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Division of Nuclear Medicine, Department of Radiology and Departments of Radiation Oncology, Diagnostic Radiology, Neurosurgery and Biomathematical Sciences, Mount Sinai School of Medicine, City University of New York, New York
Correspondence: For correspondence or reprints contact: Mordechai Lorberboym, MD, Division of Nuclear Medicine, Mount Sinai Medical Center, Box 1141, New York, NY 10029.
ABSTRACT
This study prospectively assessed the diagnostic accuracy andprognostic value of 201TI uptake and retention in primary andmetastatic intracranial tumors treated by conventional radiotherapyand/or radiosurgery. Methods: An initial 201TI study (early anddelayed images), was obtained in 60 postsurgical patients, 6–12 wkafter radiotherapy or radiosurgery. Repeat imaging was performedas clinically warranted. Tumor-to-background count ratios and aretention index (RI) were calculated for all lesions. Results: Abnormallyincreased 201TI uptake was observed in 40 of 60 patients. In allpatients with positive results, the diagnosis of residual tumor wasconfirmed at biopsy or by clinical follow-up. In 20 of 60 patients, noabnormal 201TI uptake was observed, despite findings on CT and/orMRI scans that were suspicious for tumor. Ten of the negative 201TIstudies were confirmed as true-negatives by the clinical course andby resolution of CT/MRI abnormalities. The remaining 10 negativeSPECT studies ultimately proved to be false-negatives: six of thesepatients had lesions <1 cm in maximum diameter one patient hada large metastatic choriocarcinoma; and three patients had lowgrade astrocytomas >2 cm in minimum diameter. Tumor-to-back-groundratio of 201TI uptake did not distinguish between tumor type,or predict clinical outcome. The RI of 201TI was significantly higherfor metastatic melanoma than for other tumor metastases. It demonstratedreasonably good correlation with clinical outcome: 6/7patients with eventual tumor regression showed a decrease in RI onfollow-up examination, and 4/5 patients with eventual tumor progressionhad an increase in RI. Conclusion: Thallium-201 brainSPECT appears to be a useful noninvasive imaging technique inpatients irradiated for intracranial tumors. Thallium-201 scintigraphyhas very high specificity (100% in this cohort) for detecting viableresidual tumor. False-negative findings may occur. Quantitativeanalysis of 201TI uptake has limited diagnostic and prognosticsignificance, but changes in 201TI retention after radiation therapyseems to have prognostic value.
Key Words: thallium-201 • intracranial tumors • radiation therapy • retention index
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