Diagnostic accuracy of 201Thallium-SPECT and 18F-FDG-PET in the clinical assessment of glioma recurrence.
(2008)
Journal - European journal of nuclear medicine and molecular imaging (Germany )
Abstract :
PURPOSE: Reliable differential diagnosis between tumour recurrence and treatment-induced lesions is required to take advantage of new therapeutic approaches to recurrent gliomas. Structural imaging methods offer a high sensitivity but a low specificity, which might be improved by neurofunctional imaging. This study aimed to test the hypothesis that incorporation of 18-fluoro-deoxy-glucose positron emission tomography (FDG-PET) increases the accuracy of this differential diagnosis obtained with 201Tl chloride-single-photon emission computed tomography (201Tl-SPECT). MATERIALS AND METHODS: Seventy-six patients (mean age 47.72 +/- 16.19 years) under suspicion of glioma recurrence, 42% with low-grade and 58% with high-grade lesions, were studied by (201)Tl-SPECT and FDG-PET, reporting results under blinded conditions using visual analysis. Tumour was confirmed by histological confirmation (23 patients) or clinical and structural neuroimaging follow-up (mean of 2.6 years). RESULTS: This population had a high disease prevalence (72%). Globally, highest sensitivity was obtained using 201Tl-SPECT assessed with MRI (96%) and highest specificity using FDG-PET + MRI (95%). FDG-PET appeared slightly better for confirming tumour recurrence, whereas 201Tl-SPECT was superior for ruling out possible recurrence (disease present in 38% of FDG-PET negative explorations). In the high-grade subgroup, there were no false-positive examinations (specificity: 100%), but sensitivity differed among techniques (201Tl-SPECT : 94%; 201Tl-SPECT + MRI: 97%; FDG-PET + MRI: 83%). In the low-grade subgroup, 201Tl-SPECT + MRI showed highest sensitivity (95%) and lowest posttest negative probability (9%); FDG-PET + MRI offered highest specificity (92%) with a posttest negative probability of 35%. CONCLUSIONS: FDG-PET does not clearly improve the diagnostic accuracy of (201)Tl-SPECT, which appears to be a more appropriate examination for the diagnosis of possible brain tumour recurrence, especially for ruling it out.
| ISSN : | 1619-7070 |
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| Mesh Heading : | Brain Neoplasms Female Fluorodeoxyglucose F18 Glioma Humans Male Middle Aged Neoplasm Recurrence, Local Positron-Emission Tomography Radiopharmaceuticals Reproducibility of Results Sensitivity and Specificity Thallium Tomography, Emission-Computed, Single-Photon diagnostic use |
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| Mesh Heading Relevant : | radionuclide imaging diagnostic use radionuclide imaging radionuclide imaging methods diagnostic use methods |
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(201)Tl-SPECT in low-grade gliomas: diagnostic accuracy in differential diagnosis between tumour recurrence and radionecrosis.
(2004)
Journal - European journal of nuclear medicine and molecular imaging (Germany )
Abstract :
PURPOSE: The aim of this work was to describe the usefulness of a simple (201)Tl single-photon emission computed tomography (SPECT) technique in the differential diagnosis between tumour recurrence and radionecrosis during the follow-up of patients treated for low-grade gliomas. METHODS: The study population comprised 84 patients treated for low-grade gliomas who showed suspicion of tumour recurrence during their follow-up. All patients were examined by neuro-anatomical imaging procedures (CT, MRI) and (201)Tl-SPECT. (201)Tl-SPECT images were assessed by visual analysis based only on the information on the prescription form and by estimation of the uptake index (ratio of mean counts in the lesion to those in the contralateral mirror area). Examiners were blinded to the results of other tests. RESULTS: Under these conditions, the neuro-anatomical procedures yielded 26.2% inconclusive reports, with a global diagnostic accuracy of 0.61, a sensitivity of 0.63 and a specificity of 0.59. The global diagnostic accuracy for (201)Tl-SPECT was 0.83, with a sensitivity of 0.88 and a specificity of 0.76. Diagnostic pitfalls were observed in regions with physiological (201)Tl uptake, i.e. the posterior cranial fossa, diencephalon, lateral ventricles and cavernous and longitudinal venous sinuses. An uptake index cut-off value of 1.25 showed a sensitivity of 0.90 and specificity of 0.80 for detection of tumour activity. CONCLUSION: (201)Tl-SPECT has adequate diagnostic accuracy to be part of routine algorithms in the follow-up of patients with low-grade glioma suspected of tumour recurrence, as an alternative to neuro-anatomical procedures and not solely as a complementary test.
| ISSN : | 1619-7070 |
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| Mesh Heading : | Adult Brain Brain Neoplasms Diagnosis, Differential Female Glioma Humans Male Necrosis Neoplasm Recurrence, Local Prognosis Radiation Injuries Radiopharmaceuticals Reproducibility of Results Sensitivity and Specificity Severity of Illness Index Thallium Tomography, Emission-Computed, Single-Photon Treatment Outcome radiotherapy radiotherapy etiology diagnostic use methods |
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| Mesh Heading Relevant : | pathology radionuclide imaging radionuclide imaging radionuclide imaging radionuclide imaging pathology radionuclide imaging diagnostic use |
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