Comparison of diffusion tensor,dynamic susceptibility contrast MRI and Tc-Tetrofosmin brain SPECT for the detection of recurrent high-grade glioma |
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| Authors: | George A Alexiou Anastasia Zikou Spyridon Tsiouris Anna Goussia Paraskevi Kosta Athanasios Papadopoulos Spyridon Voulgaris Pericles Tsekeris Athanasios P Kyritsis Andreas D Fotopoulos Maria I Argyropoulou |
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| Institution: | 1. Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece;2. Department of Radiology, University Hospital of Ioannina, Ioannina, Greece;3. Department of Nuclear Medicine, University Hospital of Ioannina, Ioannina, Greece;4. Department of Pathology, University Hospital of Ioannina, Ioannina, Greece;5. Department of Radiation Therapy, University Hospital of Ioannina, Ioannina, Greece;6. Department of Neurology, University Hospital of Ioannina, Ioannina, Greece |
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| Abstract: | IntroductionTreatment 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 99mTc-Tetrofosmin brain single-photon emission computed tomography (SPECT) for differentiation of recurrent glioma from treatment induced necrosis.MethodsA 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, 99mTc-Tetrofosmin brain SPECT.ResultsBoth 99mTc-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 99mTc-Tetrofosmin uptake ratio and rCBV (P = 0.003).ConclusionsDynamic susceptibility contrast MRI and brain SPECT with 99mTc-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. |
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| Keywords: | SPECT 99mTc-Tetrofosmin MRI Diffusion tensor imaging Perfusion imaging Glioma |
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