RT Journal Article
SR Electronic
T1 Use of Stereotactic PET Images in Dosimetry Planning of Radiosurgery for Brain Tumors: Clinical Experience and Proposed Classification
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1146
OP 1154
VO 45
IS 7
A1 Marc Levivier
A1 Nicolas Massager
A1 David Wikler
A1 José Lorenzoni
A1 Salvador Ruiz
A1 Daniel Devriendt
A1 Philippe David
A1 Françoise Desmedt
A1 Stéphane Simon
A1 Paul Van Houtte
A1 Jacques Brotchi
A1 Serge Goldman
YR 2004
UL http://jnm.snmjournals.org/content/45/7/1146.abstract
AB We developed a technique that allows the routine integration of PET in stereotactic neurosurgery, including radiosurgery. We report our clinical experience with the combined use of metabolic (i.e., PET) and anatomic (i.e., MRI and CT) images for the radiosurgical treatment of brain tumors. We propose a classification describing the relative role of the information provided by PET in this multimodality image-guided approach. Methods: Between December 1999 and March 2003, 57 patients had stereotactic PET as part of their image acquisition for the planning of gamma knife radiosurgery. Together with stereotactic MRI and CT, stereotactic PET images were acquired on the same day using either 18F-FDG or 11C-methionine. PET images were imported in the planning software for the radiosurgery dosimetry, and the target volume was defined using the combined information of PET and MRI or CT. To analyze the specific contribution of the PET findings, we propose a classification that reflects the strategy used to define the target volume. Results: The patients were offered radiosurgery with PET guidance when their tumor was ill-defined and we anticipated some limitation of target definition on MRI alone. This represents 10% of the radiosurgery procedures performed in our center during the same period of time. There were 40 primary brain lesions, 7 metastases, and 10 pituitary adenomas. Abnormal PET uptake was found in 62 of 72 targets (86%), and this information altered significantly the MRI-defined tumor in 43 targets (69%). Conclusion: The integration of PET in radiosurgery provides additional information that opens new perspectives for the optimization of the treatment of brain tumors.