High-Resolution Contrast-Enhanced, Susceptibility-Weighted MR Imaging at 3T in Patients with Brain Tumors: Correlation with Positron-Emission Tomography and Histopathologic Findings

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.

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The integration of metabolic imaging in stereotactic procedures including radiosurgery: a review

Journal of Neurosurgery ◽

10.3171/jns.2002.97.supplement_5.0542 ◽

2002 ◽

Vol 97 ◽

pp. 542-550 ◽

Cited By ~ 35

Author(s):

Marc Levivier ◽

David Wikler ◽

Nicolas Massager ◽

Philippe David ◽

Daniel Devriendt ◽

...

Keyword(s):

Positron Emission Tomography ◽

Brain Tumors ◽

Treatment Planning ◽

Target Volume ◽

Emission Tomography ◽

Low Grade ◽

Content Type ◽

Positron Emission ◽

Pet Scanning ◽

Fine Print

Object. The authors review their experience with the clinical development and routine use of positron emission tomography (PET) during stereotactic procedures, including the use of PET-guided gamma knife radiosurgery (GKS). Methods. Techniques have been developed for the routine use of stereotactic PET, and accumulated experience using PET-guided stereotactic procedures over the past 10 years includes more than 150 stereotactic biopsies, 43 neuronavigation procedures, and 34 cases treated with GKS. Positron emission tomography—guided GKS was performed in 24 patients with primary brain tumors (four pilocytic astrocytomas, five low-grade astrocytomas or oligodendrogliomas, seven anaplastic astrocytomas or ependymomas, five glioblastomas, and three neurocytomas), five patients with metastases (single or multiple lesions), and five patients with pituitary adenomas. Conclusions. Data obtained with PET scanning can be integrated with GKS treatment planning, enabling access to metabolic information with high spatial accuracy. Positron emission tomography data can be successfully combined with magnetic resonance imaging data to provide specific information for defining the target volume for the radiosurgical treatment in patients with recurrent brain tumors, such as glioma, metastasis, and pituitary adenoma. This approach is particularly useful for optimizing target selection for infiltrating or ill-defined brain lesions. The use of PET scanning contributed data in 31 cases (93%) and information that was specifically utilized to adapt the target volume in 25 cases (74%). It would seem that the integration of PET data into GKS treatment planning may represent an important step toward further developments in radiosurgery: this approach provides additional information that may open new perspectives for the optimization of the treatment of brain tumors.

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[18F]fluoro-2-deoxy-d-glucose ([18F]FDG) positron emission tomography imaging of thymic carcinoid tumor presenting with recurrent Cushing’s syndrome

Acta Endocrinologica ◽

10.1530/eje.1.01839 ◽

2005 ◽

Vol 152 (4) ◽

pp. 521-525 ◽

Cited By ~ 39

Author(s):

Athina Markou ◽

Patrick Manning ◽

Banu Kaya ◽

Sam N Datta ◽

Jamshed B Bomanji ◽

...

Keyword(s):

Positron Emission Tomography ◽

High Resolution ◽

Carcinoid Tumor ◽

Fdg Pet ◽

Pet Scan ◽

Emission Tomography ◽

Thymic Carcinoid ◽

Acth Secretion ◽

Positron Emission ◽

Thymic Carcinoid Tumor

We report a case of a young woman with Cushing’s syndrome (CS), in whom although endocrine investigations and negative pituitary imaging were suggestive of ectopic ACTH secretion, the results of inferior petrosal sinus (IPS) sampling after coricotropin-releasing hormone (CRH) stimulation were suggestive of pituitary ACTH hypersecretion. 111In-labelled octreotide and high-resolution computer tomography (CT) revealed a lesion possibly responsible for the ACTH source in the thymus. Thymectomy confirmed concomitant ectopic CRH and probable ACTH production by a thymic neuroendocrine carcinoma. After an 8-year remission period the patient developed a clinical and biochemical relapse. A high-resolution computed tomography (CT) scan of the thorax showed a 2-cm nodule in the thymic bed, which was positive on a [18F]fluoro-2-deoxy-d-glucose ([18F]FDG) positron emission tomography (PET) scan. However, a repeated thymectomy did not result in remission. A repeat [18F]FDG PET study showed persistent disease in the thymic bed and also uptake in the adrenals. The patient underwent bilateral adrenalectomy, which resulted in clinical remission. A further [18F]FDG PET scan 8 months later showed no progression of the thymic tumor and confirmed complete excision of the adrenals. This is a rare case of concomitant CRH and ACTH secretion from a thymic carcinoid tumor; the case illustrates the usefulness of functional imaging with [18F]FDG PET in the diagnosis, management and follow-up of neuroendocrine tumors.

