title: The integration of metabolic imaging in stereotactic procedures including radiosurgery: a review.
abstract: OBJECTIVE
  The authors review their experience with the clinical development and routine use of positron emission tomography (PET) during stereotactic procedures, including the use of PET-guided gamma knife radiosurgery (GKS).
  
  
  METHODS
  Techniques have been developed for the routine use of stereotactic PET, and accumulated experience using PET-guided stereotactic procedures over the past 10 years includes more than 150 stereotactic biopsies, 43 neuronavigation procedures, and 34 cases treated with GKS. Positron emission tomography-guided GKS was performed in 24 patients with primary brain tumors (four pilocytic astrocytomas, five low-grade astrocytomas or oligodendrogliomas, seven anaplastic astrocytomas or ependymomas, five glioblastomas, and three neurocytomas), five patients with metastases (single or multiple lesions), and five patients with pituitary adenomas.
  
  
  CONCLUSIONS
  Data obtained with PET scanning can be integrated with GKS treatment planning, enabling access to metabolic information with high spatial accuracy. Positron emission tomography data can be successfully combined with magnetic resonance imaging data to provide specific information for defining the target volume for the radiosurgical treatment in patients with recurrent brain tumors, such as glioma, metastasis, and pituitary adenoma. This approach is particularly useful for optimizing target selection for infiltrating or ill-defined brain lesions. The use of PET scanning contributed data in 31 cases (93%) and information that was specifically utilized to adapt the target volume in 25 cases (74%). It would seem that the integration of PET data into GKS treatment planning may represent an important step toward further developments in radiosurgery: this approach provides additional information that may open new perspectives for the optimization of the treatment of brain tumors.
authors.affiliation: Centre Gamma Knife, Université Libre de Bruxelle, Départmente de Neurochirurgie, PET-Cyclotron Biomedical, Hôpital Erasme, Bruxelle, Belgique. Marc.Levivier@ulb.ac.be
authors.forename: Marc
authors.initials: M
authors.lastname: Levivier
authors.forename: David
authors.initials: D
authors.lastname: Wikler
authors.forename: Nicolas
authors.initials: N
authors.lastname: Massager
authors.forename: Philippe
authors.initials: P
authors.lastname: David
authors.forename: Daniel
authors.initials: D
authors.lastname: Devriendt
authors.forename: Jose
authors.initials: J
authors.lastname: Lorenzoni
authors.forename: Benoit
authors.initials: B
authors.lastname: Pirotte
authors.forename: Françoise
authors.initials: F
authors.lastname: Desmedt
authors.forename: Stephane
authors.initials: S
authors.lastname: Simon
authors.forename: Serge
authors.initials: S
authors.lastname: Goldman
authors.forename: Paul
authors.initials: P
authors.lastname: Van Houtte
authors.forename: Jacques
authors.initials: J
authors.lastname: Brotchi
mesh_terms: D001254:Astrocytoma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery*; D006801:Humans; D038361:Neuronavigation; D016634:Radiosurgery; D014055:Tomography, Emission-Computed