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 01/13/2014] [Accepted: 01/28/2014] [Indexed: 12/01/2022]
Abstract
The non-invasive assessment of (patho-)physiological parameters such as, perfusion and oxygenation, is of great importance for the characterization of pathologies e.g., tumors, which may be helpful to better predict treatment response and potential outcome. To better understand the influence of physiological parameters on the investigated oxygenation and perfusion sensitive MRI methods, MRI measurements were correlated with subsequent invasive micro probe measurements during free breathing conditions of air, air+10% CO2 and 100% O2 in healthy mice brain. MRI parameters were the irreversible (R2), reversible (R2') and effective (R2*) transverse relaxation rates, venous blood oxygenation level assessed by quantitative blood oxygenation level dependent (qBOLD) method and cerebral blood flow (CBF) assessed by arterial spin labeling (ASL) using a 7 T small animal MRI scanner. One to two days after MRI, tissue perfusion and pO2 were measured by Laser-Doppler flowmetry and fluorescence quenching micro probes, respectively. The tissue pO2 values were converted to blood oxygen saturation by using the Hill equation. The animals were anesthetized by intra peritoneal injection of ketamine-xylazine-acepromazine (10-2-0.3 mg/ml · kg). Results for normal/hypercapnia/hyperoxia conditions were: R2[s(∧)-1] = 20.7/20.4/20.1, R2*[s(∧)-1] = 31.6/29.6/25.9, R2'[s-(∧)1] = 10.9/9.2/5.7, qBOLD venous blood oxygenation level = 0.43/0.51/0.56, CBF[ml · min(∧)-1 · 100 g(∧)-1] = 70.6/105.5/81.8, Laser-Doppler flowmetry[a.u.] = 89.2/120.2/90.6 and pO2[mmHg] = 6.3/32.3/46.7. All parameters were statistically significantly different with P < 0.001 between all breathing conditions. All MRI and the corresponding micro probe measurements were also statistically significantly (P ≤ 0.03) correlated with each other. However, converting the tissue pO2 to blood oxygen saturation = 0.02/0.34/0.63, showed only very limited agreement with the qBOLD venous blood oxygenation level. We found good correlation between MRI and micro probe measurements. However, direct conversion of tissue pO2 to blood oxygen saturation by using the Hill equation is very limited. Furthermore, adverse effects of anesthesia and trauma due to micro probe insertion are strong confounding factors and need close attention for study planning and conduction of experiments. Investigation of the correlation of perfusion and oxygenation sensitive MRI methods with micro probe measurements in pathologic tissue such as tumors is now of compelling interest.
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Affiliation(s)
- Jan Sedlacik
- Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Matthias Reitz
- Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Divya S Bolar
- Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Elfar Adalsteinsson
- Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Nils O Schmidt
- Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lefranc F, Sadeghi N, Camby I, Metens T, Dewitte O, Kiss R. Present and potential future issues in glioblastoma treatment. Expert Rev Anticancer Ther 2014; 6:719-32. [PMID: 16759163 DOI: 10.1586/14737140.6.5.719] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The treatment of glioblastomas requires a multidisciplinary approach that takes the presently incurable nature of the disease into consideration. Treatments are multimodal and include surgery, radiotherapy and chemotherapy. Current recommendations are that patients with glioblastomas should undergo maximum surgical resection, followed by concurrent radiation and chemotherapy with the novel alkylating drug temozolomide. This is then to be followed by additional adjuvant temozolomide for a period of up to 6 months. Major advances in surgical and imaging technologies used to treat glioblastoma patients are described. These technologies include magnetic resonance imaging and metabolic data that are helpful in the diagnosis and guiding of surgical resection. However, glioblastomas almost invariably recur near their initial sites. Disease progression usually occurs within 6 months and leads rapidly to death. A number of signaling pathways can be activated constitutively in migrating glioma cells, thus rendering these cells resistant to proapoptotic insults, such as conventional chemotherapies. Therefore, the molecular and cellular therapies and local drug delivery that could be used to complement conventional treatments are described, and some of the currently ongoing clinical trials are reviewed, with respect to these new approaches.
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Affiliation(s)
- Florence Lefranc
- Departments of Neurosurgery, Erasme University Hospital, Brussels, Belgium.