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Evaluation of the Quantitative Capability of a High-Resolution Positron Emission Tomography Scanner for Small Animal Imaging

Journal of Computer Assisted Tomography ◽

10.1097/00004728-200411000-00020 ◽

2004 ◽

Vol 28 (6) ◽

pp. 842-848 ◽

Cited By ~ 11

Author(s):

Frederic H. Fahey ◽

H. Donald Gage ◽

Nancy Buchheimer ◽

Holly C. Smith ◽

Beth A. Harkness ◽

...

Keyword(s):

Positron Emission Tomography ◽

High Resolution ◽

Small Animal Imaging ◽

Small Animal ◽

Emission Tomography ◽

Positron Emission Tomography Scanner ◽

Positron Emission ◽

Animal Imaging

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Investigation of brain tumors using 18F-fluorobutyl ethacrynic amide and its metabolite with positron emission tomography

OncoTargets and Therapy ◽

10.2147/ott.s78404 ◽

2015 ◽

pp. 1877 ◽

Cited By ~ 1

Author(s):

Chung-Shan Yu ◽

Ying-Cheng Huang ◽

Ho-Lien Huang ◽

Chun-Nan Yeh ◽

Kun-Ju Lin

Keyword(s):

Positron Emission Tomography ◽

Brain Tumors ◽

Emission Tomography ◽

Positron Emission

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Hyperosmolar blood-brain barrier disruption in baboons: an in vivo study using positron emission tomography and rubidium-82

Journal of Neurosurgery ◽

10.3171/jns.1996.84.3.0494 ◽

1996 ◽

Vol 84 (3) ◽

pp. 494-502 ◽

Cited By ~ 21

Author(s):

Bernhard Zünkeler ◽

Richard E. Carson ◽

Jeffrey Olson ◽

Ronald G. Blasberg ◽

Mary Girton ◽

...

Keyword(s):

Positron Emission Tomography ◽

Brain Tumors ◽

Blood Brain Barrier ◽

Emission Tomography ◽

Brain Barrier ◽

Blood Brain ◽

Positron Emission ◽

The Mean ◽

Rubidium 82

✓ Hyperosmolar blood-brain barrier (BBB) disruption remains controversial as an adjuvant therapy to increase delivery of water-soluble compounds to extracellular space in the brain in patients with malignant brain tumors. To understand the physiological effects of BBB disruption more clearly, the authors used positron emission tomography (PET) to study the time course of BBB permeability in response to the potassium analog rubidium-82 (82Rb, halflife 75 seconds) following BBB disruption in anesthetized adult baboons. Mannitol (25%) was injected into the carotid artery and PET scans were performed before and serially at 8- to 15-minute intervals after BBB disruption. The mean influx constant (K1), a measure of permeability-surface area product, in ipsilateral, mannitol-perfused mixed gray- and white-matter brain regions was 4.9 ± 2.4 µl/min/ml (± standard deviation) at baseline and increased more than 100% (ΔK1 = 9.4 ± 5.1 µl/min/ml, 18 baboons) in brain perfused by mannitol. The effect of BBB disruption on K1 correlated directly with the total amount of mannitol administered (p < 0.005). Vascular permeability returned to baseline with a halftime of 24.0 ± 14.3 minutes. The mean brain plasma volume rose by 0.57 ± 0.34 ml/100 ml in ipsilateral perfused brain following BBB disruption. This work provides a basis for the in vivo study of permeability changes induced by BBB disruption in human brain and brain tumors.

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