title: Usefulness of thallium-201 SPECT for prediction of early progression in low-grade astrocytomas diagnosed by stereotactic biopsy.
abstract: OBJECTIVE
  To establish the value of thallium-201 single-photon emission computed tomography ((201)Tl-SPECT) as a predictor of early progression in low-grade astrocytomas (LGAs).
  
  
  METHODS
  We studied 57 consecutive patients who underwent 201 Tl-SPECT before stereotactic biopsy (n=33) or surgical resection (n=24). The value of radiologic and histopathological variables ((201)Tl index and MIB-1 index) in predicting progression free survival (PFS) was examined in each group of patients.
  
  
  RESULTS
  During a median follow up of 55 months (range, 11-101), progression of the primary lesion was identified in 46 patients (80.7%). Based on Cox's proportional hazards model, the increased thallium uptake was associated with a short PFS in both biopsy and resection groups, whereas the MIB-1 index was significant only in the resection group. Considering the cut-off value, (201)Tl index>1.7 was statistically significant for reduced PFS in the biopsy group; however, MIB-1 index was not directly related to the PFS at any level. For the surgical resection group, both a (201)Tl index>1.9 and a MIB-1 index>6% were associated with short PFS.
  
  
  CONCLUSIONS
  (201)Tl SPECT may play a role in prediction of early tumor progression not only in resected LGAs, but also in biopsy-proven LGAs. Therefore, we suggest that patients with LGAs established from biopsy should be considered as high-risk groups for early progression if the tumor shows a high (201)Tl uptake, even if the tumor demonstrates low proliferative activity on histopathologic examination.
authors: Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, 126-1, 5-ga, Anam-dong, Seongbuk-gu, Seoul 136-705, Republic of Korea.
authors: Kyung-Jae
authors: KJ
authors: Park
authors: Shin-Hyuk
authors: SH
authors: Kang
authors: Dong-Hyuk
authors: DH
authors: Park
authors: Tai-Hyoung
authors: TH
authors: Cho
authors: Jae Gol
authors: JG
authors: Choe
authors: Yong-Gu
authors: YG
authors: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001254:Astrocytoma / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D001706:Biopsy; D001932:Brain Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D003131:Combined Modality Therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000032:analysis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals; D012737:Sex Factors; D013238:Stereotaxic Techniques; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019394:Ki-67 Antigen; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes