Diagnostic value of 201Tl—single-photon emission computerized tomography studies in cases of posterior fossa hemangioblastomas

2001 ◽  
Vol 95 (2) ◽  
pp. 292-297 ◽  
Author(s):  
Takeo Kondo ◽  
Toshihiro Kumabe ◽  
Shin Maruoka ◽  
Takashi Yoshimoto
Keyword(s):  
Computerized Tomography ◽  
Posterior Fossa ◽  
Single Photon ◽  
Photon Emission ◽  
Magnetic Resonance Images ◽  
Thallium 201 ◽  
Homologous Region ◽  
Single Photon Emission ◽  
Content Type ◽  
Fine Print

Object. The 201Tl uptake index was evaluated for its usefulness in formulating a diagnosis of hemangioblastoma. Thallium-201—single-photon emission computerized tomography (SPECT) studies were performed in nine patients harboring hemangioblastomas in the posterior fossa and in five patients (six lesions) with gliomas in the posterior fossa. Methods. The 201Tl uptake index was defined as the ratio of mean counts of isotope per pixel in the tumor to mean counts of isotope per pixel in the homologous region of the healthy brain. The 201Tl uptake indices of the early image (TlE) and that of the delayed image (TlD) were calculated. The isotope retention index (RI) was calculated as (TlE − TlD)/TlE. The TlE was 2.7 ± 0.7 in hemangioblastomas and 2.9 ± 1.7 in gliomas (mean ± standard deviation). The TlD was 1.5 ± 0.4 in hemangioblastomas and 2.4 ± 1.6 in gliomas. There were no significant differences between hemangioblastomas and gliomas when TlEs and TlDs were compared. The isotope RI was 0.43 ± 0.07 in hemangioblastomas and 0.15 ± 0.1 in gliomas, showing a significantly higher RI in hemangioblastomas compared with gliomas (p < 0.01). Conclusions. Thallium-201 washout is significantly faster in hemangioblastomas. Hemangioblastoma is biologically benign, but contains a rich capillary network that forms a hypervascular tumor bed. Variations in its appearance on magnetic resonance images may cause difficulties in the differential diagnosis of hemangioblastoma. Thallium-201 SPECT studies can be used to distinguish hemangioblastomas from gliomas in the posterior fossa.

Reversible ischemia around intracerebral hemorrhage: a single-photon emission computerized tomography study

2002 ◽  
Vol 96 (4) ◽  
pp. 736-741 ◽  
Author(s):  
M. Shahid Siddique ◽  
Helen M. Fernandes ◽  
Thomas D. Wooldridge ◽  
John D. Fenwick ◽  
Piotr Slomka ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Computerized Tomography ◽  
Single Photon ◽  
Photon Emission ◽  
Single Photon Emission ◽  
Large Space ◽  
Content Type ◽  
Ischemic Change ◽  
Late Image ◽  
Fine Print

Object. A zone of perilesional ischemia has been demonstrated around intracerebral hemorrhage (ICH) in numerous experimental models and in human studies. There is potential for perfusion recovery in the zone of perilesional oligemia around ICH. The authors sought to demonstrate, quantify, and study the chronological evolution of perilesional ischemic change in ICH in humans by measuring cerebral blood flow. Methods. Eleven patients with spontaneous supratentorial ICH underwent two technetium-99m hexamethylpropyleneamine oxime single-photon emission computerized tomography (SPECT) scanning, one in the acute stage (within days of ictus) and the other in the late stage (6–9 months postictus). All patients in this study were treated nonsurgically. Methods of SPECT data analysis based on count differences in regions of interest can be difficult to apply to images with large space-occupying lesions such as ICH, because of the distortion of intracranial anatomy, midline shift, and alterations in the three-dimensional (3D) characteristics of the lesion over time (that is, absorption of the hematoma on the later studies). The authors used the following method: the late and early images were registered and aligned to a common 3D orientation and were normalized to maximal counts. The late images were then compared voxel by voxel with the early ones. The region-growing algorithm was used to discern the difference between the two images, outlining voxels in the perihematoma region, with a signal improvement of at least 15% on the late image. Discrete brain regions around the hematoma with at least a 15% improvement in radiotracer uptake (and hence perfusion) in the late images were observed in all cases. The mean volume of brain with a greater than 15% improvement in perfusion between the two studies was 34.8 cm3 (range 7.2–71.3 cm3). These volumes represent regions of the brain that were poorly perfused in the initial studies. This may represent a zone of reversible perilesional oligemia (penumbra) in ICH in humans. Conclusions. This is the first study in which it is documented that some of the perilesional hypoperfused tissue around human ICH regains its perfusion in the long term, leading the authors to suggest that there may be a penumbra in human ICH. Medical or surgical therapeutic interventions could increase the volume of perilesional brain that recovers after the initial insult. The results of this study therefore support the concept that intervention in ICH has the potential to reduce the ultimate neurological deficit and improve outcome.

