Perioperative single photon emission computed tomography in predicting survival of malignant glioma patients

Abstract

Abstract. Single photon emission computed tomography (SPECT) is widely used in the evaluation of glioma patients and has been demonstrated to correlate with glioma malignancy and proliferation indexes. The aim of this study was to evaluate the association between perioperative technetium-99m-methoxyisobutylisonitrile ( 99m Tc-MIBI) uptake on SPECT scans and survival of malignant glioma patients. A total of 17 patients (11 males and 6 women; mean age, 62.2±8.4 years) with histologically confirmed malignant gliomas (16 glioblastoma multiforme and 1 gliosarcoma) underwent 99m Tc-MIBI SPECT scans 2.8±1.9 days before surgery and 9.8±1.5 days after surgery. The total intensity index (TII) that corresponds to the area and intensity of tracer uptake was calculated before and after surgery. In addition, the change of TII before versus after surgery (Δ TII) was calculated. The overall survival (OS) was defined as the period between the date of surgery and the date of death. The median overall survival time was 12.4 months, ranging from 1.4 to 88 months; there were nine (45%) 12-month survivors. In univariate analyses using a log-rank test, worse OS was significantly associated with higher preoperative TII (≥12), higher postoperative TII (≥6), lower Δ TII (<50%) and higher number of neurological symptoms prior to surgery (≥4). In multivariate analyses, higher postoperative TII, a greater number of neurological symptoms and female gender were found to be factors with independent prognostic value of OS. Patients who survived more than 12 months following surgery had a significantly lower postoperative TII, higher Δ TII and greater rate of gross total resection compared to patients who survived less than 12 months following surgery. Higher perioperative tracer uptake and lower decrease of tracer uptake following surgery (suggesting less radical resection) were associated with worse OS of malignant glioma patients. Our results suggest that SPECT may be used to predict survival of malignant glioma patients; however, further studies using larger samples are required.

Evaluation of Health-Related Quality of Life in Lithuanian Brain Tumor Patients Using the EORTC Brain Cancer Module

“…Brain tumors are a rare disease with an incidence rate of 18 per 100 000 person-years for primary brain tumors and with an estimated overall prevalence rate reaching 222 per 100 000 persons (1). The prognosis of brain tumor is often devastating with an estimated 5-year survival rate reaching approximately 20% for all ages and all tumor types (2)(3)(4). In addition, brain tumor patients are subjected to a severe neurological impairment and the increased risk for mental distress and psychiatric comorbidities that can consequentially contribute to deteriorated quality of life (5)(6)(7)(8).…”

The value of quantitative pentavalent 99mTc-dimercaptosuccinic acid scan in predicting progression-free survival and overall survival in patients with glioblastoma multiforme

“…In GBM, less than 5% of patients survive more than 3 years after diagnosis in spite of recent advances in treatment. 15 Therefore, we need new prognostic tools for GBM.…”

“…However, SPECT is widely available and routinely used in contrast to PET, which remains relatively expensive. 15 Thallium-201(Tl-201) is the most studied SPECT radiotracer, but it cannot be used as the sole non-invasive diagnostic or prognostic tool in brain tumour patients due to overlap between tumour uptake and histologic grades. 14 99mTc-labelled compounds as (V) DMSA, MIBI and tetrofosmin have advantages compared to Tl-201 due to better image resolution and significantly less radiation exposure to patients.…”

“…Changes in the bulk of malignant glioma tissue following surgery evaluated by SPECT may possibly serve as a novel prognostic ma rker of malignant glioma''. 15 Hence, they evaluated MIBI uptake [pre-and post-operative] in predicting survival of malignant glioma patients and concluded that worse OS was associated with higher MIBI uptake. Their study included all grades of glioma, while in the present study GBM only was included where statistical analysis showed that (V) DMSA could have a prognostic role.…”

Increasing feasibility and utility of 18 F-FDOPA PET for the management of glioma

“…In addition to MR and PET imaging, SPECT has been investigated for glioma grading [68][69][70], predicting survival [71] and identifying recurrence [72][73][74]. In a study by Karunanithi et al [75], tumour recurrence was assessed by both 18 [76,77].…”