Integration of [11C]methionine-positron emission tomographic and magnetic resonance imaging for image-guided surgical resection of infiltrative low-grade brain tumors in children.
OBJECTIVE
To evaluate the interest of integrating positron emission tomography (PET) images with the radiolabeled tracer [(11)C]methionine (Met) into the image-guided navigation planning of infiltrative low-grade brain tumors (LGBTs) in children.


METHODS
Twenty-two children underwent combined Met-PET with magnetic resonance imaging (MRI) scans in the planning of a navigation procedure. These children presented an LGBT (astrocytomas, 10; oligodendrogliomas, 4; ependymomas, 4; gangliogliomas, 4) located close to functional areas. Tumor boundaries were ill-defined on MRI (including T2-weighted and fluid-attenuated inversion-recovery scans) and could not be clearly identified for allowing a complete, or at least a large, image-guided resection. The PET tracer Met was chosen because of its higher sensitivity and specificity than MRI to detect tumor tissue. The level and extension of MET uptake were analyzed to define the PET contour, subsequently projected onto MRI scans to define a final target contour for volumetric resection. The quality of tumor resection was assessed by an early postoperative MRI and Met-PET workup.


RESULTS
In 20 of the 22 children with ill-defined LGBTs, PET improved tumor delineation and contributed to define a final target contour different from that obtained with MRI alone. Met-PET guidance allowed a total resection of Met uptake in 17 cases that were considered total tumor resections because the operative margin left in place contained nontumor tissue.


CONCLUSIONS
These data suggested that Met-PET guidance could help to improve the number of total resections and the amount of tumor removed in infiltrative LGBTs in children.
Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. bpirotte@ulb.ac.be
Benoit
B
Pirotte
Serge
S
Goldman
Patrick
P
Van Bogaert
Philippe
P
David
David
D
Wikler
Sandrine
S
Rorive
Jacques
J
Brotchi
Marc
M
Levivier
D000293:Adolescent; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008715:Methionine; D009361:Neoplasm Invasiveness; D038361:Neuronavigation / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D013382:Subtraction Technique; D025321:Surgery, Computer-Assisted / Q000379:methods*; D018511:Systems Integration
D019275:Radiopharmaceuticals; C086242:carbon-11 methionine; D008715:Methionine