Authors: Booth, Thomas C.; Tang, Yenzhi; Waldman, Adam D.; Quigley, Anne-Marie; Lewis, David; Soloviev, Dimtri; Nathan, Malavika; Bhogal, Pervinder; Jefferies, Sarah; Buscombe, John R.

Source: Neurographics, Volume 1, Number 3, December 2011 , pp. 108-120(13)

Publisher: American Society of Neuroradiology

Abstract:

There is increasing need for noninvasive biomarkers for glioma treatment-response evaluation and for distinguishing tumor progression and recurrence from treatment-related changes. Here, SPECT, particularly ²⁰¹Tl SPECT, plays an important role. SPECT takes advantage of glioma cellular make-up. Specifically, Na⁺/K⁺ pump expression, mitochondrial attenuation, and amino acid transporter expression are probed with ²⁰¹Tl, ^99mTc-MIBI, and ¹²³IMT radiotracers respectively. ²⁰¹Tl can be used to distinguish brain tumors and nontumors and to determine brain tumor type and grade gliomas. However, it is especially valuable in the detection of tumor recurrence in patients treated with radiation therapy for supratentorial glioma. Similarly, ^99mTc-MIBI can be used to distinguish recurrence from treatment residua. ^99mTc-TF is comparable with ^99mTc-MIBI, and both may allow clear identification of tumor boundaries. ¹²³IMT appears to be superior to ^99mTc-MIBI in determining tumor recurrence and is particularly promising in detecting LGG recurrence. Additionally, ¹²³IMT shows promise in treatment planning where there is a survival advantage. LGGs frequently express somatostatin receptors; however, because radiolabeled somatostatin analogs do not cross the BBB and because LGGs frequently do not disturb the BBB, somatostatin-receptor imaging is limited in glioma imaging. Among the non-natural amino acid class, ¹²³IPA is not preferable to the more established ¹²³IMT. In summary, most international experience by using SPECT is with ²⁰¹Tl; however, other radiotracers are used with good effect in some clinics.

Keywords: ADC = apparent diffusion coefficient; ATPase = adenosine triphosphatase; BBB = blood brain barrier; Cho = choline; 11C MET = L-methyl-11C methionine; Cr = creatine; DTPA = diethylenetriamine pentaacetic acid; 18F = fluorine 18; 18FDG = 18F-fluorodeoxyglucose; 18FET = O-(2-[18F]fluoroethyl)-l-tyrosine; GBM = glioblastoma multiforme; GLUT = glucose transporter; 201Hg = mercury 201; HGG = high-grade glioma; HMPAO = hexamethypropyleneamine oxime; 123I = iodine 123; 123IMT = iodine-123-α-methyl tyrosine; 111In = indium 111; 123IPA = p-[(123)I]-iodo-L-phenylalanine; LGG = low-grade glioma; MRS = MR spectroscopy; MRSI = MR spectroscopic imaging; MIBI = hexakis-2-methoxyisobutyl isonitrile; NAA = N-acetyl aspartate; Na+/K+ = sodium/potassium; 201Pb = lead 201; PCV = procarbazine, lomustine, and vincristine; PET = positron-emission tomography; rCBV = relative cerebral blood volume; ROI = region of interest; SPECT = single-photon emission CT; SRS = somatostatin receptor scintigraphy; 201Tl = thallium 201; 99mTc = technetium 99m; TF = 1,2-bis[bis(2-ethoxyethyl)phospino] ethane; TI = thallium index

Document Type: Research article

DOI: http://dx.doi.org/10.3174/ng.3110014

Publication date: 2011-12-01

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• Neurographics is the peer-reviewed, quarterly educational journal of the American Society of Neuroradiology. The journal comprises mainly articles created from select scientific exhibits at the ASNR Annual Meeting. Neurographics will also publish other high-quality submissions that are primarily educational and have a high emphasis on a pictorial approach. Articles are available free online, and a print-on-demand edition can be ordered from the Neurographics site.
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