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Fluorine-18-FDG PET and Iodine-123-IMT SPECT in the Evaluation of Brain Tumors

Departments of Nuclear Medicine and Radiation Oncology, Klinikum Rechts der Isar
Department of Neurosurgery Krankenhaus München-Bogenhausen, Technical University of Münich, Münich, Germany

Correspondence: For correspondence or reptints contact: Wolfgang Weber, MD, Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Münich, Ismaningerstrasse 22, D-81675 Münich, Germany.

ABSTRACT

The high glucose utilization of normal gray matter limits the detection of brain tumor tissue by PET using ¹⁸F-fluorodeoxyglucose (FDG). The aim of this study was to evaluate whether the examination of amino acid transport with the SPECT tracer ¹²³I-alpha-methyl-L-tyrosine (IMT) allows better identification of tumor tissue than FDG PET. Methods: Nineteen patients (16 with gliomas, 3 with nontumorous lesions) were included in the study. Two independent observers classified PET and SPECT images as posifive or negative for tumor tissue and defined the extent of tumor with regions of interest. Tracer uptake of FDG and IMT was quantified by calculating the tumor uptake relative to contralateral gray and white matter. Results: SPECT studies were interpreted concordantly in 18 patients (kappa = 0.77) and all tumors were identified by both observers. PET studies were interpreted discordantly in 4 patients (kappa = 0.52) and only 10 tumors were identified by both observers. Interobserver variability in definition of tumor extent was significantly lower in the IMT-SPECT than in the FDG-PET studies (p = 0.03). Mean tumor uptake relativeto gray and white matter was 1.93 ± 0.42 and 2.25 ± 0.46 for IMT and 0.93 ± 0.32 and 1.61 ± 0.52 for FDG. All tumor uptake ratios were significantly (p < 0.01) higher for IMT than FDG, even when only glioblastomas were analyzed. No significant corralation was observed between the various uptake ratios of FDG and IMT. Conclusion: Despite the lower resolution and lower sensitivity of SPECT compared with PET, IMT-SPECT was clearly superior to FDG-PET in the detection and delineation of tumor tissue.

Key Words: fluorine-18-FDG • iodine-123-IMT • gliomas

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