Evaluation of tumor viability in Post radiation therapy pediatric brain tumors with 99mTc- glucoheptonate single photon emission computed tomography (SPECT)
Published 2020-12-01
Keywords
- Glucoheptonate,
- Fanbeam collimator,
- Fanbeam collimator post radiation gliosis
How to Cite

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Abstract
Brain single photon emission computed tomography (SPECT) with 99mTc- glucoheptonate, a blood brain barrier imaging agent, is rapidly regaining interest after it has been shown that the uptake of tumor seeking agents like thallium, tetrofosmin, sestamibi and pertechnate by brain tumors is solely dependent on disruption of the blood brain barrier. Therefore, the use of 99mTc glucoheptonate may yield the same diagnostic information as other agents such as the much more expensive 99mTc-sestamibi. The purpose of the study was to evaluate 99mTc-glucoheptonate as an imaging agent for recurrent primary brain tumors in children. Methods: Fifty-one patients aged 5-18 years were evaluated for tumor recurrence following radiotherapy for primary malignant brain tumors, using brain single photon emission computed tomographies (SPECT) with 99mTc-Glucoheptonate. Contrast enhanced computerized tomography (CT) of brain was performed in all patients within + 1 week of brain SPECT as a diagnostic standard and compared. Results: Recurrent tumors showed avid 99mTc- glucoheptonate concentration and a high 99mTc-glucoheptonate retention index (6.06 + 1.41) compared with post radiation gliosis, which showed no 99mTc-glucoheptonate concentration over the affected site and had a 99mTc-glucoheptonate retention index of 1.10 + 0.18 (p=0.001). 99mTc- glucoheptonate SPECT had a sensitivity of 79.48% and a specificity of 91.66% when compared with contrast-enhanced computed tomography as a gold standard. However, this technique did not show good performance in the differential diagnosis of lesions in posterior fossa. Conclusion: This study suggests that 99mTc-glucoheptonate brain SPECT can be used as a sensitive and specific diagnostic test to differentiate recurrent tumor from post radiation gliosis, with the exception of tumors located in posterior fossa. Further studies should address this limitation before definite protocols are established.
Downloads
References
- Sklar CA. Childhood brain tumors. J Pediatr Endocrinol Metab 15 Suppl 2:669-73; 2002
- Chan JL, Lee SW, Fraass BA, Normolle DP, Greenberg HS, Junck LR, Gebarski SS, Sandler HM. Survival and failure patterns of high grade gliomas after three-dimensional conformal radiotherapy. J Clin Oncol 20:1635-42; 2002
- Shaw E, Arusell R, Scheithauer B, et al. Prospective randomized trial of low- versus high-dose radiation therapy in adults with supratentorial low-grade glioma: initial report of a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group study. J Clin Oncol 20: 2267-76; 2002
- Utriainen M, Metsahonkala L, Salmi TT, et al. Metabolic characterization of childhood brain tumors: comparison of 18F-fluorodeoxyglucose and 11C-methionine positron emissiontomography . Cancer.95:1376-86; 2002
- Kaplan WD, Takvorian T, Morris JH, Rumbaugh CL, Conndly BT, Atkins HL. Thallium-201 brain tumor imaging. A comparative study with pathological correlation. Journal of Nuclear Medicine 28: 47 - 52; 1987
- Nishiyama Y, Yamamoto Y, Fukunaga K, Satoh K, Kunishio K, Ohkawa M. Comparison of 99Tcm-MIBI with 201Tl chloride SPET in patients with malignant brain tumours. Nucl Med Commun 22: 631-9; 2001
- Choi JY, Kim SE, Shin HJ, Kim BT, Kim JH. Brain tumor imaging with 99mTc-tetrofosmin: comparison with 201Tl, 99mTc-MIBI, and18F-fluorodeoxyglucose. J Neurooncol; 46:63-70; 2000
- Soricelli A, Cuocolo A, Varrone A, et al. Technetium-99m-Tetrofosmin uptake in brain tumors by SPECT: Comparison with Thallium-201 imaging. Journal of Nuclear Medicine 39:802-806; 1998
- Staudenherz A, Fazeny B, Marosi C, et al. Does (99m) Tc-sestamibi in high-grade malignant brain tumors reflect blood-
- brain barrier damage only? Neuroimage 12: 109-11; 2000
- Chang LT. A method for attenuation correction in radionuclide computed tomography. IEEE Trans Nucl Sci NS 25: 638-643
- Pauwels EKJ, Feitsma RIJ. Radiochemical quality control of 99mTc-labeled radiopharmaceuticals. Eur J Nucl Med 2: 97;1977
- Dooms GC, Hecht S, Brant-Zawadzki M, et al. Brain radiation lesion: MR imaging. Radiology 158: 149-155;1986
- Waxman AD, Tanasescu D, Siemsen JK et al. Techenetium-99m- glucoheptonate as a brain screening agent. Journal of Nuclear Medicine 17; 345-348;1977
- Roland Muller-surr. Radiopharmaceuticals: their intrarenal handling and localization. In: Nuclear medicine in clinical diagnosis and treatment Vol. 1. New York, US Churchill Livingstone, 1994
- Lee HB, Blaufox MD. Mechanism of renal concentration of technetium-99m-glucoheptonate. Journal of Nuclear Medicine 26: 1308-1313; 1985
- Levielle J, Pision C, Karakand Y et al. Technetium-99m glucoheptonate in brain tumor detection: an important advance in radiotracer technique. Journal of Nuclear Medicine 18: 957- 961;1977
- Tanasescu D, Wolfstein R, Waxman AD. Technetium-99m- glucoheptonate as a brain scanning agent. Editorial Journal of Nuclear Medicine18: 1037-1038; 1977
- Platts EA, North TL, Pickett RD, Kelly JD. Mechanism of uptake of technetium tetrofosmin 1: uptake into isolated adult rat ventricular myocyte and subcellular localization. Journal of Nuclear Cardiology 2: 317-316; 1995
- Younes A, Singled JA, Maublant J, Platts E, Pickett R, Veyre A. Mechanism of uptake of technetium-tetrofosmin, II: uptake into isolated adult rat heart mitochondria. Journal of Nuclear Cardiology 2: 317-316; 1995
- Perek N, Prevot N, Koumanov F, Frere D, Sabido O, Beauchesne P, Dubois F. Involvement of the glutathione S- conjugate compounds and the MRP protein in Tc-99m- tetrofosmin and Tc-99m-sestamibi uptake in glioma cell lines. Nucl Med Biol 27: 299-307; 2000
- Arbab AS, Koizumi K, Toyama K, Arai T. Uptake of 99mTc-
- tetrofosmin, technetium-99m-MIBI and thallium-201 in a tumor cell line. Journal of Nuclear Medicine 37: 1551-1556; 1996
- Kristiansen K, Hagen S, Kollevolt T, et al. Combined modality therapy of operated astrocytoma grade 3 and 4: Confirmation of the value of post operative irradiation and lack of potentiation of Bleomycin on survival time: a prospective multicenter trial of the Scandinavian Glioblastoma study group. Cancer 47: 649; 1981
- Yamamoto M, Oshiro S, Tsugu H, et al. Treatment of recurrent malignant supratentorial astrocytomas with carboplatin and etoposide combined with recombinant mutant human tumor necrosis factor-alpha. Anticancer Res 22: 2447-53; 2002
- Bae KT, Piwnica-Worms D. Pharmacokinetic modeling of multidrug resistance P-glycoprotein transport of gamma-
- emitting substrates. Q J Nucl Med Jun 41:101-10; 1997