gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Neuronavigation guided microsurgery of gliomas using magnetic resonance imaging and 11C-methionine positron emission tomography image fusion

Operationen von Gliomen mit Neuronavigation und MRT/Methionin-PET-Bildfusion

Meeting Abstract

  • corresponding author Hartmut Gumprecht - Abt. für Neurochirurgie, Krankenhaus München-Bogenhausen, München
  • W. Weber - Klinik für Nuklearmedizin der Technischen Universität München, München
  • A. L. Grosu - Klinik für Strahlentherapie der Technischen Universität München, München
  • M. Schwaiger - Klinik für Nuklearmedizin der Technischen Universität München, München
  • C. B. Lumenta - Abt. für Neurochirurgie, Krankenhaus München-Bogenhausen, München

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMO.06.01

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0062.shtml

Veröffentlicht: 23. April 2004

© 2004 Gumprecht et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Positron emission tomography with 11C-methionine (MET-PET) provides information about the metabolism of gliomas. A high methionine uptake of glioma cells is reported in the literature. The aim of this study was to investigate whether MET-PET can add helpful information concerning delineation of the tumor.

Methods

Sixteen patients underwent MET-PET before surgery. MRI sequences (EPI RAGE axial selectice and FLAIR sequences) were used for neuronavigation planning. The MET-PET data set as well as the MRI data sets were transferred to the neuronavigation planning station. The lesions were lined out in colors. The data sets were fused by using an automatic image fusion software. Biopsies were taken from outlined areas before surgical removal of the lesion. All tumors were WHO classification verified gliomas.

Results

A methionine uptake was demonstrated in 87.5% of all gliomas. Our series included 11 malignant gliomas (astrocytoma III: n=4, glioblastoma: n=7), and 5 benign gliomas (astrocytoma II: n=3, oligo-astrocytoma II: n=1, pilocytic astrocytoma: n=1).

A: High grade gliomas: Methionine uptake was found in all 11 high grade gliomas (100%). In 3 cases no contrast medium enhancement was shown on MRI. Methionine PET showed tumor infiltration outside of the changes in MRI in 8 cases (72,7%). All biopsies from these areas demonstrated tumor cells. In two cases (18.2%) the MET-uptake area was smaller than the pathologic lesion demonstrated on MRI. Tumor cells were verified histologically within the areas without changes on PET images. In one case the pathologic area was defined similar in both, MRI and MET- PET.

B: Low grade grade: In the low lesions a MET uptake was demonstrated in 3/5 cases (60%) in two cases no MET uptake was found (40%). In one case the pathologic areas were similar in both investigations, in three cases the delineation of the tumor was better performed on MRI and in one case the tumor was better demonstrated by MET- PET.

Conclusions

We found a high MET uptake in high grade gliomas and a low or no uptake in low grade gliomas. In three cases of astrocytoma III the MRI showed no contrast medium enhancement but a high uptake of 11C-methionine was found. Without doubt, MRI is the method of choice for surgical planning of gliomas. However, we consider that, due to the high degree of exact delineation of the pathologic structures with MET-PET (80%) in malignant gliomas, this metabolic investigation provides relevant additional information for surgical procedures. Additionally MET-PET seems to be useful as a preoperative diagnostic tool for lesions without contrast medium enhancement on MRI. A biopsy is recommended in lesions with high methionine uptake even if no GDTPA uptake is shown on MRI.