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  • Title: Differentiation of Recurrent/Residual Glioma From Radiation Necrosis Using Semi Quantitative 99mTc MDM (Bis-Methionine-DTPA) Brain SPECT/CT and Dynamic Susceptibility Contrast-Enhanced MR Perfusion: A Comparative Study.
    Author: Rani N, Singh B, Kumar N, Singh P, Hazari PP, Singh H, Kumar G, Radotra B, Kumar M, Bhattacharya A, Sharma R, Kohli A, Chhabra R, Gupta SK, Mishra AK.
    Journal: Clin Nucl Med; 2018 Mar; 43(3):e74-e81. PubMed ID: 29356734.
    Abstract:
    PURPOSE: In this study, Tc MDM (bis-methionine-DTPA) SPECT was used for the detection and differentiation of recurrent/residual glioma from radiation necrosis and the results were compared with dynamic susceptibility contrast-enhanced (DSCE)-MRI and clinical findings. MATERIALS AND METHODS: Twenty-eight patients (18 men and 10 women; mean ± SD age, 41.4 ± 15.03 years) with histologically proven glioma (grade IV, 14; grade III, 7; grade II, 7) who were planned for postsurgical standard radio/chemo therapy were recruited prospectively. All the patients underwent technetium Tc MDM SPECT/CT and DSCE-MRI imaging at 6 months after surgery/radio-chemotherapy, 9 of 28 patients also underwent SPECT imaging at 1 to 2 weeks after surgery. RESULTS: Tc MDM SPECT/CT analysis demonstrated significantly higher target to nontarget (T/NT) ratio of the radiotracer in tumor recurrence than in radiation necrosis (3.59 ± 1.70 vs 1.16 ± 0.42). Likewise, the normalized cerebral blood volume (nCBV) values in patients with tumor recurrence were also significantly higher than in radiation necrosis (5.16 ± 2.30 vs 1.63 ± 0.94). A positive correlation (rho = 0.823, P < 0.0001) between T/NT ratios and nCBV was observed. The cutoff T/NT ratios and nCBV values estimated by receiver operating characteristic analysis were greater than 1.50 (area under the curve, 0.944 ± 0.34) and greater than 2.12 (area under the curve, 0.931 ± 0.39), respectively. Combining the results of Tc MDM SPECT/CT, DSCE-MRI, and clinical findings, diagnosis of recurrent/residual glioma or radiation necrosis was made in 18 and 10 patients, respectively. Sensitivity and specificity of 2 techniques were comparable, that is, 92.0%: 78.6% for MDM SPECT/CT and of 92.0%: 71.4% for DSCE-MRI, respectively. CONCLUSION: Thus, combining MDM SPECT with DSCE MRI may provide an accurate method for differentiation of tumor recurrence from radiation-induced necrosis in glioma patients.
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