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Stereotactic Coregistration of ²⁰¹Tl SPECT and MRI Applied to Brain Tumor Biopsies

¹ Research Unit on Movement Disorders (URMA), University Hospital, Montpellier, France; ² Anatomopathology Department, University Hospital, Montpellier, France; ³ Biophysics and Nuclear Medicine Department, University Hospital, Montpellier, France; ⁴ Biostatistics Department, University Hospital, Montpellier, France; ⁵ Neurosurgery Department, University Hospital, Montpellier, France

The aim of the present study was to determine the clinical feasibility of integration of stereotactic SPECT (sSPECT) with ²⁰¹Tl in the stereotactic MRI (sMRI)-based planning of brain tumor biopsy. Furthermore, the predictive value of the integrated techniques was analyzed by comparison with the corresponding histologically determined metabolic activity. Methods: Ten patients underwent combined ²⁰¹Tl SPECT- and MRI-guided stereotactic biopsy of intracranial lesions according to a previously described technique. An area of abnormal ²⁰¹Tl uptake was used to guide the stereotactic biopsy trajectory. Several samples were taken along the trajectory above and beneath the target. An extensive histologic diagnosis (tumor grade, mitotic index [MI], and Ki67 index) and the ²⁰¹Tl index were obtained for all samples and compared statistically. Results: Combined ²⁰¹Tl sSPECT- and sMRI-guided biopsy could be performed on all patients. Ki67 index, MI, and tumor grade correlated significantly. The correlations between MI or Ki67 index and ²⁰¹Tl index were not significant (0.18 and 0.09, respectively). A trend to significance existed between tumor grade and ²⁰¹Tl index (R = 0.31; P = 0.06). Mean ²⁰¹Tl index for grade III tumors (3.27 ± 1.89 [SD]) was significantly different from that for grade IV tumors (4.34 ± 1.29). The sample position on the trajectory correlated with the MI (R = 0.39; P = 0.01). In 4 of the 10 patients, a variation in tumor grade could be observed along the trajectory. In all patients, the highest proliferative activity was within 5–10 mm of the target. Conclusion: These results support the view that ²⁰¹Tl SPECT may contribute to the successful management of brain tumor patients requiring stereotactic biopsy, without causing a significant increase in discomfort or morbidity. The development of similar techniques integrating sSPECT data in the planning of stereotactic biopsy should be considered by centers performing stereotactic surgery and having access to SPECT technology. In the long term, this technique could become a support for focused gene therapy and cell transfer.

Key Words: stereotactic ²⁰¹Tl SPECT • stereotactic MRI • coregistration • biopsy • brain tumors