Intraoperative tissue fluorescence using 5-aminolevolinic acid (5-ALA) is more sensitive than contrast MRI or amino acid positron emission tomography (18F-FET PET) in glioblastoma surgery
Intraoperative tissue fluorescence using 5-aminolevolinic acid (5-ALA) is more sensitive than contrast MRI or amino acid positron emission tomography (18F-FET PET) in glioblastoma surgery
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DOI：
10.1179/1743132811y.0000000078
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发表时间：
2012-04-01
影响因子：
1.9
通讯作者：
Zachenhofer, Iris
中科院分区：
文献类型：
--
作者：
Roessler, Karl;Becherer, Alexander;Zachenhofer, Iris
目的：通过回顾性图像相关性研究，对 5-氨基左旋亚酸 (5-ALA) 检测术中胶质母细胞瘤 GBM 组织与术后正电子发射断层扫描 (PET) 和磁共振成像 MRI) 扫描中肿瘤细胞的 F-18-氟乙基-L-酪氨酸和 T1 造影剂摄取的敏感性进行比较。方法：10 例组织学证实位于口才脑区的 GBM 患者接受了 11 次手术，神经导航和 5-ALA 辅助肿瘤切除。术中在导航 MRI 扫描上标记残余 5-ALA 荧光，并将图像与术后 F-18-FET PET 和 T1 对比 MRI 融合。结果：术中，在保存切除结束时，在所有患者中检测到 2-5 个微弱的 5-ALA 阳性切除平面（平均 3.6），相比之下，检测到 0-4 个 F-18-FET 阳性切除平面（平均 1.4）和 0-2 个阳性。术后扫描中的 T1 对比 MRI 切除平面。 5-ALA和F-18-FET阳性切除平面数量之间的差异具有统计学意义（P=0.0002）。 5-ALA 阳性切除边缘的组织学检查表明每个病例均存在浸润性肿瘤。在所有病例中，切除边缘和术后 F-18-FET 摄取区域或残留对比 T1 区域上的残留 5-ALA 荧光均共定位，通过术前/术后图像融合记录。结论：在 GBM 切除结束时，大面积记录了残余微弱 5ALA 摄取，对应于肿瘤浸润。这些 5-ALA 阳性切除计划超出了术后 PET 扫描中的 F-18-FET 摄取区域。因此，对于恶性胶质瘤中的残留肿瘤，术中 5-ALA 残留荧光似乎比 F-18-FET PET 更敏感。
Objective: The sensitivity of 5-aminolevolinic acid (5-ALA) in detecting intraoperative glioblastoma GBM) tissue compared to postoperative F-18-fluoroethyl-L-tyrosine and T1 contrast uptake of tumor cells in positron emission tomography PET) and magnetic resonance imaging MRI) scans was investigated in a retrospective image correlative study.Methods: Ten patients with histological verified GBM in eloquent brain regions underwent 11 surgeries with neuronavigation and 5-ALA assisted tumor resection. Residual 5-ALA fluorescence was labeled intraoperatively on the navigation MRI scans and images were fused with postoperative F-18-FET PET and T1 contrast MRI.Results: Intraoperatively, at the end of save resection, in all patients 2-5 faint 5-ALA positive resection planes were detected mean 3.6), compared to 0-4 F-18-FET positive resection planes mean 1.4) and 0-2 positive T1 contrast MRI resection planes in postoperative scans. The difference between the number of 5-ALA and F-18-FET positive resection planes was statistically significant P=0.0002). The histological investigation of 5-ALA positive resection margins demonstrated infiltrative tumor in every case. Residual 5-ALA fluorescence on resection margins and postoperative F-18-FET uptake areas or residual contrast T1 areas were colocalized in all cases, documented by pre-/postoperative image fusion.Conclusion: Residual faint 5ALA uptake is documented in large areas at the end of GBM resection and corresponds to tumor infiltration. These 5-ALA positive resection plans exceeded the F-18-FET uptake areas in postoperative PET scans. Thus, intraoperative 5-ALA residual fluorescence seems to be a more sensitive marker than F-18-FET PET for residual tumor in malignant gliomas.