Pirotte Benoit J M, Lubansu Alphonse, Massager Nicolas, Wikler David, Van Bogaert Patrick, Levivier Marc, Brotchi Jacques, Goldman Serge
Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, 808, route de Lennik, B-1070 Brussels, Belgium.
J Neurosurg Pediatr. 2010 May;5(5):486-99. doi: 10.3171/2010.1.PEDS09481.
In this paper, the authors' goal was to evaluate the impact of PET information on brain tumor surgery in children.
Between 1995 and 2007, 442 children were referred to the authors' institution for a newly diagnosed brain lesion. Of these, 85 were studied with FDG-PET and/or L-(methyl-(11)C)-methionine -PET in cases in which MR images were unable to assist in selecting accurate biopsy targets (35 patients) or to delineate tumors for maximal resection (50 patients). In surgical cases, PET and MR images were combined in image fusion planning for stereotactic biopsies or navigation-based resections. The preoperative planning images were compared postoperatively with MR imaging and PET findings and histological data for evaluating the clinical impact on the diagnostic yield and tumor resection.
The PET data influenced surgical decisions or procedures in all cases. The use of PET helped to better differentiate indolent from active components in complex lesions (in 12 patients); improved target selection and diagnostic yield of stereotactic biopsies without increasing the sampling; provided additional prognostic information; reduced the amount of tissue needed for biopsy sampling in brainstem lesions (in 20 cases); better delineated lesions that were poorly delineated on MR imaging and that infiltrated functional cortex (in 50 cases); significantly increased the amount of tumor tissue removed in cases in which total resection influenced survival (in 20 cases); guided resection in hypermetabolic areas (in 15 cases); improved early postoperative detection of residual tumor (in 20 cases); avoided unnecessary reoperation (in 5 cases); and supported the decision to undertake early second-look resection (in 8 cases).
The authors found that PET has a significant impact on the surgical decisions and procedures for managing pediatric brain tumors. Further studies may demonstrate whether PET improves outcomes in children.
在本文中，作者的目标是评估PET信息对儿童脑肿瘤手术的影响。
1995年至2007年间，442名儿童因新诊断的脑病变被转诊至作者所在机构。其中，85例在MR图像无法协助选择准确活检靶点（35例患者）或无法勾勒肿瘤以进行最大程度切除（50例患者）的情况下接受了FDG-PET和/或L-（甲基-（11）C）-蛋氨酸-PET检查。在手术病例中，PET和MR图像在立体定向活检或基于导航的切除的图像融合规划中相结合。术前规划图像在术后与MR成像、PET结果及组织学数据进行比较，以评估对诊断率和肿瘤切除的临床影响。
PET数据在所有病例中均影响了手术决策或操作。PET的使用有助于更好地区分复杂病变中的惰性成分和活性成分（12例患者）；在不增加采样的情况下改善了立体定向活检的靶点选择和诊断率；提供了额外的预后信息；减少了脑干病变活检采样所需的组织量（20例）；更好地勾勒了在MR成像上难以勾勒且浸润功能皮层的病变（50例）；在全切除影响生存的病例中显著增加了切除的肿瘤组织量（20例）；引导在高代谢区域进行切除（15例）；改善了术后早期对残留肿瘤的检测（20例）；避免了不必要的再次手术（5例）；并支持了进行早期二次切除的决策（8例）。
作者发现PET对小儿脑肿瘤的手术决策和操作有重大影响。进一步的研究可能会证明PET是否能改善儿童的治疗结果。
