Clinical value of amino acid imaging in paediatric brain tumours

Summary

Purpose: To evaluate single photon emission computed tomography (SPECT) using the amino acid l-3-[¹²³I]-α-methyl tyrosine (IMT) and contrast enhanced magnetic resonance imaging (MRI) as diagnostic tools in primary paediatric brain tumours in respect of non-invasive tumour grading. Patients, materials, methods: 45 children with primary brain tumours were retrospectively evaluated. IMT uptake was quantified as tumour/nontumour- ratio, a 4-value-scale was used to measure gadolinium enhancement on contrast enhanced MRI. Statistical analyses were performed to evaluate IMT uptake and gadolinium enhancement in low (WHO I/II) and high (WHO III/ IV) grade tumours and to disclose a potential relationship of IMT uptake to disruption of blood brain barrier as measured in corresponding MRI scans. Results: IMT uptake above background level was observed in 35 of 45 patients. IMT uptake was slightly higher in high grade tumours but the difference failed to attain statistical significance. Grading of individual tumours was neither possible by IMT SPECT nor by gadolinium enhanced MRI. Conclusion: IMT is accumulated in most brain tumours in children. Tumour grading was not possible using IMT or contrast enhancement as determined by MRI. Neither morphological nor functional imaging can replace histology in paediatric brain tumours.

Zusammenfassung

Ziel: Ziel dieser Studie war, die Wertigkeit der SPECT mit der Aminosäure Iod-123-α-Methyltyrosin (IMT) und der kontrastverstärkten Magnetresonanztomographie (MRT) als diagnostische Verfahren bei primären kindlichen Hirntumoren im Hinblick auf eine Malignitätseinschätzung zu überprüfen. Patienten, Material, Methoden: 45 Kinder mit primären Hirntumoren wurden retrospektiv untersucht. Die Aminosäureaufnahme wurde als Tumor/Nontumor- Quotient, die Kontrastmittelanreicherung quantitativ auf einer 4-Werte-Skala bestimmt. Es wurde überprüft, ob die Aminosäureaufnahme und die Kontrastmittelanreicherung bei niedrig- bzw. bei hochgradigen Hirntumoren signifikant verschieden sind und ob die Aminosäureaufnahme von einer Störung der Bluthirnschrankenfunktion abhängt, die mit der MRT gemessen wird. Ergebnisse: IMT wurde von 35 der 45 untersuchten Hirntumoren aufgenommen. Die IMT-Anreicherung war in hochgradigen Hirntumoren geringfügig intensiver im Vergleich zu niedriggradigen Tumoren, ohne dass der Unterschied statistisch signifikant war. Eine Malignitätseinschätzung war weder mit der IMTSPECT noch mit der kontrastverstärkten MRT möglich. Schlussfolgerung: IMT wird von den meisten kindlichen Hirntumoren aufgenommen. Eine Malignitätseinschätzung ist weder durch die IMT-SPECT noch durch das Kontrastmittelverhalten in der MRT möglich. Weder die funktionelle noch die morphologische Bildgebung kann die Histologie bei kindlichen Hirntumoren ersetzen.

Keywords

Brain neoplasm - ¹²³I-IMT SPECT - MRI - Grading

Schlüsselwörter

Hirntumor - ¹²³I-IMT SPECT - MRT - Malignität

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