gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Prospective evaluation of imaging and metabolic features in 11 patients with newly diagnosed WHO grade II or III glioma: Gd-enhancement, FET-uptake in PET and ALA-induced porphyrin fluorescence

Prospektive Untersuchung bildgebender und metabolischer Merkmale bei 11 Patienten mit neu diagnostizierten WHO Grad II oder III Gliomen: Gadolinium Anreicherung, FET-Aufnahme im PET und ALA induzierte Porphyrin-Fluoreszenz

Meeting Abstract

  • corresponding author F. Floeth - Department of Neurosurgery, Heinrich-Heine University, Düsseldorf
  • W. Stummer - Department of Neurosurgery, Heinrich-Heine University, Düsseldorf
  • K.J. Langen - Institute of Medicine, Research Center Jülich
  • D. Pauleit - Institute of Nuclear Chemistry, Research Center Jülich
  • G. Reifenberger - Department of Neuropathology, Heinrich-Heine University Düsseldorf
  • H.J. Steiger - Department of Neurosurgery, Heinrich-Heine University, Düsseldorf
  • M. Sabel - Department of Neurosurgery, Heinrich-Heine University, Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 04.44

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Floeth et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The aim of this prospective study was to correlate (1) the preoperative morphologic imaging feature of Gadolinium-enhancement (Gd), (2) the preoperative metabolic imaging feature of uptake of O-(2-[F18] fluoroethyl)-L-tyrosine (FET) using PET and (3) the intraoperative metabolic feature of fluorescent porphyrins synthesis after exposure to 5-aminolevulinic acid (ALA) in patients with glioma WHO grade II or III.

Methods: A group of 11 consecutive patients with intracerebral lesions suspicious for WHO grade II or III glioma underwent preoperative evaluation with contrast-enhanced MRI and FET-PET during the year 2005. All tumors were resected using ALA for detection of fluorescent tissue. Nineteen targeted tissue samples were collected with neuronavigated guidance from different tumor areas depending on the presence (positive) or absence (negative) of Gd-enhancement (Gd) and significant FET-uptake (FET), and these features were correlated with intraoperative visible fluorescence (ALA).

Results: There were four anaplastic gliomas ° III. Two of these were Gd positive and both were ALA and FET positive. The other two tumors were Gd negative and both were ALA negative with one being FET positive. Among the seven diffuse gliomas ° II there were six Gd negative tumors and all were ALA negative but three were FET positive. The one Gd positive ° II glioma was ALA and FET positive. In the group of 15 tissue samples from Gd negative areas, 14 (93%) were ALA negative and 11 (73%) were FET negative. In the group of four tissue samples from Gd positive areas all four (100%) were ALA and FET positive.

Conclusions: Although the numbers of patients and samples are still small, our results suggest a strong correlation between Gd enhancement and ALA induced fluorescence, suggesting uptake of both via blood brain barrier (BBB) disruption. In contrast, FET-uptake does not appear to be strictly associated with Gd and ALA, indicating a different mechanism of uptake at the BBB.