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Abstract
Brain tumors are one of the most challenging disorders encountered, and early and accurate diagnosis is essential for the management and treatment of these tumors. In this article, diagnostic modalities including single-photon emission computed tomography, positron emission tomography, magnetic resonance imaging, and optical imaging are reviewed. We mainly focus on the newly emerging, specific imaging probes, and their potential use in animal models and clinical settings.
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Affiliation(s)
- Huile Gao
- Key Laboratory of Smart Drug Delivery, Ministry of Education & PLA, School of Pharmacy, Fudan University, 826 Zhangheng Road, Shanghai 201203, China
| | - Xinguo Jiang
- Key Laboratory of Smart Drug Delivery, Ministry of Education & PLA, School of Pharmacy, Fudan University, 826 Zhangheng Road, Shanghai 201203, China
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Kobayashi H, Hirata K, Yamaguchi S, Terasaka S, Shiga T, Houkin K. Usefulness of FMISO-PET for glioma analysis. Neurol Med Chir (Tokyo) 2013; 53:773-8. [PMID: 24172591 PMCID: PMC4508718 DOI: 10.2176/nmc.ra2013-0256] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Glioma is one of the most common brain tumors in adults. Its diagnosis and management have been determined by histological classifications. It is difficult to establish new paradigms because the pathology has matured and a great deal of knowledge has accumulated. On the other hand, we understand that there are limitations to this gold-standard because of the heterogeneity of glioma. Thus, it is necessary to find new criteria independent of conventional morphological diagnosis. Molecular imaging such as positron emission tomography (PET) is one of the most promising approaches to this challenge. PET provides live information of metabolism through the behavior of single molecules. The advantage of PET is that its noninvasive analysis does not require tissue sample, therefore examination can be performed repeatedly. This is very useful for capturing changes in the biological nature of tumor without biopsy. In the present clinical practice for glioma, 18F-fluorodeoxyglucose (FDG) PET is the most common tracer for predicting prognosis and differentiating other malignant brain tumors. Amino acid tracers such as 11C-methionine (MET) are the most useful for detecting distribution of glioma, including low-grade. Tracers to image hypoxia are under investigation for potential clinical use, and recently, 18F-fluoromisonidazole (FMISO) has been suggested as an effective tracer to distinguish glioblastoma multiforme from others.
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Affiliation(s)
- Hiroyuki Kobayashi
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University
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32
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Application of nanoparticles on diagnosis and therapy in gliomas. BIOMED RESEARCH INTERNATIONAL 2013; 2013:351031. [PMID: 23691498 PMCID: PMC3652126 DOI: 10.1155/2013/351031] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 03/13/2013] [Indexed: 01/02/2023]
Abstract
Glioblastoma multiforme (GBM) is one of the most deadly diseases that affect humans, and it is characterized by high resistance to chemotherapy and radiotherapy. Its median survival is only fourteen months, and this dramatic prognosis has stilled without changes during the last two decades; consequently GBM remains as an unsolved clinical problem. Therefore, alternative diagnostic and therapeutic approaches are needed for gliomas. Nanoparticles represent an innovative tool in research and therapies in GBM due to their capacity of self-assembly, small size, increased stability, biocompatibility, tumor-specific targeting using antibodies or ligands, encapsulation and delivery of antineoplastic drugs, and increasing the contact surface between cells and nanomaterials. The active targeting of nanoparticles through conjugation with cell surface markers could enhance the efficacy of nanoparticles for delivering several agents into the tumoral area while significantly reducing toxicity in living systems. Nanoparticles can exploit some biological pathways to achieve specific delivery to cellular and intracellular targets, including transport across the blood-brain barrier, which many anticancer drugs cannot bypass. This review addresses the advancements of nanoparticles in drug delivery, imaging, diagnosis, and therapy in gliomas. The mechanisms of action, potential effects, and therapeutic results of these systems and their future applications in GBM are discussed.
