Clinical value of iodine-123-alpha-methyl-L-tyrosine single-photon emission tomography in the differential diagnosis of recurrent brain tumor in patients pretreated for glioma at follow-up
Clinical value of iodine-123-alpha-methyl-L-tyrosine single-photon emission tomography in the differential diagnosis of recurrent brain tumor in patients pretreated for glioma at follow-up
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DOI：
10.1200/jco.20.2.396
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发表时间：
2002-01-15
影响因子：
45.3
通讯作者：
Kirsch, CM
中科院分区：
文献类型：
--
作者：
Samnick, S;Bader, JB;Kirsch, CM
目的：评价碘-123- α -甲基- l-酪氨酸（IMT）和单光子发射断层扫描（SPET）在胶质瘤术前复发患者随访鉴别诊断中的临床潜力。患者和方法：78例患者在初次治疗后36个月接受检查。所有患者在首次治疗时都知道组织病理学诊断；除IMT-SPET外，还进行了磁共振和/或计算机断层扫描检查。静脉注射190 +/- 10 MBq的IMT 20分钟后获得大脑SPET图像。SPET图像在视觉上被分类为复发肿瘤的阳性或阴性，并通过计算病变中示踪剂积累与使用感兴趣区域的未受影响的对侧参考区域之间的比率。最终诊断基于独立于IMT-SPET获得的前瞻性临床病理结果。结果：IMT-SPET检测到所有高级别复发胶质瘤（4级，灵敏度100%）。2级和3级复发率存在差异（敏感性分别为84%和92%）。此外，良性治疗后病变（术后瘢痕、放射性坏死）被正确诊断为肿瘤复发阴性。总体而言，2年级的IMT摄取（1.45 +/- 0.24）显著低于3年级（1.70 +/- 0.41）和4年级（1.88 +/- 0.32）。然而，仅从单个病例的IMT积累情况来评估肿瘤分级是困难的。结论：IMT-SPET在检测和描绘复发性胶质瘤以及鉴别治疗后良性病变和恶性肿瘤组织方面具有重要意义。它可能是一个有价值的临床工具，以诊断复发的胶质瘤患者在后续治疗。然而，它在确定组织学肿瘤分级方面存在局限性。(C) 2002年由美国临床肿瘤学会出版。
Purpose: To assess the clinical potential of iodine-123-alpha-methyl-L-tyrosine (IMT) and single-photon emission tomography (SPET) in the differential diagnosis of recurrences in patients pretreated for gliomas at follow-up.Patients and Methods: Seventy-eight patients were examined after primary therapy over 36 months. Histopathologic diagnoses of all patients was known at first treatment; magnetic resonance and/or computed tomography examination was performed in addition to IMT-SPET. Cerebral SPET images were acquired 20 minutes after intravenous application of 190 +/- 10 MBq of IMT. SPET images were classified as positive or negative for recurrent tumor visually and by calculating the ratios between tracer accumulation in the lesion and the unaffected contralateral regions of reference using region of interest. Final diagnoses were based on prospective clinicopathologic findings obtained independently of IMT-SPET.Results: IMT-SPET detected all high-grade recurrent gliomas (grade 4; sensitivity, 100%). A difference could be demonstrated in grade 2 and 3 recurrences (sensitivity, 84% and 92%, respectively). Moreover, benign posttherapeutic lesions (postoperative scars, radiation necrosis) were correctly diagnosed as negative for tumor recurrence. In general, IMT uptake in grade 2 (1.45 +/- 0.24) was significantly lower than that in grades 3 (1.70 +/- 0.41) and 4 (1.88 +/- 0.32). However, it was difficult to evaluate tumor grade only from the IMT accumulation in individual cases.Conclusion: IMT-SPET seems highly useful for detecting and delineating recurrent gliomas and differentiating between benign posttherapeutic lesions and malignant tumor tissue. It may be a valuable clinical tool to diagnose recurrences in patients pretreated for gliomas at follow-up. However, it showed limitations in determining histologic tumor grade. (C) 2002 by American Society of Clinical Oncology.