title: Correlation of diffusion tensor, dynamic susceptibility contrast MRI and (99m)Tc-Tetrofosmin brain SPECT with tumour grade and Ki-67 immunohistochemistry in glioma.
abstract: OBJECTIVE
  Assessment of the grade and type of glioma is of paramount importance for prognosis. Tumour proliferative potentials may provide additional information on the behaviour of the tumour, its response to treatment and prognosis. The purpose of this study was to investigate the correlation between diffusion tensor imaging (DTI), dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) and (99m)Tc-Tetrofosmin brain single-photon emission computed tomography (SPECT), and the tumour grade and Ki-67 labelling index in newly diagnosed gliomas.
  
  
  METHODS
  Study was made of patients with suspected glioma on brain MRI between December 2010 and January 2012, by DTI, DSC MRI and (99m)Tc-Tetrofosmin brain SPECT. The proliferative activity of each tumour was measured by deriving the Ki-67 proliferation index from immunohistochemical staining of tumour specimens.
  
  
  RESULTS
  Glioma was newly diagnosed in 25 patients (17 men, 8 women, aged 19-79 years, median 55 years). The Ki-67 index ranged from 1% to 80% (mean 19.4%). On evaluation of the relationship between the (99m)Tc-Tetrofosmin tumour uptake by gliomas was found to be significantly correlated with cellular proliferation (rho=0.924, p<0.0001). Regarding DTI, significant negative correlation was demonstrated between the apparent diffusion coefficient (ADC) ratio and the Ki-67 index (rho=-0.545, p=0.0087). Significant correlation was also observed between the fractional anisotropy (FA) ratio and the Ki-67 index (rho=0.489, p=0.02). Strong correlation was found between relative cerebral blood volume (rCBV) and Ki-67 index (rho=0.853, p<0.0001), and between the (99m)Tc-Tetrofosmin lesion-to-normal (L/N) uptake ratio and rCBV (rho=0.808, p ≤ 0.0001). Significant negative correlation was demonstrated between the (99m)Tc-Tetrofosmin L/N ratio and ADC ratio (rho=-0.513, p=0.014). These imaging techniques were able to distinguish between low-grade and high-grade gliomas.
  
  
  CONCLUSIONS
  Findings on DSC MRI and brain SPECT with (99m)Tc-Tetrofosmin metrics were more closely correlated with glioma cellular proliferation.
authors.affiliation: Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece. Electronic address: alexiougrg@yahoo.gr.
authors.forename: George A
authors.initials: GA
authors.lastname: Alexiou
authors.affiliation: Department of Radiology, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Zikou
authors.affiliation: Department of Nuclear Medicine, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Tsiouris
authors.affiliation: Department of Pathology, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Anna
authors.initials: A
authors.lastname: Goussia
authors.affiliation: Department of Radiology, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Kosta
authors.affiliation: Department of Nuclear Medicine, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Papadopoulos
authors.affiliation: Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Voulgaris
authors.affiliation: Department of Neurology, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Athanasios P
authors.initials: AP
authors.lastname: Kyritsis
authors.affiliation: Department of Nuclear Medicine, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Andreas D
authors.initials: AD
authors.lastname: Fotopoulos
authors.affiliation: Department of Radiology, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Maria I
authors.initials: MI
authors.lastname: Argyropoulou
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000175:diagnosis / Q000473:pathology*; D056324:Diffusion Tensor Imaging / Q000379:methods; D005029:Ethylenediamines; D005260:Female; D005910:Glioma / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D019394:Ki-67 Antigen / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult
chemical_list: D005029:Ethylenediamines; D019394:Ki-67 Antigen; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; C120322:technetium Tc 99m tris((2-((pyrrol-2-yl)methylamino)ethyl)amino)amine; C078700:technetium tc-99m tetrofosmin
keywords: (99m)Tc-Tetrofosmin; Diffusion tensor imaging; Glioma; Perfusion imaging; SPECT