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Das K, Mittal BR, Vasistha RK, Singh P, Mathuriya SN. Role of (18)F-fluorodeoxyglucose Positron Emission Tomography scan in differentiating enhancing brain tumors. Indian J Nucl Med 2013; 26:171-6. [PMID: 23559710 PMCID: PMC3613621 DOI: 10.4103/0972-3919.106698] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: To determine whether F-18-fluorodeoxyglucose positron emission tomography (F-18-FDG PET) can be used to differentiate among common enhancing brain tumors such as gliomas, metastatic brain tumors, and lymphoma. Materials and Methods: We evaluated 20 patients with an enhancing brain tumor on magnetic resonance imaging (MRI). FDG PET scan was done in all patients pre operatively. For PET image analysis, regions of interest were placed over the tumor (T), contralateral cortex (C), and white matter (WM). Average and maximum pixel values were determined at each site. On the basis of these measurements, average and maximum standard uptake values (SUV avg and SUV max ) were calculated, and comparisons among lesions were then made. Results: SUVavg and SUVmax are significantly higher for central nervous system (CNS) lymphoma than for other tumors (P < 0.01). High-grade gliomas showed significantly higher SUVavg and SUVmax than the low grade gliomas (P < 0.05) and metastatic tumor showed higher SUVavg and SUVmax than all gliomas, both low and high grade (P < 0.05). When the lowest values of CNS lymphoma parameter were used as cutoff levels to distinguish CNS lymphomas from other tumors (i.e. 100% sensitivity), SUVmax was the most accurate parameter. Using a SUVmax of 15.0 as a cutoff for diagnosing CNS lymphoma, only one case of metastasis (SUV max , 16.3) was found to be false positive in this study. Conclusion: FDG PET appears to provide additional information for differentiating common enhancing malignant brain tumors, namely lymphoma versus high grade glioma and metastatic tumor, particularly when differential diagnoses are difficult to narrow using MRI alone.
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Affiliation(s)
- Kajal Das
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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34
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Tan CHA, Tan EHA. Post-treatment Assessment of Glioblastoma Multiforme: Imaging with Fluorodeoxyglucose, Sestamibi, and Choline. World J Nucl Med 2012; 11:30-2. [PMID: 22942782 PMCID: PMC3425229 DOI: 10.4103/1450-1147.98745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most common primary brain tumor in adults, and is generally of poor prognosis. The post-treatment assessment of GBMs is a known diagnostic issue, with problems in the differentiation of viable remnant tumor and post-treatment inflammatory changes. We present a case where various molecular tracers (fluorodeoxyglucose, choline, and methoxyisobutylisonitrile) were used in the post-treatment assessment of a patient with histologically proven GBM.
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35
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Willowson K, Bailey D, Schembri G, Baldock C. CT-based quantitative SPECT for the radionuclide ²⁰¹Tl: experimental validation and a standardized uptake value for brain tumour patients. Cancer Imaging 2012; 12:31-40. [PMID: 22375306 PMCID: PMC3335331 DOI: 10.1102/1470-7330.2012.0005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We have previously reported on a method for reconstructing quantitative data from 99mTc single photon emission computed tomography (SPECT) images based on corrections derived from X-ray computed tomography, producing accurate results in both experimental and clinical studies. This has been extended for use with the radionuclide ²⁰¹Tl. Accuracy was evaluated with experimental phantom studies, including corrections for partial volume effects where necessary. The quantitative technique was used to derive standardized uptake values (SUVs) for ²⁰¹Tl evaluation of brain tumours. A preliminary study was performed on 26 patients using ²⁰¹Tl SPECT scans to assess residual tumor after surgery and then to monitor response to treatment, with a follow-up time of 18 months. Measures of SUVmax were made following quantitative processing of the data and using a threshold grown volume of interest around the tumour. Phantom studies resulted in the calculation of concentration values consistently within 4% of true values. No continuous relation was found between SUVmax (post-resection) and patient survival. Choosing an SUVmax cut-off of 1.5 demonstrated a difference in survival between the 2 groups of patients after surgery. Patients with an SUVmax<1.5 had a 70% survival rate over the first 10 months, compared with a 47% survival rate for those with SUVmax>1.5. This difference did not achieve significance, most likely due to the small study numbers. By 18 months follow-up this difference had reduced, with corresponding survival rates of 40% and 27%, respectively. Although this study involves only a small cohort, it has succeeded in demonstrating the possibility of an SUV measure for SPECT to help monitor response to treatment of brain tumours and predict survival.
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Affiliation(s)
- Kathy Willowson
- Institute of Medical Physics, School of Physics, University of Sydney, Camperdown, NSW 2006, Australia.
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36
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Relation between FDG uptake and apparent diffusion coefficients in glioma and malignant lymphoma. Ann Nucl Med 2012; 26:262-71. [DOI: 10.1007/s12149-012-0570-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 01/05/2012] [Indexed: 01/23/2023]
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37
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Comparison of MRI, F-18 FDG, and 11C-Choline PET/CT for Their Potentials in Differentiating Brain Tumor Recurrence From Brain Tumor Necrosis Following Radiotherapy. Clin Nucl Med 2011; 36:978-81. [DOI: 10.1097/rlu.0b013e31822f68a6] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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38
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Amin A, Moustafa H, Ahmed E, El-Toukhy M. Glioma residual or recurrence versus radiation necrosis: accuracy of pentavalent technetium-99m-dimercaptosuccinic acid [Tc-99m (V) DMSA] brain SPECT compared to proton magnetic resonance spectroscopy (1H-MRS): initial results. J Neurooncol 2011; 106:579-87. [PMID: 21912937 DOI: 10.1007/s11060-011-0694-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Accepted: 08/09/2011] [Indexed: 11/27/2022]
Abstract
We compared pentavalent technetium-99m dimercaptosuccinic acid (Tc-99m (V) DMSA) brain single photon emission computed tomography (SPECT) and proton magnetic resonance spectroscopy ((1)H-MRS) for the detection of residual or recurrent gliomas after surgery and radiotherapy. A total of 24 glioma patients, previously operated upon and treated with radiotherapy, were studied. SPECT was acquired 2-3 h post-administration of 555-740 MBq of Tc-99m (V) DMSA. Lesion to normal (L/N) delayed uptake ratio was calculated as: mean counts of tumor ROI (L)/mean counts of normal mirror symmetric ROI (N). (1)H-MRS was performed using a 1.5-T scanner equipped with a spectroscopy package. SPECT and (1)H-MRS results were compared with pathology or follow-up neuroimaging studies. SPECT and (1)H-MRS showed concordant residue or recurrence in 9/24 (37.5%) patients. Both were true negative in 6/24 (25%) patients. SPECT and (1)H-MRS disagreed in 9 recurrences [7/9 (77.8%) and 2/9 (22.2%) were true positive by SPECT and (1)H-MRS, respectively]. Sensitivity of SPECT and (1)H-MRS in detecting recurrence was 88.8 and 61.1% with accuracies of 91.6 and 70.8%, respectively. A positive association between the delayed L/N ratio and tumor grade was found; the higher the grade, the higher is the L/N ratio (r = 0.62, P = 0.001). Tc-99m (V) DMSA brain SPECT is more accurate compared to (1)H-MRS for the detection of tumor residual tissues or recurrence in glioma patients with previous radiotherapy. It allows early and non-invasive differentiation of residual tumor or recurrence from irradiation necrosis.
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Affiliation(s)
- Amr Amin
- Nuclear Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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39
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Park SH, Moon WK, Cho N, Chang JM, Im SA, Park IA, Kang KW, Han W, Noh DY. Comparison of diffusion-weighted MR imaging and FDG PET/CT to predict pathological complete response to neoadjuvant chemotherapy in patients with breast cancer. Eur Radiol 2011; 22:18-25. [PMID: 21845462 DOI: 10.1007/s00330-011-2236-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 07/15/2011] [Accepted: 07/28/2011] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare the use of diffusion-weighted MR imaging (DWI) and (18)F-FDG PET/CT to predict pathological complete response (pCR) in breast cancer patients receiving neoadjuvant chemotherapy. METHODS Thirty-four women with 34 invasive breast cancers underwent DWI and PET/CT before and after chemotherapy and before surgery. The percentage changes in the apparent diffusion coefficient (ADC) and the standardised uptake value (SUV) were calculated, and the diagnostic performances for predicting pCR were evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS After surgery, 7/34 patients (20.6%) were found to have pCR. A( z ) values for DWI, PET/CT and the combined use of DWI and PET/CT were 0.910, 0.873 and 0.944, respectively. The best cut-offs for differentiating pCR from non-pCR were a 54.9% increase in the ADC and a 63.9% decrease in the SUV. DWI showed 100% (7/7) sensitivity and 70.4% (19/27) specificity and PET/CT showed 100% sensitivity and 77.8% (21/27) specificity. When DWI and PET/CT were combined, there was a trend towards improved specificity compared with DWI. CONCLUSIONS DWI and FDG PET/CT show similar diagnostic accuracy for predicting pCR to neoadjuvant chemotherapy in breast cancer patients. The combined use of DWI and FDG PET/CT has the potential to improve specificity in predicting pCR.
