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201Tl-SPECT in low-grade gliomas: diagnostic accuracy in differential diagnosis between tumour recurrence and radionecrosis

  • Manuel Gómez-Río
  • Dolores Martínez del Valle Torres
  • Antonio Rodríguez-Fernández
  • José Manuel Llamas-Elvira
  • Simeón Ortega Lozano
  • Carlos Ramos Font
  • Escarlata López Ramírez
  • Majed Katati
Original Article

Abstract

Purpose

The aim of this work was to describe the usefulness of a simple 201Tl single-photon emission computed tomography (SPECT) technique in the differential diagnosis between tumour recurrence and radionecrosis during the follow-up of patients treated for low-grade gliomas.

Methods

The study population comprised 84 patients treated for low-grade gliomas who showed suspicion of tumour recurrence during their follow-up. All patients were examined by neuro-anatomical imaging procedures (CT, MRI) and 201Tl-SPECT. 201Tl-SPECT images were assessed by visual analysis based only on the information on the prescription form and by estimation of the uptake index (ratio of mean counts in the lesion to those in the contralateral mirror area). Examiners were blinded to the results of other tests.

Results

Under these conditions, the neuro-anatomical procedures yielded 26.2% inconclusive reports, with a global diagnostic accuracy of 0.61, a sensitivity of 0.63 and a specificity of 0.59. The global diagnostic accuracy for 201Tl-SPECT was 0.83, with a sensitivity of 0.88 and a specificity of 0.76. Diagnostic pitfalls were observed in regions with physiological 201Tl uptake, i.e. the posterior cranial fossa, diencephalon, lateral ventricles and cavernous and longitudinal venous sinuses. An uptake index cut-off value of 1.25 showed a sensitivity of 0.90 and specificity of 0.80 for detection of tumour activity.

Conclusion

201Tl-SPECT has adequate diagnostic accuracy to be part of routine algorithms in the follow-up of patients with low-grade glioma suspected of tumour recurrence, as an alternative to neuro-anatomical procedures and not solely as a complementary test.

Keywords

201Tl-SPECT Low-grade gliomas Radionecrosis Glioma recurrence Diagnostic accuracy 

Notes

Acknowledgement

The authors are grateful to Richard Davis for assistance with the English version of this text.

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Manuel Gómez-Río
    • 1
  • Dolores Martínez del Valle Torres
    • 1
  • Antonio Rodríguez-Fernández
    • 1
  • José Manuel Llamas-Elvira
    • 1
  • Simeón Ortega Lozano
    • 1
  • Carlos Ramos Font
    • 1
  • Escarlata López Ramírez
    • 2
  • Majed Katati
    • 3
  1. 1.Department of Nuclear Medicine“Virgen de las Nieves” University HospitalGranadaSpain
  2. 2.Department of Radiotherapeutic Oncology“Virgen de las Nieves” University HospitalGranadaSpain
  3. 3.Department of Neurosurgery“Virgen de las Nieves” University HospitalGranadaSpain

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