Functional thalamic depression in a case of reversible central pain due to a spinal intramedullary cyst

1995 ◽  
Vol 83 (1) ◽  
pp. 163-165 ◽  
Author(s):  
Carlo Alberto Pagni ◽  
Sergio Canavero
Keyword(s):  
Spinal Cord ◽  
Computerized Tomography ◽  
Single Photon ◽  
Photon Emission ◽  
Central Pain ◽  
Single Photon Emission ◽  
Content Type ◽  
Surgical Evacuation ◽  
Intramedullary Cyst ◽  
Fine Print

✓ In this report the authors discuss a case of central pain of spinal cord origin due to a spinal thoracic intramedullary cyst. Single-photon emission computerized tomography with technetium-99 hexamethylpropyleneamineoxime showed thalamic hypoperfusion contralateral to the affected leg. Surgical evacuation resulted in total relief of the pain and normalization of the thalamic alteration. The reader can infer from these findings that functional alterations in thalamic processing may be important in the genesis of central pain.

Focal cerebral hyperemia after focal head injury in humans: a benign phenomenon?

1995 ◽  
Vol 83 (2) ◽  
pp. 277-284 ◽  
Author(s):  
Damianos E. Sakas ◽  
M. Ross Bullock ◽  
James Patterson ◽  
Donald Hadley ◽  
David J. Wyper ◽  
...  
Keyword(s):  
Head Injury ◽  
Mr Imaging ◽  
Computerized Tomography ◽  
Injury Severity ◽  
Single Photon ◽  
Wide Spectrum ◽  
Photon Emission ◽  
Normal Brain ◽  
Content Type ◽  
Fine Print

✓ To assess the relationship between posttraumatic cerebral hyperemia and focal cerebral damage, the authors performed cerebral blood flow mapping studies by single-photon emission computerized tomography (SPECT) in 53 patients within 3 weeks of brain injury. Focal zones of hyperemia were present in 38% of patients. Hyperemia was correlated with clinical features and early computerized tomography (CT) and magnetic resonance (MR) imaging performed within 48 hours of the SPECT study and late CT and MR studies at 3 months. The hyperemia was observed primarily in structurally normal brain tissue (both gray and white matter), as revealed by CT and MR imaging, immediately adjacent to intraparenchymal or extracerebral focal lesions; it persisted for up to 10 days, but was never seen within the edematous pericontusional zones. The percentage of patients in the hyperemic group having brief (< 30 minutes) or no loss of consciousness was significantly higher than in the nonhyperemic group (twice as high, p < 0.05). Other clinical parameters were not significantly more common in the hyperemic group. The mortality of patients with focal hyperemia was lower than that of individuals without it, and the outcome of survivors with hyperemia was slightly better than patients without hyperemia. These results differ from the literature, which suggests that global posttraumatic hyperemia is primarily an acute, malignant phenomenon associated with increased intracranial pressure, profound unconsciousness, and poor outcome. The current results agree with more recent studies which show that posttraumatic hyperemia may occur across a wide spectrum of head injury severity and may be associated with favorable outcome.

Diffuse vertebral body metastasis from a glioblastoma multiforme: a technetium-99m Sestamibi single-photon emission computerized tomography study

2000 ◽  
Vol 93 (5) ◽  
pp. 887-890 ◽  
Author(s):  
Patrick Beauchesne ◽  
Claude Soler ◽  
Jean-François Mosnier
Keyword(s):  
Glioblastoma Multiforme ◽  
Bone Metastasis ◽  
Computerized Tomography ◽  
Single Photon ◽  
Photon Emission ◽  
Iliac Bone ◽  
Single Photon Emission ◽  
Radiological Investigation ◽  
Content Type ◽  
Mibi Spect

✓ The authors report on a case of right temporal glioblastoma multiforme (GBM) that metastasized to multiple bone regions (dorsolumbar vertebrae and iliac bone) 8 months after initial diagnosis, despite combined radio- and chemotherapy. Results of a whole-bone single-photon emission computerized tomography (SPECT) study using the imaging agent Sestamibi (MIBI) revealed extracranial metastases from the GBM. A magnetic resonance imaging study of the dorsolumbar spinal region completed the radiological investigation. Cells immunoreactive to glial fibrillary acidic protein were observed in a specimen obtained from the right iliac bone. Postmortem examination confirmed metastasis to extracranial bone and revealed two other metastatic localizations in the lung and heart. This is the first reported case of extracranial bone metastasis from a GBM demonstrated on a whole-bone MIBI SPECT scan. In patients with malignant glioma and lower-back pain (especially prolonged pain), bone metastasis, although uncommon, does occasionally occur and its possibility should be investigated; a MIBI SPECT study may prove useful in this regard.

