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KMID : 0378020060490110060
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New Medical Journal
2006 Volume.49 No. 11 p.60 ~ p.67
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Stereotactic Biopsy with Multiple Modality for the better Therapeutic Approach in the Glioma
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Bong Ho-Jin
Lee Tae-Gyu
Jeun Sin-Soo
Park Chun-Kun
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Abstract
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Purpose: The aims of this study were to assess the usefulness of 201Tl Single Photon Emission Computed Tomography (SPECT) and Proton Magnetic Resonance Spectroscopy (1H-MRS) in diagnosis of intracranial tumors and to elucidate their relationship to the cell proliferative activity of the glioma.
Methods and Materials : Biopsy targets were localized preoperatively with intracranial lesions using 201Tl Single Photon Emission Computed Tomography (SPECT) and Proton Magnetic Resonance Spectroscopy (1H-MRS). Patients were scanned by early (15 min: TIE) and delayed (3hr: TID) 201Tl SPECT and single voxel 1H-MRS, and Ki-67 labelling index were obtained in 29 patients. The 201Tl SPECT data were transferred to the neuronavigation workstation and and matched with a preoperative 3D-MRI using an automatic image-fusion algorithm with 1H-MRS data. Intraoperative target localization and biopsy was performed using brain-mapping techniques and framless image guided stereotactic system
Results: 201Tl SPECT images were integrated into the MRI-based neuronavigational system and could be transferred exactly to the operative field. By the additional integration of and 1H-MRS, intraoperative targeting findings can be directly compared with preoperative MRI images.
On 201Tl SPECT study, 201Tl uptake index (p<0.05) correlated positively between TlD and Ki-67 labelling index; astrocytoma (TIE, 0.15±0.34; TID, 0.23±0.52), glioblastoma (TIE, 4.40±3.58; TID, 4.16±2.37). The sensitivity and specificity of 201Tl SPECT 79.3% and 93.8%, which were higher than those of 1H MRS (58.6% and 68.8%).
Conclusion: In this study Higher grade of gliomas had a positive correlation with 201Tl SPECT and 1H-MRS in reference to Ki-67 proliferating index. Preoperative multimodal study with 1H-MRS and 201Tl-SPECT is useful in the iagnosis of pathological grade of the Glioma.
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KEYWORD
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Biopsy, 01Tl SPECT, H-MRS
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