Integrated positron emission tomography and magnetic resonance imaging-guided resection of brain tumors: a report of 103 consecutive procedures.

Details

Serval ID
serval:BIB_9DFE20AED287
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Integrated positron emission tomography and magnetic resonance imaging-guided resection of brain tumors: a report of 103 consecutive procedures.
Journal
Journal of Neurosurgery
Author(s)
Pirotte B., Goldman S., Dewitte O., Massager N., Wikler D., Lefranc F., Ben Taib N.O., Rorive S., David P., Brotchi J., Levivier M.
ISSN
0022-3085 (Print)
ISSN-L
0022-3085
Publication state
Published
Issued date
2006
Peer-reviewed
Oui
Volume
104
Number
2
Pages
238-253
Language
english
Notes
Publication types: Clinical Trial ; Journal Article
Publication Status: ppublish
Abstract
OBJECT: The aim of this study was to evaluate the integration of positron emission tomography (PET) scanning data into the image-guided resection of brain tumors.
METHODS: Positron emission tomography scans obtained using fluorine-18 fluorodeoxyglucose (FDG) and L-[methyl-11C]methionine (MET) were combined with magnetic resonance (MR) images in the navigational planning of 103 resections of brain tumors (63 low-grade gliomas [LGGs] and 40 high-grade gliomas [HGGs]). These procedures were performed in 91 patients (57 males and 34 females) in whom tumor boundaries could not be accurately identified on MR images for navigation-based resection. The level and distribution of PET tracer uptake in the tumor were analyzed to define the lesion contours, which in turn yielded a PET volume. The PET scanning-demonstrated lesion volume was subsequently projected onto MR images and compared with MR imaging data (MR volume) to define a final target volume for navigation-based resection-the tumor contours were displayed in the microscope's eyepiece. Maximal tumor resection was accomplished in each case, with the intention of removing the entire area of abnormal metabolic activity visualized during surgical planning. Early postoperative MR imaging and PET scanning studies were performed to assess the quality of tumor resection. Both pre- and postoperative analyses of MR and PET images revealed whether integrating PET data into the navigational planning contributed to improved tumor volume definition and tumor resection. Metabolic information on tumor heterogeneity or extent was useful in planning the surgery. In 83 (80%) of 103 procedures, PET studies contributed to defining a final target volume different from that obtained with MR imaging alone. Furthermore, FDG-PET scanning, which was performed in a majority of HGG cases, showed that PET volume was less extended than the MR volume in 16 of 21 cases and contributed to targeting the resection to the hypermetabolic (anaplastic) area in 11 (69%) of 16 cases. Performed in 59 LGG cases and 23 HGG cases, MET-PET demonstrated that the PET volume did not match the MR volume and improved the tumor volume definition in 52 (88%) of 59 and 18 (78%) of 23, respectively. Total resection of the area of increased PET tracer uptake was achieved in 54 (52%) of 103 procedures.
CONCLUSIONS: Imaging guidance with PET scanning provided independent and complementary information that helped to assess tumor extent and plan tumor resection better than with MR imaging guidance alone. The PET scanning guidance could help increase the amount of tumor removed and target image-guided resection to tumor portions that represent the highest evolving potential.
Keywords
Adolescent, Adult, Aged, Brain Neoplasms/pathology, Brain Neoplasms/radionuclide imaging, Child, Child, Preschool, Female, Fluorodeoxyglucose F18/diagnostic use, Humans, Infant, Magnetic Resonance Imaging, Male, Methionine/analogs & derivatives, Methionine/diagnostic use, Middle Aged, Neuronavigation/methods, Positron-Emission Tomography, Radiopharmaceuticals/diagnostic use, Sensitivity and Specificity
Pubmed
Web of science
Create date
20/01/2008 17:36
Last modification date
20/08/2019 15:04
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