title: Sequential scintigraphic strategy for the differentiation of brain tumours.
abstract: Both thallium-201 and iodine-123 alpha-methyltyrosine (123I-IMT) have been shown to be useful in the diagnostic evaluation of brain tumours. The aim of this study was to investigate the respective contributions of 201Tl and 123I-IMT single-photon emission tomography (SPET) in the non-invasive evaluation of intracerebral tumours. We analysed 65 patients with the following brain tumours: 8 non-neoplastic lesions, 4 meningiomas, 12 low-grade gliomas, 28 high-grade gliomas, 11 metastases and 2 high-grade lymphomas. 201Tl SPET and 123I-IMT SPET were performed [start of 201Tl SPET: 15 min p.i. (early) and 180 min p.i. (delayed); start of 123I-IMT SPET: 15 min p.i.]. The intensity of uptake was quantified as the ratio between tracer accumulation in the tumour and in the contralateral hemisphere. None of the non-neoplastic lesions or low-grade gliomas expressed marked 201Tl uptake. All malignant tumours except one small metastasis and all meningiomas except one small, cystic and degenerated lesion showed significant 201Tl accumulation [Tl(15')>2.0]; 123I-IMT uptake was either absent or intermediate in non-malignant lesions except in two low-grade gliomas; the highest levels were observed in high-grade gliomas followed by metastases and lymphomas (mean IMT: 2.7 vs. 2.1 vs. 1.8), with metastases showing a high variability in 123I-IMT uptake (range: 0.8-3.6). Using 201Tl to distinguish non-neoplastic lesions from malignant tumours and meningiomas, 63 of 65 patients were characterised correctly. In the latter group, high-grade gliomas were correctly identified in 27 of 28 cases by their amino acid uptake. It is concluded that the combination of 201Tl and 123I-IMT surpasses the accuracy of each single test in the differentiation of space-occupying lesions of the brain. Based on these preliminary results, a sequential strategy is proposed involving an initial 201Tl SPET study and an additional 123I-IMT SPET study in the event of positive 201Tl uptake.
authors.affiliation: Department of Nuclear Medicine, University of Münster, Germany. matheja@uni-muenster.de
authors.forename: P
authors.initials: P
authors.lastname: Matheja
authors.forename: C
authors.initials: C
authors.lastname: Rickert
authors.forename: M
authors.initials: M
authors.lastname: Weckesser
authors.forename: S
authors.initials: S
authors.lastname: Palkovic
authors.forename: J
authors.initials: J
authors.lastname: Löttgen
authors.forename: B
authors.initials: B
authors.lastname: Riemann
authors.forename: K
authors.initials: K
authors.lastname: Kopka
authors.forename: T
authors.initials: T
authors.lastname: Kuwert
authors.forename: H
authors.initials: H
authors.lastname: Wassmann
authors.forename: W
authors.initials: W
authors.lastname: Paulus
authors.forename: O
authors.initials: O
authors.lastname: Schober
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging* / Q000378:metabolism; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008781:Methyltyrosines / Q000493:pharmacokinetics; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012189:Retrospective Studies; D013794:Thallium Radioisotopes / Q000493:pharmacokinetics
chemical_list: C090322:3-iodo-O-methyl-alpha-methyltyrosine; D007457:Iodine Radioisotopes; D008781:Methyltyrosines; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes