Sensitivity and specificity of thallium-201 single-photon emission tomography in the functional detection and differential diagnosis of brain tumours

Abstract

The aim of this retrospective study was to assess the contribution of thallium-201 single-photon emission tomography (SPET) in the detection and differential diagnosis of brain tumours. In 90 patients 201Tl SPET was performed because of clinical or radiological suspicion of tumoral invasion, completed by technetium-99m hexamethylpropylene amine oxime and 99mTc-sestamibi SPET in some patients. For all tumours, diagnosis was based on biopsy or autopsy. Other diagnoses were made only after clinical and radiological follow-up for at least 6 months. Histologically tumours consisted of astrocytoma stage I or II (number of patients, n = 6), astrocytoma stage III (n = 8), glioblastoma multiforme (n = 14) and oligodendroglioma (n = 3), brain metastasis (n = 14), lymphoma (n = 3), meningioma (n = 3), pituitary adenoma (n = 2), pineal tumour (n = 1), colloid cyst (n = 1) and craniopharyngioma (n = 1). False-negative studies included pineal tumour (n = 1), colloid cyst (n = 1), craniopharyngioma (n = 1), astrocytomas stage I or II (n = 6) and stage III (n = 3), oligodendroglioma (n = 2) and metastasis in the brain stem (n = 1). Additional metastases approximately < 1.5 cm were not detected in two patients and 201Tl SPET underestimated tumoral extent in one patient suffering from glioblastoma multiforme (n = 1). A false-positive study was obtained in a patient with skull metastasis (n = 1). All 15 patients who were finally shown to suffer from ischaemic infarction had a normal SPET study 9-28 days after the onset of symptomatology. Of five patients with haemorrhagic infarction, studied within 2 weeks, four were false-positive. Of six patients with intracranial haemorrhage, studied 9-39 days later, one showed focal 201Tl accumulation. Two further false-positive studies consisted of angioma and epidural haematoma. Finally, SPET studies were normal in six patients with definite diagnosis of (reactive) gliosis (n = 3), Binswanger's encephalopathy (n = 1), postinfectious encephalopathy (n = 1) and multiple sclerosis (n = 1). In the patient population presented, sensitivity of 201Tl SPET for supratentorial brain tumours was 71.7% and specificity was 80.9%. Clinical information and control SPET studies in combination with early, 30-min and 3- to 4-h delayed imaging may be expected to improve on these figures. On the other hand it seems that, in addition to tumoral histology, the presence of tumours in the fossa posterior and small volumes contribute to the occurrence of false-negative 201Tl SPET studies.

Technetium-99m Sestamibi Single Photon Emission Computed Tomography Findings Correlated With P-glycoprotein Expression, Encoded by the Multidrug Resistance Gene-1 Messenger Ribonucleic Acid, in Intracranial Meningiomas

“…201 Tl Cl uptake is correlated with malignancy or proliferative potential in brain tumors. 5,11,15,24,29,35) The retention of 201 Tl as measured by 201 Tl Cl SPECT is predictive of the malignant potential in meningiomas. 16) Technetium-99m sestamibi ( 99m Tc-MIBI), a lipophilic radiopharmaceutical, was developed as an alternative to 201 Tl for myocardial perfusion imaging, and is known to be taken up by various types of tumors including brain tumors.…”

Multifocal Inflammatory Leukoencephalopathy: Use of Thallium-201 SPECT and Proton MRS

“…Uptake of 201 Tl into tumor cells may be related to multiple factors, including regional blood flow, blood-brain barrier permeability, and cellular uptake. The sensitivity of 201 Tl SPECT for supratentorial tumors in general was 71.7% and specificity was 80.9% in one study (8). In their subgroup of 14 patients with brain metastases, only one patient with pontine metastasis was negative on the scan (8).…”

“…The sensitivity of 201 Tl SPECT for supratentorial tumors in general was 71.7% and specificity was 80.9% in one study (8). In their subgroup of 14 patients with brain metastases, only one patient with pontine metastasis was negative on the scan (8). One patient who showed multiple enhancing white matter lesions in MRI and in whom brain metastasis was suspicious was diagnosed as MIL aided with negative 201 Tl SPECT and active demyelination revealed by histopathologic examination (3).…”

“…201 Tl SPECT is a noninvasive method which may help to differentiate intracranial tumors from other non-neoplastic diseases (8). Uptake of 201 Tl into tumor cells may be related to multiple factors, including regional blood flow, blood-brain barrier permeability, and cellular uptake.…”

Usefulness of Thallium-201 Chloride Single Photon Emission Computed Tomography for the Preoperative Diagnosis of Fourth Ventricle Meningioma-Case Report-

“…11,14,16,17,19,[22][23][24][25]28,29) Thallium index is usually calculated as the ratio of counts in the lesion to the normal brain, and is 201 Tl is very high in the delayed phase in meningothelial meningioma. 13) The thallium kinetics of other intracranial tumors should be considered in the differential diagnosis of fourth ventricle meningioma.…”