Imaging regional variation of cellular proliferation in gliomas using 3′-deoxy-3′-[18 F]fluorothymidine positron-emission tomography: an image-guided biopsy study

Aim To compare regional variations in uptake of 3′-deoxy-3′- [18 F]-fluorothymidine (FLT) images using positron-emission tomography (PET) with measures of cellular proliferation from biopsy specimens obtained by image-guided brain biopsies. Materials and methods Fourteen patients with a supratentori...

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Published in:	Clinical radiology Vol. 64; no. 1; pp. 52 - 63
Main Authors:	Price, S.J, Fryer, T.D, Cleij, M.C, Dean, A.F, Joseph, J, Salvador, R, Wang, D.D, Hutchinson, P.J, Clark, J.C, Burnet, N.G, Pickard, J.D, Aigbirhio, F.I, Gillard, J.H
Format:	Journal Article
Language:	English
Published:	Amsterdam Elsevier Ltd 01-01-2009 Elsevier
Subjects:	Adolescent Adult Aged Biological and medical sciences Biopsy - methods Brain Mapping - methods Brain Neoplasms - diagnostic imaging Brain Neoplasms - pathology Cell Proliferation Dideoxynucleosides Female Glioma - diagnostic imaging Glioma - pathology Humans Investigative techniques, diagnostic techniques (general aspects) Magnetic Resonance Imaging - methods Male Medical sciences Middle Aged Neurology Positron-Emission Tomography - methods Radiology Radiology, Interventional - methods Radiopharmaceuticals Sensitivity and Specificity Tumors of the nervous system. Phacomatoses Young Adult Radionuclide study Nuclear medicine Nervous system diseases Glioma Biopsy Central nervous system disease Radiology Tumor Positron emission tomography Emission tomography
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Summary:	Aim To compare regional variations in uptake of 3′-deoxy-3′- [18 F]-fluorothymidine (FLT) images using positron-emission tomography (PET) with measures of cellular proliferation from biopsy specimens obtained by image-guided brain biopsies. Materials and methods Fourteen patients with a supratentorial glioma that required an image-guided brain biopsy were imaged preoperatively with dynamic PET after the administration of FLT. Maps of FLT irreversible uptake rate ( Ki ) and standardized uptake value (SUV) were calculated. These maps were co-registered to a gadolinium-enhanced T1-weighted spoiled gradient echo (SPGR) sequence that was used for biopsy guidance, and the mean and maximum Ki and SUV determined for each biopsy site. These values were correlated with the MIB-1 labelling index (a tissue marker of proliferation) from these biopsy sites. Results A total of 57 biopsy sites were studied. Although all measures correlated with MIB-1 labelling index, Kimax provided the best correlation (Pearson coefficient, r = 0.68; p < 0.001). In low-grade gliomas the Kimean (±SD) was significantly higher than in normal tissue (3.3 ± 1.7 × 10−3 mlplasma /min/mltissue versus 1.2 ± 0.7 × 10−3 mlplasma /min/mltissue ; p = 0.001). High-grade gliomas showed heterogeneous uptake with a mean Ki of 7.7 ± 4 × 10−3 mlplasma /min/mltissue . A threshold Kimean of 1.8 × 10−3 differentiates between normal tissue and tumour (sensitivity 84%, specificity 88%); however, the latter threshold underestimated the extent of tumour in half the cases. SUV closely agreed with Ki measurements. Conclusion FLT PET is a useful marker of cellular proliferation that correlates with regional variation in cellular proliferation; however, it is unable to identify the margin of gliomas.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0009-9260 1365-229X
DOI:	10.1016/j.crad.2008.01.016