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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Correlation of 5-ALA derived porphyrins to contrast enhancement in MRI, Amino acid-PET, IDH1 mutation, 1p19q deletion and MGMT promoter methylation in gliomas

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  • Mohammed Jaber - Klinik für Neurochirurgie, Westfälische-Willhelms-Universität, Münster
  • Christian Ewelt - Klinik für Neurochirurgie, Westfälische-Willhelms-Universität, Münster
  • Markus Holling - Klinik für Neurochirurgie, Westfälische-Willhelms-Universität, Münster
  • Martin Hasselblatt - Institut für Neuropathologie, Westfälische-Willhelms-Universität, Münster
  • Walter Stummer - Klinik für Neurochirurgie, Westfälische-Willhelms-Universität, Münster

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 190

doi: 10.3205/14dgnc584, urn:nbn:de:0183-14dgnc5847

Published: May 13, 2014

© 2014 Jaber et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The aim of this study was to assess histological and imaging factors associated with the intraoperative accumulation of 5-aminolaevulinic acid (5-ALA) derived porphyrins in gliomas.

Method: Retrospectively, we analyzed the data of patients operated at our department between 01/2012 and 05/2013 regarding 5-ALA induced porphyrins during resection, enhancement on pre-operative MRI, and O-(2-(18)F-fluoroethyl)-l-tyrosine ((18)F-FET) PET or 11-C-Methionine (MET) PET hypermetabolism. Further, intraoperative fluorescence findings were related to IDH1 mutation and MGMT promoter methylation, as examined by direct sequencing and methylation-specific PCR, respectively, and 1p19q co-deletion as detected by fluorescence in situ hybridization. We studied 257 gliomas (153 glioblastomas and 4 gliosarcomas, 45 anaplastic astrocytomas, 16 anaplastic oligodendrogliomas or anaplastic oligoastrocytomas, 34 astrocytomas and 5 oligodendrogliomas). 255 of 257 patients were operated by fluorescence guided surgery and 253 contrast MRIs were performed. 196 MGMT promoter methylation status were recorded, 155 IDH1 mutations and 21 1p19q deletions were analyzed.

Results: ALA-induced fluorescence correlated with contrast enhancement (P<0.001), ALA MGMT promoter methylation (P<0.001) and IDH1 mutation status (P<0.001). No significant correlation was found between fluorescence and hypermetabolism in the amino acid PET (P=0.160) or 1p19q deletion (P=0.081).

Conclusions: Our results help predict ex ante whether ALA application could be of use in individual patients. They also indicated that molecular factors may be involved in determining porphyrin accumulation in gliomas.