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Affiliation(s)
- Sang Hee Park
- Department of Radiology, Seoul National University Hospital, 28 Yongon-Dong, Chongno-Gu, Seoul 110-744, South Korea
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40
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Cheng X, Li Y, Xu Z, Li D, Wang J. A meta-analysis of 99mTc-MIBI SPECT for detection of recurrent glioma after radiation therapy. J Clin Neurosci 2011; 18:307-12. [DOI: 10.1016/j.jocn.2010.07.113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Accepted: 07/19/2010] [Indexed: 10/18/2022]
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41
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Kläsner BD, Krause BJ, Beer AJ, Drzezga A. PET imaging of gliomas using novel tracers: a sleeping beauty waiting to be kissed. Expert Rev Anticancer Ther 2011; 10:609-13. [PMID: 20469990 DOI: 10.1586/era.10.37] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Benjamin D Kläsner
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
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42
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Arbizu J, Domínguez P, Diez-Valle R, Vigil C, García-Eulate R, Zubieta J, Richter J. Neuroimagen de los tumores cerebrales. ACTA ACUST UNITED AC 2011; 30:47-65. [DOI: 10.1016/j.remn.2010.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 11/02/2010] [Indexed: 10/18/2022]
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43
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Okamoto S, Shiga T, Hattori N, Kubo N, Takei T, Katoh N, Sawamura Y, Nishijima K, Kuge Y, Tamaki N. Semiquantitative analysis of C-11 methionine PET may distinguish brain tumor recurrence from radiation necrosis even in small lesions. Ann Nucl Med 2010; 25:213-20. [PMID: 21188660 DOI: 10.1007/s12149-010-0450-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 11/04/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE (11)C-Methionine positron emission tomography (MET-PET) has been used to distinguish brain tumor recurrence from radiation necrosis. Because the spatial resolution of conventional PET scanners is low, partial volume effect (PVE) may decrease the detectability of small tumor recurrence. The aim of this study is to investigate the diagnostic value of MET-PET upon semiquantitative analyses in particular PVE-affected small lesions. METHODS First, we performed a phantom experiment to investigate what size lesion is affected by PVE. This study included 29 patients (33 lesions) suspected of recurrent brain tumors by magnetic resonance imaging (MRI) after radiation therapy. All of them received MET-PET. Semiquantitative analysis was performed using maximum standardized uptake value (SUVmax) and lesion-versus-normal ratio (L/N ratio). ROC analysis was also assessed about the diagnostic value of MET-PET. RESULTS From the result of the phantom experiment, lesions smaller than 20 mm in brain mode or smaller than 30 mm in whole-body mode were defined as PVE-affected lesions. Histological analysis or clinical follow-up confirmed the diagnosis of tumor recurrence in 22 lesions, and radiation necrosis in 11 lesions. L/N ratios of recurrence and necrosis for overall lesions were 1.98 ± 0.62 and 1.27 ± 0.28, respectively (p < 0.01). In the PVE-affected lesions, L/N ratio for recurrence (1.72 ± 0.44) was also significantly higher than that for necrosis (1.20 ± 0.11) (p < 0.01). On the ROC analysis for the PVE-affected lesions, the area under the curve for L/N ratio (0.897) was significantly higher than that for SUVmax (0.718) (p < 0.05). These areas under the curve were almost equal to that of overall lesions for L/N ratio (0.886) and for SUVmax (0.738). CONCLUSIONS Semiquantitative analysis of MET provided high diagnostic value even for PVE-affected small lesions. MET-PET enables early diagnosis of recurrence of brain tumor in the follow-up after the radiation therapy.
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Affiliation(s)
- Shozo Okamoto
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, North 15th, West 7th, Kitaku, Sapporo, 060-8638, Japan.
