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.
Department of Nuclear Medicine, University Hospital Utrecht, The Netherlands.
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M
Stokkel
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H
Stevens
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M
Taphoorn
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P
Van Rijk
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