title: Diagnosis of recurrent glioma with SPECT and iodine-123-alpha-methyl tyrosine.
abstract: Iodine-123-alpha-methyl tyrosine (IMT) allows the investigation of amino acid transport rate in brain neoplasms. It was the aim of this study to evaluate the potential of IMT-SPECT to diagnose the recurrence of gliomas after primary therapy.
  
  
  METHODS
  Using a triple-headed SPECT camera, the cerebral uptake of IMT was determined in 27 patients 22 mo, on average, after surgical removal of a primary brain tumor. Eighteen patients had suffered from high-grade gliomas, and nine had suffered from low-grade tumors. Four patients were examined before and after surgical revision of a presumed tumor recurrence. A total of 31 studies were evaluated. The final diagnosis was based on prospective clinicopathological follow-up. Recurrence was diagnosed in 23 cases, with marked clinical deterioration occurring 3.1 mo, on average, after SPECT, and was confirmed by histopathology in 14 instances. Eight cases were free of recurrence, as evidenced by inconspicuous clinical follow-up, ranging from 6 mo to 17 mo after SPECT in seven cases, and by clinical course and histopathology in the remaining subject.
  
  
  RESULTS
  Patients with recurrence had significantly higher ratios of IMT uptake in the tumor area to that in a background region than did patients without recurrence (2.27 +/- 0.59 compared to 1.47 +/- 0.29; p < 0.002). The best cutoff level of the IMT uptake ratio in the differentiation between recurrence and benign posttherapeutic lesion was 1.8. Using this study-specific discrimination threshold, the sensitivity and specificity of IMT-SPECT for detecting glioma recurrence were 18 of 23 (78%) and 8 of 8 (100%), respectively. The area under the binormal receiver operating characteristic curve, fitted to the data, was 0.90 +/- 0.06.
  
  
  CONCLUSIONS
  Iodine-123-alpha-methyl tyrosine-SPECT is a promising new tool in the follow-up of patients with gliomas after primary therapy.
authors.affiliation: Department of Nuclear Medicine, Westfälische Wilhelms-Universität, Münster, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Kuwert
authors.forename: B
authors.initials: B
authors.lastname: Woesler
authors.forename: C
authors.initials: C
authors.lastname: Morgenroth
authors.forename: H
authors.initials: H
authors.lastname: Lerch
authors.forename: M
authors.initials: M
authors.lastname: Schäfers
authors.forename: S
authors.initials: S
authors.lastname: Palkovic
authors.forename: P
authors.initials: P
authors.lastname: Matheja
authors.forename: W
authors.initials: W
authors.lastname: Brandau
authors.forename: H
authors.initials: H
authors.lastname: Wassmann
authors.forename: O
authors.initials: O
authors.lastname: Schober
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008781:Methyltyrosines; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D012372:ROC Curve; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D007457:Iodine Radioisotopes; D008781:Methyltyrosines; D019275:Radiopharmaceuticals; C030855:3-iodo-alpha-methyltyrosine