Thallium-201 versus Tc99m-glucoheptonate SPECT for evaluation of recurrent brain tumours: a within-subject comparison with pathological correlation.
BACKGROUND
Thallium-201 (Tl-201) is the most commonly used tracer for functional imaging of recurrent brain tumours. However, the physical properties of Tl-201 are not particularly suitable for this application, thus, a technetium-99 (Tc99m) labelled alternative with more favourable physical properties has been sought. The aim of this study was to compare the ability of Tl-201 and Tc99m-glucoheptonate single photon emission computed tomography (SPECT) to detect viable recurrent tumour and differentiate post-radiation gliosis.


METHODS
Brain SPECT with Tl-201 and Tc99m-glucoheptonate was performed in 20 patients with malignant brain tumour in whom recurrent disease was suspected. Tracer uptake in the mass was defined as high, moderate or low and was correlated with histological verification of the lesion in all cases.


RESULTS
Recurrent tumour was demonstrated in 17 patients by both Tl-201 and Tc99m-glucoheptonate SPECT and confirmed by surgical resection in all 17 patients. Three patients had no tracer uptake on either Tl-210 or Tc99m-glucoheptonate SPECT and surgical resection revealed only fibrotic tissue with areas of necrosis. Tc99m-glucoheptonate images were found to correlate more closely with the surgical findings with regard to the location of tumour margin, extent of tumour invasion and intratumoural necrosis.


CONCLUSIONS
Tc99m-glucoheptonate brain SPECT is an accurate agent for SPECT imaging of recurrent brain tumours and may provide more information about the location of the tumour margin and its extent and intratumoural necrosis than Tl-201. Tc99m-glucoheptonate may be a viable replacement for Tl-201.
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi. danzig@rediffmail.com
S
S
Barai
Rajkamal
G P
GP
Bandopadhayaya
G S
GS
Pant
A K
AK
Haloi
A
A
Malhotra
H
H
Dhanpathi
D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002533:Cerebral Angiography; D002648:Child; D003627:Data Interpretation, Statistical; D005260:Female; D005682:Gadolinium; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D013400:Sugar Acids; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D013400:Sugar Acids; D013794:Thallium Radioisotopes; D005682:Gadolinium; C100014:technetium Tc 99m gluceptate