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Evaluation of brain tumor recurrence by 99mTc-tetrofosmin SPECT: a prospective pilot study

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Abstract

Objective

The differentiation between brain tumor recurrence and post-irradiation injury remains an imaging challenge. Computed tomography (CT) and magnetic resonance imaging (MRI) cannot always distinguish between the two. Although glioma cell line studies substantiated a plausible imaging superiority of 99mTc-tetrofosmin (99mTc-TF) over other radiopharmaceuticals, little has been reported on its in vivo imaging properties. We assessed 99mTc-TF single-photon emission CT (SPECT) in cases where morphologic brain imaging was inconclusive between recurrence and radionecrosis.

Methods

A total of 11 patients (7 men, 4 women) were evaluated. The initial diagnosis was glioblastoma multiforme (4), anaplastic astrocytoma (1), anaplastic oligodendroglioma (3), grade-II astrocytoma (2), and low-grade oligodendroglioma (1). All patients had been operated on and then received adjuvant external-beam radiotherapy. After a mean follow-up period of 25 months, there was clinical suspicion of recurrence, for which 99mTc-TF SPECT was performed.

Results

In 8/11 cases, an abnormally increased tracer uptake appeared in the region that CT and/or MRI indicated as suspicious; in half of these cases, recurrence was confirmed histologically after surgery and in the other four by growth of the lesion over a 6-month follow-up period, and clinical deterioration. The remaining 3/11 patients had faint tracer uptake in the suspicious region, compatible with radiation injury; these lesions remained morphologically unaltered in a mean 12-month follow-up period, with no clinical deterioration in the patient's condition, a course strongly favoring the diagnosis of radiation injury.

Conclusions

Metabolic brain imaging by 99mTc-TF could offer useful information in the workup of treated brain tumors, where radiomorphologic findings between recurrence and radionecrosis are inconclusive.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Ioannina School of Medicine, P.O. Box 103, Neohoropoulo, Ioannina, 45500, Greece

    George A. Alexiou & Konstantinos S. Polyzoidis

  2. Department of Nuclear Medicine, University of Ioannina School of Medicine, Ioannina, Greece

    Andreas D. Fotopoulos, Athanasios Papadopoulos & Spyridon Tsiouris

  3. Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece

    Athanasios P. Kyritsis

Authors
  1. George A. Alexiou
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  2. Andreas D. Fotopoulos
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  3. Athanasios Papadopoulos
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  4. Athanasios P. Kyritsis
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  5. Konstantinos S. Polyzoidis
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  6. Spyridon Tsiouris
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Correspondence to George A. Alexiou.

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Alexiou, G., Fotopoulos, A., Papadopoulos, A. et al. Evaluation of brain tumor recurrence by 99mTc-tetrofosmin SPECT: a prospective pilot study. Ann Nucl Med 21, 293–298 (2007). https://doi.org/10.1007/s12149-007-0027-x

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  • DOI: https://doi.org/10.1007/s12149-007-0027-x

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