Pirotte B, Goldman S, David P, Wikler D, Damhaut P, Vandesteene A, Salmon L, Brotchi J, Levivier M
Department of Neurosurgery, Université Libre de Bruxelles, Erasme Hospital, Belgium.
Acta Neurochir Suppl. 1997;68:133-8. doi: 10.1007/978-3-7091-6513-3_25.
The aim of the present study was to compare the contribution of the labelled tracers [C-11]methionine (Met) and [F-18]-fluorodeoxyglucose (FDG) in positron emission tomography (PET)-guided stereotactic biopsy of non resectable brain lesions. Twenty-five patients underwent combined Met-PET-, FDG-PET- and computerized tomography (CT)- or magnetic resonance (MR)-guided stereotactic biopsy according to a previously described technique for stereotactic FDG-PET. Met-PET and FDG-PET images were analyzed to determine which tracer offers the best information to guide at least one stereotactic biopsy trajectory. Histological diagnosis was obtained in all patients (23 tumours and 2 non-tumorous lesions). All tumours had an area of abnormal Met uptake and were biopsied under PET-guidance. FDG uptake in the tumour was higher than in the grey matter and was used for target selection in 12 of 23 tumours. Eleven of them were located in the basal ganglia or the brainstem. Met was used for target selection in 11 of 23 tumours where there was no FDG uptake or where FDG uptake was equivalent to that of the grey matter. Ten of them were located in the cortex. Two nontumoral lesions had no Met uptake and were biopsied under CT- or MR-guidance only. Forty-three out of 53 stereotactic trajectories obtained in these 25 patients were based on PET-defined targets and had an area of abnormal Met uptake. These trajectories always yielded a diagnosis of tumour. Moreover, all tumorous trajectories had an area of abnormal Met uptake. Finally, all non-diagnostic trajectories (n = 4) were CT/MR-defined because there was no area of abnormal Met uptake. These results suggest that patients who can benefit the most from Met-PET guidance could be selected pre-operatively. In conclusion, this work shows that Met is a good alternative to FDG for target selection in PET-guided stereotactic brain biopsy.
本研究的目的是比较标记示踪剂[C-11]蛋氨酸（Met）和[F-18]氟脱氧葡萄糖（FDG）在正电子发射断层扫描（PET）引导下对不可切除脑病变进行立体定向活检中的作用。25例患者根据先前描述的立体定向FDG-PET技术，接受了Met-PET、FDG-PET以及计算机断层扫描（CT）或磁共振（MR）引导下的立体定向活检。对Met-PET和FDG-PET图像进行分析，以确定哪种示踪剂能提供最佳信息来引导至少一条立体定向活检路径。所有患者（23个肿瘤和2个非肿瘤性病变）均获得了组织学诊断。所有肿瘤均有Met摄取异常区域，并在PET引导下进行活检。肿瘤中的FDG摄取高于灰质，23个肿瘤中有12个以此用于靶点选择。其中11个位于基底神经节或脑干。在23个肿瘤中，11个肿瘤在无FDG摄取或FDG摄取与灰质相当的情况下，采用Met进行靶点选择。其中10个位于皮质。2个非肿瘤性病变无Met摄取，仅在CT或MR引导下进行活检。这25例患者获得的53条立体定向活检路径中，有43条基于PET确定的靶点，且有Met摄取异常区域。这些路径总能得出肿瘤诊断。此外，所有肿瘤性活检路径均有Met摄取异常区域。最后，所有未得出诊断的路径（n = 4）均由CT/MR确定，因为没有Met摄取异常区域。这些结果表明，术前可选择出最能从Met-PET引导中获益的患者。总之，这项研究表明，在PET引导的立体定向脑活检中，Met是FDG进行靶点选择的良好替代方案。
