Results of positron emission tomography guidance and reassessment of the utility of and indications for stereotactic biopsy in children with infiltrative brainstem tumors
Results of positron emission tomography guidance and reassessment of the utility of and indications for stereotactic biopsy in children with infiltrative brainstem tumors
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DOI：
10.3171/ped-07/11/392
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发表时间：
2007-11-01
影响因子：
4.1
通讯作者：
Levivier, Marc
中科院分区：
文献类型：
--
作者：
Pirotte, Benoit J. M.;Lubansu, Alphonse;Levivier, Marc
物体。在儿童中诊断的大多数固有浸润性脑干病变是胶质瘤，这些肿瘤预后非常差。尽管立体定向活检在固有浸润性脑干病变中的有效性和风险受到广泛质疑，但在大约25%的病例中，神经影像诊断可能不准确，经验性治疗的后果不应被低估。许多中心仍在进行立体定向活检取样，但报告的诊断率从83%到96%不等。作者将正电子发射断层扫描(PET)图像整合到立体定向活检术的计划中，以将活检针的轨迹引导到固有浸润性脑干病变的高代谢灶。他们的目的是评估该技术在靶点选择和诊断结果方面的益处。20例新诊断的固有浸润性脑干病变的儿童接受了PET引导的立体定向活检术。6例PET示踪剂为F-18-2-氟-2-脱氧-D-葡萄糖(FDG)，8例为C-蛋氨酸，6例同时使用两种显像剂。在所有病例中，在PET示踪剂摄取率最高的41个区域中选择一个单一的活检目标。将PET检查结果与诊断结果进行比较。使用PET引导改进了靶点选择，并在所有轨迹和所有儿童中提供肿瘤诊断(高级别胶质瘤10例，低级别胶质瘤5例，非恶性肿瘤5例)。与仅由磁共振成像引导的轨迹相比，PET引导的轨迹提供了更高的诊断效率，从而使采样减少到单一轨迹。PET数据也可能具有预后价值，可用于肿瘤治疗。这些数据支持这样的建议，即PET引导提高了立体定向活检抽样的诊断效率，允许医生减少抽样程序的数量，并可能导致重新评估立体定向活检在患有固有浸润性脑干病变的儿童中的用途和适应证。
Object. Most intrinsic infiltrative brainstem lesions diagnosed in children are gliomas, and these carry a very bad prognosis. Although the utility and risk of stereotactically guided biopsy procedures in intrinsic infiltrative brainstem lesions have been widely questioned, the neuroimaging diagnosis may be inaccurate in approximately 25% of cases, and the consequences of empirical therapy should not be underestimated. Stereotactic biopsy sampling is still performed in many centers, but the reported diagnostic yield ranges from 83 to 96%. The authors integrated positron emission tomography (PET) images into the planning for stereotactic biopsy procedures to direct the biopsy needle's trajectory to hypermetabolic foci of intrinsic infiltrative brainstem lesions. Their aim was to assess the benefit of the technique in terms of target selection and diagnostic yield.Methods. Twenty children with newly diagnosed intrinsic infiltrative brainstem lesions underwent a PET-guided stereotactic biopsy procedure. The PET tracer was F-18-2-fluoro-2-deoxy-D-glucose (FDG) in six cases, C-methionine in eight, and both agents were used in six. A single biopsy target was selected in the area of highest PET tracer uptake 41 in all cases. The PET data were compared with diagnoses and outcome.Results. Use of PET guidance improved target selection and provided tumor diagnosis in all trajectories and in all children (high-grade glioma was diagnosed in 10, low-grade glioma in five, and nonglial tumor in five). The PET-guided trajectories provided a higher diagnostic yield than those guided by magnetic resonance imaging alone, which allowed the sampling to be reduced to a sin le trajectory. The PET data might also carry a prognostic value that could be 9 41 useful for oncological management.Conclusions. These data support the suggestion that PET guidance improves the diagnostic yield of stereotactic biopsy sampling, allows the practitioner to reduce the number of sampling procedures, and might lead to a reassessment of the utility of and indications for stereotactic biopsy in children with intrinsic infiltrative brainstem lesions.