Comte Frédéric, Bauchet Luc, Rigau Valérie, Hauet Jean Robert, Fabbro Michel, Coubes Philippe, Chevalier Jeanine, Mariano-Goulart Denis, Rossi Michel, Zanca Michel
Service de Médecine Nucléaire, CHU Montpellier, France.
Nucl Med Commun. 2006 Feb;27(2):137-42. doi: 10.1097/01.mnm.0000191855.19327.af.
The management and prognosis of a glioma depend on the tumour's histological grade. Thus, preoperative prediction of the grade is routinely needed to indicate whether surgery or biopsies are required. It has been proposed that thallium single photon emission computed tomography (SPECT), in a relative short series, will aid this prediction.
To confirm the correlation between the results of preoperative thallium SPECT and grade of tumour as well as patient survival, and to define the cut-off value of the optimal thallium index for the detection of high grade gliomas in a large series of patients.
One hundred and eighteen patients treated for glioma were retrospectively included in this study. All patients underwent preoperative 201Tl SPECT upon initial presentation and were referred for neurosurgery. Initial scintigraphic findings were correlated with the histological grade of the tumour and overall patient survival.
Thallium uptake was highly correlated with histological grade; the mean thallium indices for low grade and high grade gliomas were 1.8 and 4.9, respectively. On the basis of receiver operating characteristic analysis, the optimal cut-off value of the thallium index for the detection of high grade glioma was determined. By using 2.2 as the value for the threshold thallium index, the sensitivity and specificity were 93% and 72%, respectively. Kaplan-Meier estimates of the overall survival curves, as a function of the thallium index, indicated that it was correlated with the overall survival (P<0.001).
Thallium SPECT provides useful information about the histological grade of the tumour and overall patient survival. Additionally, in spite of its relatively weak resolution, it appears to be a powerful routine clinical tool for the management of gliomas.
胶质瘤的治疗与预后取决于肿瘤的组织学分级。因此，通常需要在术前预测分级，以确定是否需要进行手术或活检。有人提出，在相对较短的一系列病例中，铊单光子发射计算机断层扫描（SPECT）将有助于这种预测。
证实术前铊SPECT结果与肿瘤分级以及患者生存率之间的相关性，并在大量患者中确定用于检测高级别胶质瘤的最佳铊指数临界值。
本研究回顾性纳入了118例接受胶质瘤治疗的患者。所有患者在初次就诊时均接受了术前201Tl SPECT检查，并被转诊至神经外科。最初的闪烁扫描结果与肿瘤的组织学分级和患者总体生存率相关。
铊摄取与组织学分级高度相关；低级别和高级别胶质瘤的平均铊指数分别为1.8和4.9。基于受试者工作特征分析，确定了用于检测高级别胶质瘤的铊指数的最佳临界值。以2.2作为铊指数阈值，敏感性和特异性分别为93%和72%。作为铊指数函数的总体生存曲线的Kaplan-Meier估计表明，它与总体生存率相关（P<0.001）。
铊SPECT提供了有关肿瘤组织学分级和患者总体生存率的有用信息。此外，尽管其分辨率相对较低，但它似乎是一种用于胶质瘤管理的强大的常规临床工具。