Diagnostic value of thallium-201 chloride single-photon emission computerized tomography in differentiating tumor recurrence from radiation injury after gamma knife surgery for metastatic brain tumors

2005 ◽  
Vol 102 ◽  
pp. 266-271 ◽  
Author(s):  
Toru Serizawa ◽  
Naokatsu Saeki ◽  
Yoshinori Higuchi ◽  
Junichi Ono ◽  
Shinji Matsuda ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Tumor Recurrence ◽  
Radiation Injury ◽  
Single Photon ◽  
Photon Emission ◽  
Diagnostic Value ◽  
Metastatic Brain Tumors ◽  
Single Photon Emission ◽  
Content Type ◽  
Fine Print

Object.The authors assessed the diagnostic value of201Tl Cl single-photon emission computerized tomography (SPECT), performed after gamma knife surgery (GKS) for metastatic brain tumors in differentiating tumor recurrence from radiation injury.Methods.Of 6503 metastatic brain tumors treated with GKS,201Tl SPECT was required in 72 to differentiate between tumor recurrence and radiation injury. When the Tl index was greater than 5, the lesion was diagnosed as a tumor recurrence. When the index was < 3.0 it was called radiation injury. In cases with a Tl index between 3 and 5,201Tl SPECT was repeated once per month until the Tl index was greater than 5 or less than 3. If the Tl index fluctuated between 3 and 5 for 2 months, the lesion was diagnosed as radiation injury. The final diagnosis was based on histological examination or clinical course.The sensitivity of the method was 91%; thus201Tl SPECT is effective for differentiating between tumor recurrence and radiation injury in metastatic brain tumors treated with GKS. Caution is necessary, however, for the following reasons: 1) simple interinstitutional comparisons of Tl indices are not possible because measurement methods are institute specific; 2) steroid administration decreases the Tl index to a variable degree; and 3) a severe radiation injury lesion, as is often seen after repeated GKS or very high dose GKS, may have a Tl index greater than 5.Conclusions.Used with critical insight201Tl Cl SPECT can be useful in distinguishing between tumor regrowth and radiation necrosis in patients with cerebral metastases.

Diagnostic value of thallium-201 chloride single-photon emission computerized tomography in differentiating tumor recurrence from radiation injury after gamma knife surgery for metastatic brain tumors

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 266-271 ◽  
Author(s):  
Toru Serizawa ◽  
Naokatsu Saeki ◽  
Yoshinori Higuchi ◽  
Junichi Ono ◽  
Shinji Matsuda ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Tumor Recurrence ◽  
Radiation Injury ◽  
Single Photon ◽  
Photon Emission ◽  
Diagnostic Value ◽  
Metastatic Brain Tumors ◽  
Single Photon Emission ◽  
Content Type ◽  
Fine Print

Object. The authors assessed the diagnostic value of 201Tl Cl single-photon emission computerized tomography (SPECT), performed after gamma knife surgery (GKS) for metastatic brain tumors in differentiating tumor recurrence from radiation injury. Methods. Of 6503 metastatic brain tumors treated with GKS, 201Tl SPECT was required in 72 to differentiate between tumor recurrence and radiation injury. When the Tl index was greater than 5, the lesion was diagnosed as a tumor recurrence. When the index was < 3.0 it was called radiation injury. In cases with a Tl index between 3 and 5, 201Tl SPECT was repeated once per month until the Tl index was greater than 5 or less than 3. If the Tl index fluctuated between 3 and 5 for 2 months, the lesion was diagnosed as radiation injury. The final diagnosis was based on histological examination or clinical course. The sensitivity of the method was 91%; thus 201Tl SPECT is effective for differentiating between tumor recurrence and radiation injury in metastatic brain tumors treated with GKS. Caution is necessary, however, for the following reasons: 1) simple interinstitutional comparisons of Tl indices are not possible because measurement methods are institute specific; 2) steroid administration decreases the Tl index to a variable degree; and 3) a severe radiation injury lesion, as is often seen after repeated GKS or very high dose GKS, may have a Tl index greater than 5. Conclusions. Used with critical insight 201Tl Cl SPECT can be useful in distinguishing between tumor regrowth and radiation necrosis in patients with cerebral metastases.

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