Datta Niloy Ranjan, Pasricha Rajesh, Gambhir Sanjay, Prasad Shambhu Nath, Phadke Rajendra Vishnu
Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Barelli Road, Lucknow-226014, India.
Int J Clin Oncol. 2004 Feb;9(1):51-8. doi: 10.1007/s10147-003-0362-4.
Radiation-induced changes in post-irradiated brain tumors may produce morphological alterations similar to those of tumor recurrence on computed tomography (CT). However, 201Tl single-photon-emission computed tomography (SPECT), with its ability to image metabolic changes, may differentiate post-irradiated gliotic changes from metabolically active congregations of viable tumor cells. This study was carried out to compare these two imaging modalities for the follow-up evaluation of post-irradiated brain tumors.
Thirty-five patients with previously irradiated primary brain tumors were evaluated for this study. 201Tl SPECT and CT were carried out during follow-up, which ranged from 3 to 125 months (median, 18 months). These findings were compared with the clinical outcome, as observed during the subsequent follow-up.
Sensitivity, specificity, and the overall accuracy of 201Tl SPECT were 82.7%, 83.3%, and 82.8%, compared to 58.6%, 66.6%, and 58.3%, respectively, for CT. Post-scan progression-free survival (PFS) was significantly different for those patients having positive and those having negative evidence of tumor recurrence based on the imaging studies during follow-up. However, PFS was better correlated with 201Tl SPECT results than with the CT results. With 201Tl SPECT, median PFS was 4 months for those with positive reports, versus 33 months for those with negative reports (P = 0.003), compared to a corresponding median PFS of 3 months versus 14 months (P = 0.025), respectively, with CT. On multivariate analysis, age and 201Tl SPECT were the only significant variables for predicting post-scan PFS.
201Tl SPECT, with its ability to be taken up by viable tumor tissues, is superior to CT for the follow-up evaluation of post-irradiated brain tumors.
放射诱发的照射后脑肿瘤变化可能在计算机断层扫描（CT）上产生与肿瘤复发相似的形态学改变。然而，201铊单光子发射计算机断层扫描（SPECT）能够对代谢变化进行成像，它或许能将照射后胶质增生性改变与存活肿瘤细胞的代谢活跃聚集区分开来。开展本研究以比较这两种成像方式用于照射后脑肿瘤的随访评估。
35例曾接受过照射的原发性脑肿瘤患者纳入本研究评估。随访期间（3至125个月，中位数为18个月）进行了201铊SPECT和CT检查。将这些检查结果与后续随访期间观察到的临床结局进行比较。
201铊SPECT的敏感性、特异性和总体准确率分别为82.7%、83.3%和82.8%，而CT的相应数值分别为58.6%、66.6%和58.3%。根据随访期间影像学检查，肿瘤复发证据为阳性和阴性的患者，扫描后无进展生存期（PFS）存在显著差异。然而，PFS与201铊SPECT结果的相关性优于与CT结果的相关性。对于201铊SPECT，报告阳性者的中位PFS为4个月，报告阴性者为33个月（P = 0.003），相比之下，CT检查报告阳性者和阴性者的相应中位PFS分别为3个月和14个月（P = 0.025）。多因素分析显示，年龄和201铊SPECT是预测扫描后PFS的唯一显著变量。
201铊SPECT能够被存活肿瘤组织摄取，在照射后脑肿瘤的随访评估方面优于CT。
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