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Thallium-201 Versus Technetium-99m-MIBI SPECT in Evaluation of Childhood Brain Tumors: A Within-Subject Comparison

Departments of Radiology (Division of Nuclear Medicine), Neurology, Neurosurgery, Hematology/Oncology and Radiation Therapy, Children's Hospital Harvard Medical School, Boston, Massachusetts

Correspondence: For correspondence or reprints contact: L.A. O'Tuama MD, Department of Radiology (Nuclear Medicine), Children's Hospital, 300 Longwood Ave., Boston, MA 02115.

ABSTRACT

We previously found that ²⁰¹Tl SPECT is a highly specific agent for detection of metabolic activity of childhood brain tumors. To compare the relative diagnostic accuracy of ²⁰¹Tl and a technetium-based tumor-avid agent, we have obtained SPECT in 19 children using ²⁰¹Tl (37–111 MBq) followed immediately by ²⁰¹Tl-methoxyisobutylisontrile (MIBI) (370–740 MBq) intravenously. Moderate to intense focal uptake of both tracers characterized true positive cases (n = 6). Lesion boundaries were better defined by MIBI. Uptake of MIBI by choroid plexus occurred despite pretreatment with potassium perchlorate (6 mg/kg) and complicated interpretation of deep/paraventricular lesions. Preliminary assessment indicated sensitivity 67% (Tl and MlBl); specificity 91% (TI); 100% (MIBI). Two tumors (medulloblastoma, dysgerminoma) were Tl/MIBI nonavid. Semi-quantitative assessment of tracer uptake was made using a ratio of radioactivity in tumor-containing areas compared to uninvolved brain. Ratio values were (mean ± s.d.) 7.88 ± 7.70 (Tl) and 27.1 ± 36.41 (MIBI). The spectrum of tumor avidity is similar for Tl and MIBI. Clearer identification of boundaries by MIBI may be an advantage in applications, e.g., radiotherapy port planning.

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