Article
The relevance of 11C-methionine positron emission tomography and perfusion weighted MRI in 5-ALA and iMRI assisted resection of glioblastoma
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Authors
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Andrej Pala
- Universitätsklinikum Ulm, Nuklearmedizin, Ulm, Deutschland
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Thomas Kull
- Universitätsklinikum Ulm, Nuklearmedizin, Ulm, Deutschland
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Angelika Scheuerle
- Universtätsklinikum Ulm, Institut für Pathologie, Ulm, Deutschland
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Ambros J. Beer
- Universitätsklinikum Ulm, Nuklearmedizin, Ulm, Deutschland
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Ralph König
- Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
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Christian Rainer Wirtz
- Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
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Jan Coburger
- Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Amino-acid positron emission tomography (PET) characterizes the metabolic activity of high grade gliomas (HGG). Perfusion weighted MRI (PWI) seems to help to identify malignant tumor remnants intraoperatively. We have evaluated residual 11C-methionine-PET (met-PET) metabolic activity and PWI of glioblastoma (GB) after a combined 5-ALA fluorescence and iMRI assisted gross total resection (GTR) as well as sensitivity and specificity in correlation with histopathological assessment of met-PET, PWI, Gd-DTPA MRI and 5-ALA.
Methods: A total of 59 intraoperative biopsies were correlated with imaging findings in Gd-DTPA MRI, PWI, met-PET and 5-ALA. Only patients eligible for GTR with confirmed diagnosis of GB were evaluated. Met-PET was performed before and after surgery. Gd-DTPA MRI and PWI were performed before, during and after surgery. A combined 5-ALA and iMRI-guided surgery was performed. Sensitivity and specificity was calculated for all imaging modalities according to histopathological grading. Furthermore, volumetric analysis was performed and evaluated for all imaging modalities except for 5-ALA.
Results: Met-PET detected active tumor remnants in 73.3% and PWI in 46.7% of patients after 5-ALA and iMRI-assisted GTR resection. Intraoperative PWI reading was impaired in 33.3% due to artifacts. Met-PET depicted significantly larger tumor volume before surgery (p=0.01) compared to PWI and Gd-DTPI MRI. Both PWI and met-PET showed significantly larger tumor volume after surgery when compared to Gd-DTPA (p=0.018 and p=0.003 respectively). Met-PET showed the highest sensitivity for detection of GB with 95%. The lowest sensitivity was found with intraoperative Gd-DTPA MRI (50%), while 5-ALA and intraoperative PWI showed similar results (69% and 67% respectively).
Conclusion: Met-PET has the highest sensitivity to identify residual tumor in GB. Intraoperative PWI seems to have a synergistic effect to Gd-DTPA and to 5-ALA. Nevertheless, its value may be limited by artifacts. Met-PET is a highly valuable imaging modality for surgical planning. When not available, the combined use of a multimodal intraoperative imaging techniques consisting of 5-ALA, PWI and Gd-DTPA iMRI might significantly improve extent of resection (EoR) in GB patients.
