Comparison of diffusion tensor, dynamic susceptibility contrast MRI and (99m)Tc-Tetrofosmin brain SPECT for the detection of recurrent high-grade glioma.
BACKGROUND
Treatment induced necrosis is a relatively frequent finding in patients treated for high-grade glioma. Differentiation by imaging modalities between glioma recurrence and treatment induced necrosis is not always straightforward. This is a comparative study of diffusion tensor imaging (DTI), dynamic susceptibility contrast MRI and (99m)Tc-Tetrofosmin brain single-photon emission computed tomography (SPECT) for differentiation of recurrent glioma from treatment induced necrosis.


METHODS
A prospective study was made of 30 patients treated for high-grade glioma who had suspected recurrent tumor on follow-up MRI. All had been treated by surgical resection of the tumor followed by standard postoperative radiotherapy with chemotherapy. No residual tumor had been found on brain imaging immediately after the initial treatment. All the patients were studied with dynamic susceptibility contrast brain MRI and, within a week, (99m)Tc-Tetrofosmin brain SPECT.


RESULTS
Both (99m)Tc-Tetrofosmin brain SPECT and dynamic susceptibility contrast MRI could discriminate between tumor recurrence and treatment induced necrosis with 100% sensitivity and 100% specificity. An apparent diffusion coefficient (ADC) ratio cut-off value of 1.27 could differentiate recurrence from treatment induced necrosis with 65% sensitivity and 100% specificity and a fractional anisotropy (FA) ratio cut-off value of 0.47 could differentiate recurrence from treatment induced necrosis with 57% sensitivity and 100% specificity. A significant correlation was demonstrated between (99m)Tc-Tetrofosmin uptake ratio and rCBV (P=0.003).


CONCLUSIONS
Dynamic susceptibility contrast MRI and brain SPECT with (99m)Tc-Tetrofosmin had the same accuracy and may be used to detect recurrent tumor following treatment for glioma. DTI also showed promise for the detection of recurrent tumor, but was inferior to both dynamic susceptibility contrast MRI and brain SPECT.
Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece. Electronic address: alexiougrg@yahoo.gr.
George A
GA
Alexiou
Department of Radiology, University Hospital of Ioannina, Ioannina, Greece.
Anastasia
A
Zikou
Department of Nuclear Medicine, University Hospital of Ioannina, Ioannina, Greece.
Spyridon
S
Tsiouris
Department of Pathology, University Hospital of Ioannina, Ioannina, Greece.
Anna
A
Goussia
Department of Radiology, University Hospital of Ioannina, Ioannina, Greece.
Paraskevi
P
Kosta
Department of Nuclear Medicine, University Hospital of Ioannina, Ioannina, Greece.
Athanasios
A
Papadopoulos
Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece.
Spyridon
S
Voulgaris
Department of Radiation Therapy, University Hospital of Ioannina, Ioannina, Greece.
Pericles
P
Tsekeris
Department of Neurology, University Hospital of Ioannina, Ioannina, Greece.
Athanasios P
AP
Kyritsis
Department of Nuclear Medicine, University Hospital of Ioannina, Ioannina, Greece.
Andreas D
AD
Fotopoulos
Department of Radiology, University Hospital of Ioannina, Ioannina, Greece.
Maria I
MI
Argyropoulou
D001921:Brain / Q000473:pathology* / Q000528:radiation effects; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000628:therapy; D059248:Chemoradiotherapy / Q000009:adverse effects*; D003287:Contrast Media; D003937:Diagnosis, Differential; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D005910:Glioma / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000517:prevention & control; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011832:Radiation Injuries / Q000209:etiology / Q000473:pathology*; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016896:Treatment Outcome
D003287:Contrast Media; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin
(99m)Tc-Tetrofosmin; Diffusion tensor imaging; Glioma; MRI; Perfusion imaging; SPECT