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Correlation Between Postoperative 3-[¹²³I]Iodo-L--Methyltyrosine Uptake and Survival in Patients with Gliomas

Departments of Nuclear Medicine, Radiotherapy, and Medical Statistics, Technische Universitaet Muenchen, Munich; and Department of Neurosurgery, Krankenhaus-Muenchen Bogenhausen, Munich, Germany

View larger version (126K): [in a new window]   FIGURE 1. In patients with anaplastic astrocytoma, examples of IMT SPECT studies with (A) and without (B) focal IMT uptake at resection site. (A) On left, MR image (T1-weighted after administration of gadolinium-DTPA) shows resection cavity (white arrow) and rim of contrast enhancement (black arrow). Resection cavity contains blood and is, therefore, hyperintense in T1-weighted image. On right, IMT SPECT image shows intense uptake of IMT at resection margin. This patient died 6 mo after SPECT study. (B) On left, MR image shows resection cavity (white arrow) and surrounding contrast enhancement (black arrow). However, on right, IMT SPECT image shows no clear focal IMT uptake. This patient was still alive after 38 mo of follow-up.

View larger version (15K): [in a new window]   FIGURE 2. IMT uptake and tumor grading. On left, no significant correlation (P = 0.71) is seen between IMT uptake and tumor grading in the 43 patients who were imaged after stereotactic biopsy. On right, no significant correlation (P = 0.16) is seen between IMT uptake and tumor grading in the 71 patients who were imaged after tumor resection.

View larger version (14K): [in a new window]   FIGURE 3. Kaplan–Meier estimates of overall survival among patients with low and high postoperative IMT uptake (n = 71). In patients with IMT uptake ratio > 1.7 (high IMT uptake, n = 35), survival is significantly shorter (P < 0.001 by log-rank test) than in patients with uptake ratio 1.7 (low IMT uptake, n = 36).

View larger version (14K): [in a new window]   FIGURE 4. Kaplan–Meier estimates of overall survival among untreated patients with low and high IMT uptake (n = 43). There was no significant difference (P = 0.95 by log-rank test) in overall survival between patients with IMT uptake ratio > 2.2 (high IMT uptake, n = 21) and patients with uptake ratio 2.2 (low IMT uptake, n = 22).