Karlberg Anna, Berntsen Erik Magnus, Johansen Håkon, Myrthue Mariane, Skjulsvik Anne Jarstein, Reinertsen Ingerid, Esmaeili Morteza, Dai Hong Yan, Xiao Yiming, Rivaz Hassan, Borghammer Per, Solheim Ole, Eikenes Live
Department of Radiology and Nuclear Medicine, St. Olavs University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Radiology and Nuclear Medicine, St. Olavs University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
World Neurosurg. 2017 Dec;108:989.e1-989.e8. doi: 10.1016/j.wneu.2017.08.085. Epub 2017 Aug 24.
Structural magnetic resonance imaging (MRI) and histopathologic tissue sampling are routinely performed as part of the diagnostic workup for patients with glioma. Because of the heterogeneous nature of gliomas, there is a risk of undergrading caused by histopathologic sampling errors. MRI has limitations in identifying tumor grade and type, detecting diffuse invasive growth, and separating recurrences from treatment induced changes. Positron emission tomography (PET) can provide quantitative information of cellular activity and metabolism, and may therefore complement MRI. In this report, we present the first patient with brain glioma examined with simultaneous PET/MRI using the amino acid tracer F-fluciclovine (F-FACBC) for intraoperative image-guided surgery.
A previously healthy 60-year old woman was admitted to the emergency care with speech difficulties and a mild left-sided hemiparesis. MRI revealed a tumor that was suggestive of glioma. Before surgery, the patient underwent a simultaneous PET/MRI examination. Fused PET/MRI, T1, FLAIR, and intraoperative three-dimensional ultrasound images were used to guide histopathologic tissue sampling and surgical resection. Navigated, image-guided histopathologic samples were compared with PET/MRI image data to assess the additional value of the PET acquisition. Histopathologic analysis showed anaplastic oligodendroglioma in the most malignant parts of the tumor, while several regions were World Health Organization (WHO) grade II.
F-Fluciclovine uptake was found in parts of the tumor where regional WHO grade, cell proliferation, and cell densities were highest. This finding suggests that PET/MRI with this tracer could be used to improve accuracy in histopathologic tissue sampling and grading, and possibly for guiding treatments targeting the most malignant part of extensive and eloquent gliomas.
结构磁共振成像（MRI）和组织病理学组织采样是胶质瘤患者诊断检查的常规组成部分。由于胶质瘤具有异质性，存在因组织病理学采样误差导致分级过低的风险。MRI在识别肿瘤分级和类型、检测弥漫性浸润性生长以及区分复发与治疗引起的变化方面存在局限性。正电子发射断层扫描（PET）可以提供细胞活性和代谢的定量信息，因此可能补充MRI的不足。在本报告中，我们展示了首例使用氨基酸示踪剂F-氟代氯代脱氧胸苷（F-FACBC）进行术中图像引导手术的同时进行PET/MRI检查的脑胶质瘤患者。
一名60岁既往健康的女性因言语困难和轻度左侧偏瘫入住急诊。MRI显示一个提示为胶质瘤的肿瘤。手术前，患者接受了同时进行的PET/MRI检查。融合的PET/MRI、T1、液体衰减反转恢复序列（FLAIR）和术中三维超声图像用于指导组织病理学组织采样和手术切除。将导航的、图像引导的组织病理学样本与PET/MRI图像数据进行比较，以评估PET采集的附加价值。组织病理学分析显示肿瘤最恶性部分为间变性少突胶质细胞瘤，而几个区域为世界卫生组织（WHO）二级。
在肿瘤中WHO分级、细胞增殖和细胞密度最高的部分发现了F-氟代氯代脱氧胸苷摄取。这一发现表明，使用该示踪剂的PET/MRI可用于提高组织病理学组织采样和分级的准确性，并可能用于指导针对广泛且功能区胶质瘤最恶性部分的治疗。
