Role of post-therapy 99mTc-MIBI single-photon emission computed tomography/computed tomography scan in predicting survival in patients with high-grade glioma

Abstract

Objective High-grade gliomas (HGGs) carry dismal prognosis with survival typically reported as less than a year. We explored the predictive value of qualitative and quantitative evaluations of post-treatment 99m-technetium-labelled methoxyisobutylisonitrile (99mmTc-MIBI) brain single-photon emission computed tomography-computed tomography (SPECT/CT) tumor uptake in relation to overall survival (OS) in patients with HGG. Methods Thirty patients with pathologically or radiologically documented high-grade glioma (HGG) were prospectively recruited for this study (24 male, 6 female; mean age 43 ± 14 years). All patients had a clinical or radiological suspicion of residual/recurrent tumor after initial therapy. 99mTc-MIBI brain SPECT/CT scanning was performed, and the scans were evaluated qualitatively on a five-point probability score (1–5, scores ≥3 considered positive for residual/recurrent tumor); and quantitively via drawing volumes of interest (VOI) on the suspected lesions and normal contralateral brain tissue. All patients were followed up for 1 year or till death. Results Positive visual MIBI results were associated with poor survival. Among 10 patients with negative MIBI scores, only two patients died (OS = 75%), while 11/20 patients reported positive on MIBI died, with a median survival of 9 months (OS = 14.5%; P = 0.03). All patients with active isocontour volume ≤1.96 cm3 were alive at the end of the study, compared to a median survival of 9 months and OS of 12% for patients with an isocontour volume of >1.97% (P = 0.003). Conclusion In patients with HGG, post-therapy brain SPECT/CT with 99mTc-MIBI can provide useful prognostic information.

Conventional and Advanced Imaging Techniques in Post-treatment Glioma Imaging

“…201 Tl is a potassium analog and undergoes active transport through the adenosine triphosphate (ATP) cell membrane transporter; thus, 201 Tl uptake is related to cellular growth with non-viable tissue exhibiting little 201 Tl uptake ( 40 , 129 ). 99m Tc-MIBI passively diffuses through the cell membrane under the transmembrane potential with higher uptake in malignant cells, but its physiological biodistribution in the choroid plexus as well as the temporalis and extraocular muscles limits its use in brain tumor imaging ( 130 , 131 ). 99m Tc-DSMA is thought to be a phosphorus anion ( ) analog with its intracellular accumulation linked to phosphate uptake and kinase pathway activation; its advantage over 99m Tc-MIBI is a lack of uptake across the intact BBB ( 128 ).…”

Filamentous Bacteriophage—A Powerful Carrier for Glioma Therapy

“…At present, the clinical therapies for gliomas are surgical therapy, radiation therapy, chemotherapy, gene therapy, and other comprehensives (1,(71)(72)(73)(74). However, it is easy to relapse after these treatments, and the patients' survival rates are not significantly improved.…”

“…Glioma is the most common cerebral malignancy with high morbidity and mortality. Despite the current treatment measures such as surgery, radiation, and chemotherapy, the prognosis and mortality of patients has not improved significantly (1)(2)(3). The annual death rate in China is as high as 30,000.…”

“…The annual death rate in China is as high as 30,000. Currently, the adverse reactions to glioma drugs are more prominent, and drug resistance is readily developed (1,4,5). To overcome the limits of existing therapies, there is a pressing need for a treatment strategy that can selectively target cancer tissues and avoid non-target tissues.…”

Posttherapy technetium-99m pentavalent dimercaptosuccinic acid brain single-photon emission computed tomography/computed tomography: diagnostic and prognostic values in patients with glioma

“…Another SPECT agent technetium-99m ( 99m Tc)-methoxy isobutyl isonitrile ( 99m Tc-MIBI) showed favorable results and was associated with outcome. However, MIBI is excreted in the choroid plexus and could lead to false results [9,10]. Pentavalent dimercaptosuccinic acid (DMSA-V) has the advantage of easy preparation and better background clearance with no excretion in the ventricles [11].…”