title: 99mTc-MDM Brain SPECT for the Detection of Recurrent/Remnant Glioma-Comparison With ceMRI and 18F-FLT PET Imaging: Initial Results.
abstract: OBJECTIVE
  To evaluate the diagnostic use of an indigenously developed single vial ready to label (with Tc) kit preparation of bis-methionine-DTPA (Tc-MDM) for the detection of recurrent/residual glioma.
  
  
  METHODS
  We prospectively studied 32 patients (21 male and 11 female subjects aged 43.0±16.0 years) with clinical suspicion of postoperative recurrent/residual glioma. After radical radiotherapy (54.0-60.0 Gy) with or without concurrent temozolomide as indicated, Tc-MDM SPECT and ceMRI of the brain was performed in all the patients and F-FLT-PET imaging in 16 of 32 patients.
  
  
  RESULTS
  MDM SPECT and ceMRI findings were concordant in 28 patients (15 positive and 13 negative). The findings were discordant in the remaining 5 patients, with positive ceMRI and negative MDM-SPECT in 2 patients and negative ceMRI and positive MDM-SPECT in 3 patients. Tc-MDM-SPECT, F-FLT PET, and ceMRI scan findings were positive in 9 of 16 and negative in 5 of 16 patients. In the remaining 2 of 16 patients, both F-FLT-PET and Tc-MDM-SPECT were positive, but ceMRI was negative. Sensitivity, specificity, PPV, NPV, and DA of Tc-MDM-SPECT for diagnosing recurrent/residual glioma were 88.24%, 81.25%, 83.3%, 86.7%, and 84.8%, respectively.
  
  
  CONCLUSIONS
  The diagnostic accuracy of Tc-bis-methionine (MDM)-SPECT imaging was comparable with that of ceMRI and F-FLT-PET and may be useful in the management of glioma patients in the postsurgical follow-up period. This imaging technique may be of special interest in peripheral hospitals/developing countries lacking access to expensive PET/cyclotron technology. However, comparison with the existing "gold standard" PET tracers, especially with C-11-methionine-PET imaging and histopathological correlation, is warranted in a large cohort of glioma patients through multicentric studies.
authors.affiliation: From the *Nuclear Medicine & PET, PGIMER, Chandigarh, India; †Radiation Oncology, PGIMER, Chandigarh, India; ‡Division of Radiopharmacy and PET/Cyclotron Centre, INMAS, DRDO, Delhi, India; and §Department of Radiodiagnosis, PGIMER, Chandigarh, India.
authors.forename: Baljinder
authors.initials: B
authors.lastname: Singh
authors.forename: Narendra
authors.initials: N
authors.lastname: Kumar
authors.forename: Sarika
authors.initials: S
authors.lastname: Sharma
authors.forename: Ankit
authors.initials: A
authors.lastname: Watts
authors.forename: Puja P
authors.initials: PP
authors.lastname: Hazari
authors.forename: Nisha
authors.initials: N
authors.lastname: Rani
authors.forename: Sameer
authors.initials: S
authors.lastname: Vyas
authors.forename: Bhattacharya
authors.initials: B
authors.lastname: Anish
authors.forename: Anil K
authors.initials: AK
authors.lastname: Mishra
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging*; D015224:Dideoxynucleosides; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D004369:Pentetic Acid / Q000031:analogs & derivatives*; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D015224:Dideoxynucleosides; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C549406:technetium 99m DTPA-bis(methionine); D004369:Pentetic Acid; C002854:alovudine