gms | German Medical Science

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 tumor depiction in glioblastoma multiforme between 5-amniolevulinic acid based fluorescence, intraoperative perfusion weighted MRI and (11)C-methionine-PET-CT based on a histopathological assessment

Meeting Abstract

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  • Jan Coburger - Klinik für Neurochirurgie der Universität Ulm
  • Angelika Scheuerle - Sektion Neuropathologie der Universität Ulm
  • Bernd Schmitz - Sektion Neuroradiologie der Universität Ulm
  • Sven N. Reske - Klinik für Nuklearmedizin der Universität Ulm
  • Christian R. Wirtz - Klinik für Neurochirurgie der Universität Ulm
  • Ralph König - Klinik für Neurochirurgie der Universität Ulm

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. DocDI.02.03

doi: 10.3205/14dgnc120, urn:nbn:de:0183-14dgnc1208

Published: May 13, 2014

© 2014 Coburger 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: (11)C-methionine-positrone-emission-tomography-CT (MET-PET) reliably detects proliferating tumor cells in glioblastoma multiforme(GBM) beyond the extend of Gd-DPTA-enhanced MRI. Aim of study is to evaluate correlation of intraoperative imaging techniques with preoperative MET-PET. Most promising methods are perfusion-weighted iMRI using relative cerebral blood volume (rCBV) and 5-aminolevulinic acid fluorescence (5-ALA).

Method: We prospectively assessed 10 patients harboring a GBM eligible for gross total removal. All patients underwent pre- and postoperative MET-PET/CT and MRI including rCBV. Surgeons were blinded for the results of MET-PET and rCBV. Intraoperatively, after complete white light resection a 1.5TiMRI including rCBV was performed. Further resection was based on residual Gd-DTPA-enhancement and 5-ALA fluorescence. Specimens were harvested from the resection cavity using navigated biopsies. Histopathological results were correlated with findings in 5-ALA, Gd-DTPA enhancement, MET-PET and rCBV. Extent of resection according to Gd-DTPA enhancement, rCBV and MET-PET were compared based on a volumetric assessment.

Results: Based on intraoperative imaging results residual tumor was seen in 4/10 cases in Gd-DTPA enhancement, in 9/10 in rCBV and in 10/10 cases using 5-ALA. In 3/10 cases complete resection based on 5-ALA was rendered impossible due to invasion of eloquent areas. After surgery complete resection of Gd-DTPA enhancement was achieved in all cases. Residual tumor was seen in 5/10 cases based on rCBV and MET-PET. 34 histopathological specimens were harvested. All revealed pathological tissue. Residual tumor tissue was detected by Gd-DTPA in 53%, by rCBV in 74%, by 5-ALA in 81% and by MET-PET in 95%. Volumetric assessment showed a significant lower Gd-DTPA tumor volume compared to rCBV in pre (p<0.04), intra (p<0.03) and postoperative imaging (p<0.03). No significant difference was found between rCBV and MET-PET tumor volume.

Conclusions: Preoperative decision making in GBM should not be based on Gd-DTPA enhancement alone. Intraoperative detection rate for residual tumor was slightly higher using 5-ALA compared to rCBV. Yet, complete 5-ALA removal did not lead to removal of MET PET hotspot in all cases. rCBV tumor volume showed statistically no difference from MET-PET volume. Combined use of perfusion-weighted iMRI and 5-ALA might leads to increased resection of proliferating tumor tissue similar to a MET-PET based resection.