title: MRI and thallium-201 SPECT in the prediction of survival in glioma.
abstract: BACKGROUND
  This paper aims to study the value of MRI and Thallium 201 ((201)Tl) single-photon emission computed tomography (SPECT) in the prediction of overall survival (OS) in glioma patients treated with temozolomide (TMZ) and to evaluate timing of radiological follow-up.
  
  
  METHODS
  We included patients treated with TMZ chemoradiotherapy for newly diagnosed glioblastoma multiforme (GBM) and with TMZ for recurrent glioma. MRIs and (201)Tl SPECTs were obtained at regular intervals. The value of both imaging modalities in predicting OS was examined using Cox regression analyses.
  
  
  RESULTS
  Altogether, 138 MRIs and 113 (201)Tl SPECTs in 46 patients were performed. Both imaging modalities were strongly related to OS (P ≤ 0.02). In newly diagnosed GBM patients, the last follow-up MRI (i.e., after six adjuvant TMZ courses) and SPECT (i.e., after three adjuvant TMZ courses) were the strongest predictors of OS (P = 0.01). In recurrent glioma patients, baseline measurements appeared to be the most predictive of OS (P < 0.01). The addition of one imaging modality to the other did not contribute to the prediction of OS.
  
  
  CONCLUSIONS
  Both MRI and (201)Tl SPECT are valuable in the prediction of OS. It is adequate to restrict to one of both modalities in the radiological follow-up during treatment. In the primary GBM setting, MRI after six adjuvant TMZ courses contributes significantly to the prediction of survival. In the recurrent glioma setting, baseline MRI appears to be a powerful predictor of survival, whereas follow-up MRIs during TMZ seem to be of little additional value.
authors.affiliation: Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands. m.vos@mchaaglanden.nl
authors.forename: Maaike J
authors.initials: MJ
authors.lastname: Vos
authors.forename: Johannes
authors.initials: J
authors.lastname: Berkhof
authors.forename: Otto S
authors.initials: OS
authors.lastname: Hoekstra
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Bosma
authors.forename: Eefje M
authors.initials: EM
authors.lastname: Sizoo
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Heimans
authors.forename: Jaap C
authors.initials: JC
authors.lastname: Reijneveld
authors.forename: Esther
authors.initials: E
authors.lastname: Sanchez
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Lagerwaard
authors.forename: Jan
authors.initials: J
authors.lastname: Buter
authors.forename: David P
authors.initials: DP
authors.lastname: Noske
authors.forename: Tjeerd J
authors.initials: TJ
authors.lastname: Postma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005910:Glioma / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D000077204:Temozolomide; D013794:Thallium Radioisotopes; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D003606:Dacarbazine; D000077204:Temozolomide