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

Stereotactic coregistration of cortical language areas and Fluorethyl-L-Tyrosin-PET activation in patients with left hemispheric gliomas

Stereotaktische Koregistrierung von Sprachaktivierung und Fluorethyl-L-Tyrosin-PET-Aktivierung bei Patienten mit linkshemisphärischen Hirntumoren

Meeting Abstract

  • corresponding author J. Nickel - Neurologische Klinik, Universitätsklinikum Düsseldorf
  • K.-J. Langen - Brain Imaging Center West (BICW) / Institut für Medizin, Forschungszentrum Jülich
  • G. Stoffels - Brain Imaging Center West (BICW) / Institut für Medizin, Forschungszentrum Jülich
  • F. Floeth - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
  • H.-J. Steiger - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
  • R. J. Seitz - Neurologische Klinik, Universitätsklinikum Düsseldorf
  • M. Sabel - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf

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.01.03

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

Published: April 11, 2007

© 2007 Nickel 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: Functional MRI (fMRI) and positron emission tomography (PET) using amino acids are established methods to evaluate neurobiological characteristics of gliomas. The information provided by both fMRI and PET can be used to optimize the extent of cytoreduction and increase the safety of the resection. We describe our first experience with a coregistration of fMRI and PET data with the aim of evaluating the extent of colocalisation between language areas and amino acid uptake in patients with left hemispheric glioma.

Methods: 11 patients (48±13 years, 7 male/ 4 female, 1 left-handed) with left hemispheric gliomas (WHO ° II-IV) were tested for syntactic language production according to the paradigm established by Sach and Kleiser using a 1.5 Tesla scanner. Amino acid uptake in tumor areas was measured using a 32-Ring-PET-Scanner after injection of 200 MBq [18F]-Fluorethyl-L-Tyrosin(FET). FET has been established as a novel tracer with a high sensitivity and specificity for in-vivo detection of gliomas. Image fusion and processing was done using the software PMOD 2.5 and BrainVoyager QX.

Results: As shown previously, a FET lesion/brain ratio of >1.6 detects tumor tissue with a sensitivity of 100% and a specificity of 88%. Using this threshold, we found a median distance between FET-accumulation and fMRI-language activation of 19±12 (4-46) mm. Using a threshold of >2.0 for a better visualization of potential hot-spots, we measured a median distance of 14±8 (2-29) mm. There was no significant correlation between the measured distance and the WHO grade, integrity of language function, handedness, maximum FET-Uptake or FET-Uptake-Volume.

Conclusions: FET-Uptake and fMRI-language activation appear to be spatiallly distinct (not overlapping) suggesting that areas with a FET lesion/brain ratio of >1.6 can be resected without a functional deficit. Since the distance between language areas and tumor areas were not predictable, our data advise the necessity of an individual evaluation of patients with gliomas in speech-relevant brain areas. Apart from the potential importance of our findings for the surgical planning, the coregistered data can be integrated into the neuronavigation system, making this method a promising tool to increase the safety of cytoreductive glioma surgery.