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Measurement of the Extracellular Space in Brain Tumors Using ⁷⁶Br-Bromide and PET

¹ Paul Scherrer Institute, Center for Radiopharmaceutical Science, Villigen, Switzerland
² Department of Nuclear Medicine, Cantonal Hospital, Aarau, Switzerland
³ Department of Neurology, Cantonal Hospital, Aarau, Switzerland

View larger version (19K): [in a new window]   FIGURE 1. (A) 76Br-Bromide time–activity curve in patient 2 with glioblastoma multiforme shows radioactivity of plasma, normal brain tissue, and tumor. Dotted and solid lines through tissue data points represent fits by 2- and 3-compartment models, respectively. (B) Logan plot of same time–activity curve as in A. (C) Patlak plot of same time–activity curve as in A, using linear regression from 60 min to end of scan. There is no significant difference between Patlak time (exposure time) and real PET time in case of 76Br-bromide PET.

View larger version (39K): [in a new window]   FIGURE 2. Proton density (A) and T2-MR (B) images of patient 2 with glioblastoma multiforme in left temporal lobe. 76Br-Bromide PET raw-count images from 60 to 90 min (C) and 24 to 24.5 h (D) after injection. (E) Corresponding parametric DVLogan image (pixel-wise Logan plot using dynamic PET data 0–110 min after injection and tracer concentration in arterial plasma as input function).

View larger version (44K): [in a new window]   FIGURE 3. Patient 4 (slowly progressive oligoastrocytoma, World Health Organization stage II). Nonenhancing T1-MR (A) but T2-MR hyperintense (B) tumor is not manifest in 76Br-bromide PET. 76Br-Bromide PET raw-count images from 60 to 90 min (C) and 24 to 24.5 h (D) after injection. (E) Corresponding parametric DVLogan image (pixel-wise Logan plot using dynamic PET data 0–110 min after injection and tracer concentration in arterial plasma as input function).

View larger version (16K): [in a new window]   FIGURE 4. (A and B) DVLogan and simple tissue-to-plasma radioactivity ratios at 75 min (A) and 4 h (B) after injection. Excellent correlation is shown and both are virtually equal. Solid, diagonal line in A–C indicates equality between y- and x-axes. (C) Tissue-to-plasma ratios after 24 h are higher than DVLogan.

View larger version (11K): [in a new window]   FIGURE 5. VD is plotted against DVLogan in brain tumor () and in normal tissue (). Solid, diagonal line indicates equality between y- and x-axes. VD is equal to DVLogan in normal tissue, where it ranges between 0.2 and 0.3, but VD is considerably lower than DVLogan in 4 tumors.

View larger version (12K): [in a new window]   FIGURE 6. Steroid treatment and ECS. Patients with () and without () dexamethasone treatment are shown. Two patients treated with dexamethasone show lowest DVLogan values in normal brain.

View larger version (12K): [in a new window]   FIGURE 7. Comparison of tumor ECS based on DVLogan (x-axis) with simple ROI method comparing radioactivity in tumor with cerebellum 60–90 min after injection (y-axis) shows positive correlation (Spearman rank correlation, P < 0.05). Solid, diagonal line indicates equality between y- and x-axes.