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Clinical significance of thallium-201 SPECT after postoperative radiotherapy in patients with glioblastoma multiforme. J Neurooncol 2010; 103:297-305. [PMID: 20811927 DOI: 10.1007/s11060-010-0373-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 08/18/2010] [Indexed: 01/01/2023]
Abstract
To assess the clinical significance of 201Tl-SPECT after postoperative radiotherapy in patients with glioblastoma multiforme (GM). Eighteen patients with macroscopically residual GM who underwent 201Tl-SPECT just after postoperative radiotherapy were analyzed. Fifteen patients (83%) received radiotherapy with a total dose of 60 Gy in conventional fractionation, and the remaining three patients were treated with 72 Gy with hyperfractionation schedules. Sixteen patients (89%) were treated with chemotherapy that consisted of procarbazine, nimustine (ACNU) and vincristine. Concerning 201Tl-SPECT, we calculated the radioactivity ratio of the tumors to contralateral normal brain (T/N ratio) on early and delayed images after 111 MBq 201Tl chloride injections. The median follow-up of all 18 patients was 14.7 months (range, 2.7-38.0 months). At the time of this analysis, 15 patients (83%) had died, and the 1-year overall survival and the median survival time were 67% and 16.2 months, respectively. Fifteen patients (83%) had disease recurrence, and the 1-year progression-free survival (PFS) rate and the median time to progression in all 18 patients were 29% and 7.6 months, respectively. Patients with a high early T/N ratio had a significantly poorer PFS than those with a low T/N ratio (P = 0.0131). On univariate analysis, early T/N ratio alone had a significant impact on PFS, and on mutivariate analysis, early T/N ratio alone was a significant prognostic factor for PFS. 201Tl-SPECT after postoperative radiotherapy was predictive of PFS in patients with macroscopically residual GM.
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Investigation of blood perfusion and metabolic activity of brain tumours in adults by using 99mTc-methoxyisobutylisonitrile. Nucl Med Commun 2010; 31:962-73. [PMID: 20802363 DOI: 10.1097/mnm.0b013e32833ea6cc] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES (i) To examine blood perfusion and metabolic activity of various brain tumours using radionuclide cerebral angiography (RCA) and single-photon emission tomography (SPET) after a single dose of Tc-methoxyisobutylisonitrile (MIBI). (ii) To examine if the inclusion of RCA can improve insight into the relative contribution of tumour perfusion to the uptake of MIBI shown by SPET, and to improve evaluation of tumour biology. (iii) To determine the value and the roles of MIBI in the management of brain tumour patients. METHODS Fifty adult patients (38 male, 12 female) with a total of 56 intracranial space-occupying lesions have been included prospectively, 37 of which were newly diagnosed and the remaining with signs of recurrence/rest of earlier resected and irradiated brain tumours. The control group consisted of nine volunteers with no evidence of organic cerebral disease. Scintigraphic examination consisted of a dynamic first-pass study lasting 60 s (3 s/frame) and two SPET studies (60 projections each, 25 s/projection), starting 15 min and 2 h after intravenous injection of MIBI. Regions of interest of the tumour and normal brain tissue were drawn on RCA and both early and delayed SPET slices. The following tumour/brain activity ratios have been calculated: (i) tumour perfusion index (P); (ii) early uptake index (E); (iii) delayed uptake index (D); and(iv) retention index (R). Analogous indices have been calculated from the same examinations performed in controls, reflecting maximal physiologic regional variations of perfusion and uptake in brain tissue. RESULTS Mean P of various brain tumours (low-grade gliomas 0.98, anaplastic gliomas 1.14, glioblastoma multiforme 1.20, metastases 1.09, lymphomas 1.08) differ little from each other and do not exceed maximal physiologic regional variations of cerebral perfusion (1.33), with the exception of meningioma (1.87, F=2.83, P=0.015). The receiver operating characteristics curve analysis of P showed that for the cut-off value of 1.45 the sensitivity for distinguishing meningioma from other tumours is 75%, specificity 87%, positive predictive value 33% and negative predictive value 97%. Mean E of malignant brain tumours (8.3, n=31, 23 primary, eight secondary), except anaplastic gliomas (3.5, n=5), differed significantly (P=0.02) from those of benign gliomas (3, n=9) but not from that of meningioma (11.9, n=4). The cut-off value for distinguishing malignant from benign lesions on the basis of E set at 4.8 resulted in sensitivity 67%, specificity 75%, accuracy 70%, positive predictive value 80% and negative predictive value 60%. D and R showed tendency of wash-out of MIBI from meningiomas, but otherwise did not improve the results substantially. CONCLUSION Integrated results of RCA and SPET with Tc-MIBI indicate that blood perfusion, blood-tumour barrier permeability and metabolic activity of the tumour are all very important for the resultant uptake shown by SPET. If the perfusion index is less than 1.45, then meningioma can be ruled out. Early SPET is recommendable for distinguishing glioblastoma from low-grade gliomas, as a complement to standard magnetic resonance imaging and/or computed tomography.
