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

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

Simone Hemm, BME¹, Valérie Rigau, MD², Jeanine Chevalier, MD³, Marie C. Picot, MD, PhD⁴, Luc Bauchet, MD, PhD⁵, Hassan El Fertit, MD⁵, Marie-Ange Rodriguez, MD⁵, Laura Cif, MD¹^,5, Nathalie Vayssière, PhD¹, Michel Zanca, MD, PhD³, Pierre Baldet, MD, PhD², François Segnarbieux, MD, PhD⁵ and Philippe Coubes, MD, PhD¹^,5

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

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FIGURE 1. Patient 2: ²⁰¹Tl sSPECT- and sMRI-guided biopsy. Target level (A–C) and level 29 mm above on trajectory (D–F) are shown on sagittal MRI slices (A and D), axial MRI slices (B and E), and axial ²⁰¹Tl sSPECT slices (C and F). Coordinates of pixel with highest metabolic activity within tumor on ²⁰¹Tl sSPECT images (C) were determined and transferred to MR images for usual biopsy planning (A and B). Sampled level 29 mm above target was visualized afterward on sMRI (D and E) and on ²⁰¹Tl sSPECT slices (F). Histologic analysis revealed grade II (–29 mm) and grade III oligoastrocytoma (target).

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FIGURE 2. Patient 7: ²⁰¹Tl sSPECT- and sMRI-guided biopsy. Target level (A–C) and level 5 mm above on trajectory (D–F) are shown on sagittal MRI slices (A and D), axial MRI slices (B and E), and axial ²⁰¹Tl sSPECT slices (C and F). Histologic analysis revealed anaplastic astrocytoma (grade III) in both samples.

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FIGURE 3. Evolution of thallium index (TI), MI, Ki67 index (KiI), and tumor grade on trajectory for patient 8 (n = 6 samples).

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FIGURE 4. Mean values of thallium index (TI), MI, Ki67 index (KiI), and tumor grade on trajectory for all patients. Samples were divided into 4 classes: class 1: x = 0 mm (target); class 2: 0 mm < |x| $≤$ 5 mm; class 3: 5 mm < |x| $≤$ 10 mm; and class 4: |x| > 10 mm.