gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Comparison of various MRI and PET techniques to assess tumor heterogeneity in malignant gliomas

Vergleich verschiedener MRT- und PET-Untersuchungstechniken zur Bestimmung der Tumorheterogenität in malignen Gliomen

Meeting Abstract

  • corresponding author Jochen Tuettenberg - Neurochirurgische Klinik, Universitätsklinik Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg
  • M.-A. Weber - Abteilung für Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg
  • B. Stieltjes - Abteilung für Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg
  • M. Henze - Abteilung Nuklearmedizin, Radiologische Klinik, Universität Heidelberg
  • P. Vajkoczy - Neurochirurgische Klinik, Universitätsklinik Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg
  • M. Essig - Abteilung für Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSA.09.10

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc193.shtml

Veröffentlicht: 11. April 2007

© 2007 Tuettenberg 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: Inherent heterogeneity of gliomas is a problem for biopsy targeting, because for correct glioma grading the biopsy should reflect the most anaplastic part of the tumor. With the advent of functional imaging modalities, these have been proposed for guiding the biopsy. However, since now several functional MRI and positron emission tomography (PET) techniques have been introduced that depict different pathophysiologic aspects of tumor tissue, the question remains, which of these techniques to use for biopsy targeting. Thus, the aim of the present study was to investigate whether various functional MRI and PET techniques identify the same “hot spot”, i.e. the most anaplastic tumor area.

Methods: In this ongoing study, in 23 patients with gliomas (7 female, 16 male; median age, 48 years) within one day first a MRI and then a PET examination could be performed. MRI was performed on a 1.5 T whole body scanner (MAGNETOM Symphony, Siemens, Erlangen, Germany) equipped with a broadband transmit/receive system and with a double-resonant birdcage coil (Rapid Biomed, Wuerzburg, Germany). The MRI protocol comprised in chronological order sodium (23Na)-MRI, proton spectroscopic imaging, dynamic contrast-enhanced (DCE) MRI and dynamicsusceptibility-weighted (DSC) MRI after a single dose each of gadobenat-dimeglumine and finally diffusion tensor imaging (DTI). The PET protocol comprised a 18F-fluorothymidine (FLT)- and 18F-fluorodeoxyglucose (FDG)-PET examination. Image analysis comprised identification of “hot spots”, i.e. those tumor areas with highest values on parameter maps. Then co-localization of these areas was assessed.

Results: Both PET and MRI could evidence heterogeneity in all 18 high-grade gliomas but was found absent in the 5 examined patients with histologically proven grade II gliomas. In our study population, tumor areas with increased thymidine-uptake and highest choline – both suggestive of increased tumor proliferation – were co-localized. Also, microcirculation was elevated in these tumor areas compared to other contrast enhancing tumor regions as demonstrated by DSC- and DCE-MRI.

Conclusions: Tumor areas with increased proliferation index also show elevated microcirculation reflecting the need of a sufficient nutrient supply for growing tumor tissue. Both MRI techniques that reflect tumor vascularity, i.e. DSC and DCE MRI, as well as MRSI and FLT-MRI identified similar tumor regions. Thus either of these techniques could be used for biopsy targeting, while 23Na-MRI and DTI were not beneficial for this issue.