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Shooman D, Belli A, Grundy PL. Image-guided frameless stereotactic biopsy without intraoperative neuropathological examination. J Neurosurg 2010; 113:170-8. [PMID: 20136389 DOI: 10.3171/2009.12.jns09573] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Stereotactic biopsy is a safe and effective technique for the diagnosis of brain tumors. The use of intraoperative neuropathological examination has been routinely advocated to increase diagnostic yield, but the procedure lengthens surgical time, may produce false-negative and -positive results, and current biopsy techniques have a very low nondiagnostic rate. Therefore, the authors questioned the need for intraoperative histological evaluation. METHODS The authors prospectively studied all patients undergoing image-guided biopsy under the care of a single surgeon (P.L.G.) between July 2005 and October 2007. A Stryker neuronavigation system with a trajectory guide was used to plan a single trajectory, and, using a side-cutting biopsy cannula, multiple biopsy samples were taken from between 1 and 4 sites within the tumor. Tissue was inspected macroscopically by the surgeon and was only submitted for neuropathological assessment postoperatively. RESULTS One hundred thirty-four biopsies were performed during the study. A positive diagnosis was established in 133 cases (99.3%). One biopsy was negative (0.7%) and postoperative imaging (performed because the tissue was macroscopically normal) demonstrated inaccurate targeting of the lesion. Significant complications were seen in 3 patients (2.2%) who all had preoperative WHO performance scores of III or IV. Two patients suffered delayed deterioration and died due to probable surgical complications--one with thalamic glioblastoma multiforme (GBM) and one with gliomatosis cerebri. One patient with GBM suffered an intracerebral hematoma that was managed conservatively. Postoperative seizures were seen in 4 patients (3%), and 2 patients (1.5%) experienced a transient neurological deficit. Histological diagnosis showed a GBM in 64 cases, Grade III glioma in 19, Grade I or II in 23, metastasis in 10, lymphoma in 13, and other disease in 4. There were 32 patients discharged to home on the same day as surgery. Compared with the authors' previous retrospective audit into 127 biopsies, this technique showed improved diagnostic yield (99.3 vs 94.5%, p = 0.032) with fewer complications (2.2 vs 4.7% [not statistically significant]). CONCLUSIONS This technique of image-guided biopsy has high diagnostic yield with acceptably low morbidity and may be performed as a day case. Intraoperative neuropathological examination would not have increased the diagnostic yield further in this study, and its routine use may not be necessary. In the authors' department pounds sterling 70,350 (UK)/$114,522 (US) would have been saved by not using intraoperative neuropathology in this series. Therefore, intraoperative neuropathology should no longer be routinely recommended.
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Affiliation(s)
- David Shooman
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Southampton, Hampshire, UK.
