Differentiation between recurrent brain tumour and post-radiation necrosis: the value of 201Tl SPET versus 18F-FDG PET using a dual-headed coincidence camera--a pilot study.
The aim of this study was to determine whether it is possible to differentiate between recurrent disease and post-treatment necrosis in patients treated for a primary brain tumour. This prospective study was designed to compare the sensitivity and specificity of 201Tl single photon emission tomography (SPET) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) using a dual-headed coincidence camera. Sixteen patients suspected of having recurrent brain tumour (10 men, 6 women) (mean age 39.5 years, range 21-57 years) were studied. 201Tl SPET and 18F-FDG PET studies were performed on the same day. An increase in activity was considered indicative of tumour recurrence. The images were also quantified using a thallium index and an FDG index. The 18F-FDG PET images were also assessed visually using a 5-point scale. The diagnosis of tumour recurrence was based on clinical course and/or follow-up computed tomography or magnetic resonance imaging. The sensitivity of 201Tl SPET and 18F-FDG PET was 92% (11/12) and 62% (7/12) respectively. One patient initially assessed as having necrosis showed a recurrence 9 months after both studies. McNemar's analysis of these results showed a statistically significant difference (P = 0.023) in the ability of the two methods to separate with accuracy tumour from radiation necrosis. No correlation was found between the thallium index and the FDG index (r = 0.36). We conclude that 201Tl SPET is a sensitive modality for the detection of brain tumour recurrence. 18F-FDG imaging using a dual-headed coincidence camera gave significantly poorer results compared to 201Tl SPET. Our results do not justify continuation of this prospective comparative study.
Stokkel
M
M
Department of Nuclear Medicine, University Hospital Utrecht, The Netherlands.
Stevens
H
H
Taphoorn
M
M
Van Rijk
P
P
D000328:Adult; D001254:Astrocytoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D005910:Glioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009837:Oligodendroglioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D010865:Pilot Projects; D011832:Radiation Injuries / Q000000981:diagnostic imaging*; D011859:Radiography; D019275:Radiopharmaceuticals; D011878:Radiotherapy / Q000009:adverse effects*; D012008:Recurrence; D013794:Thallium Radioisotopes; D014055:Tomography, Emission-Computed; D015899:Tomography, Emission-Computed, Single-Photon
D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D019788:Fluorodeoxyglucose F18