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56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

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Stereotactic biopsy in diffuse astrocytoma in children following multimodal planning and image fusion with FET-PET, MRI and CT

Stereotaktische Biopsie bei diffusen Astrozytomen im Kindesalter nach multimodaler Planung und Imagefusion mit FET-PET, MRT und CT

Meeting Abstract

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  • corresponding author A. M. Messing-Jünger - Neurochirurgische Klinik, Universitätsklinikum, Heinrich-Heine-Universität, Düsseldorf
  • F. W. Floeth - Neurochirurgische Klinik, Universitätsklinikum, Heinrich-Heine-Universität, Düsseldorf
  • D. Pauleit - Forschungszentrum Jülich

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc09.05.-15.02

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2005/05dgnc0070.shtml

Published: May 4, 2005

© 2005 Messing-Jünger 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

Text

Objective

Diffuse glial tumors with bithalamic involvement are rare in children and sometimes difficult to differentiate from non tumorous disorders due to unspecific radiological findings. Stereotactic biopsy in these cases not always proves a glial tumor but unspecific reactive changes.

Methods

In order to enhance the diagnostic yield we performed image fusion with the recently described amino acid analogue O-(2-(18F)-fluoroethyl)-thyrosine-(FET)-PET and MRI. Stereotactic biopsy was planned with neuronavigation and stereotaxy system simultaneously and additional information from MRI-spectroscopy and CT.

Results

Since 2002 we saw two children presenting with signs of raised intracranial pressure. MRI showed symmetric expansion of the thalamic structures with diffuse hyperintensity on T2/FLAIR sequences. No contrast uptake was observed. In one child additional hyperintensity was found in the right temporal lobe and right cerebellar hemisphere. MRI spectroscopy (thalamic voxel) was typical for glial tumors in both children. In the first patient FET-PET revealed an unexpected hot spot in the left cerebellar hemisphere with a brain/tumor ratio of 3.8 compared to 1.8 in the thalamus. Accordingly stereotactic biopsy was taken there and an anaplastic astrocytoma was diagnosed. The other patient showed a higher uptake (brain/tumor ratio 2.0) in the left dorsal thalamus compared to a homogeneous hyperintensity of the bilateral thalamus on MRI. Stereotactic biopsy resulted in astrocytoma WHO grade II. Target point planning was realized with both neuronavigation and stereotaxy system.

Conclusions

Image fusion with FET-PET, MRI and CT for multimodal planning can enhance the diagnostic yield of stereotactic biopsies in diffuse glial tumors in children.