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Rossi R, Figus A, Corraine S. Early presentation of de novo high grade glioma with epileptic seizures: electroclinical and neuroimaging findings. Seizure 2010; 19:470-4. [PMID: 20674398 DOI: 10.1016/j.seizure.2010.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 07/01/2010] [Indexed: 10/19/2022] Open
Abstract
We report the clinical, EEG and neuroradiologic findings from three adult patients who developed new-onset seizure disorders as early clinical manifestations of de novo high grade glioma. The malignancies could not be recognised at the time of the first epileptic seizure because of minimal non-specific brain abnormalities, which showed no signs of necrosis or significant contrast enhancement on computed tomography and magnetic resonance imaging. Focal EEG abnormalities were recorded in all cases and appeared consistent with the neuroradiologic findings. The patients regained normal neurological status after the first seizure but rapidly developed space-occupying necrotic lesions. Two patients underwent surgery and received histological diagnoses of the tumours. Another patient was finally diagnosed with a malignant glioma based on the neuroradiologic picture and rapid progression of the cerebral lesion. It should be noted that in adult patients, new-onset epileptic seizures might reveal the presence of malignant gliomas at a very early stage in the tumour formation process. This report indicates that typical anatomoradiologic features of de novo high grade glioma, such as necrosis and rim-contrast enhancement, could be absent at the time of the first epileptic seizure but become clear within a short period after clinical presentation.
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Affiliation(s)
- Rosario Rossi
- Unit of Neurology, San Francesco Hospital, via Mannironi, 08100 Nuoro, Italy.
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Detection of histological anaplasia in gliomas with oligodendroglial components using positron emission tomography with 18F-FDG and 11C-methionine: report of two cases. J Neurooncol 2010; 101:335-41. [DOI: 10.1007/s11060-010-0262-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 05/30/2010] [Indexed: 11/25/2022]
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Ozsunar Y, Mullins ME, Kwong K, Hochberg FH, Ament C, Schaefer PW, Gonzalez RG, Lev MH. Glioma recurrence versus radiation necrosis? A pilot comparison of arterial spin-labeled, dynamic susceptibility contrast enhanced MRI, and FDG-PET imaging. Acad Radiol 2010; 17:282-90. [PMID: 20060750 DOI: 10.1016/j.acra.2009.10.024] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 10/21/2009] [Accepted: 10/21/2009] [Indexed: 10/20/2022]
Abstract
RATIONALE AND OBJECTIVES Distinguishing recurrent glial tumor from radiation necrosis can be challenging. The purpose of this pilot study was to preliminarily compare unenhanced arterial spin-labeled (ASL) imaging, dynamic susceptibility contrast-enhanced cerebral blood volume (DSCE-CBV) magnetic resonance imaging, and positron emission tomographic (PET) imaging in distinguishing predominant glioma recurrence or progression from predominant radiation necrosis in postoperative patients treated with proton-beam therapy. METHODS Patients with grade II to IV glioma previously treated with surgery and proton-beam therapy were enrolled on the basis of new enhancing nodules or masses with primary differential diagnoses of predominant tumor recurrence or progression versus radiation necrosis. ASL, DSCE-CBV, and PET examinations were assessed by visual qualitative and quantitative analysis for the detection of predominant tumor recurrence. Imaging results were correlated with a clinical-pathologic reference standard. RESULTS Thirty patients were studied, resulting in 33 ASL, 32 DSCE-CBV, and 26 PET examinations. On the basis of visual inspection, the sensitivities of PET, ASL, and DSCE-CBV examinations for detecting high-grade tumor foci were 81%, 88%, and 86%, respectively. The highest sensitivity values for quantitative ASL imaging were obtained using a normalized cutoff ratio of 1.3, resulting in sensitivity of 94% for ASL imaging and 71% for DSCE-CBV imaging. When predominant high-grade tumors with superimposed regions of predominant mixed radiation necrosis were excluded, DSCE-CBV sensitivity improved to 90%, but ASL sensitivity remained unchanged. CONCLUSIONS Compared with DSCE-CBV imaging, ASL imaging may more accurately distinguish predominant recurrent high-grade glioma from radiation necrosis, especially in regions with mixed radiation necrosis, for which DSCE-CBV imaging may underestimate true blood volume because of leakage artifacts.
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Bello L, Fava E, Casaceli G, Bertani G, Carrabba G, Papagno C, Falini A, Gaini SM. Intraoperative mapping for tumor resection. Neuroimaging Clin N Am 2010; 19:597-614. [PMID: 19959007 DOI: 10.1016/j.nic.2009.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article describes the rationale, indications, and modality for intraoperative brain mapping for safe and effective surgical removal of tumors located within functional brain areas.
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Affiliation(s)
- Lorenzo Bello
- Department of Neurological Sciences, Università degli Studi di Milano, 20122. Milano, Italy.
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