99mTc-MDM Brain SPECT for the Detection of Recurrent/Remnant Glioma—Comparison With ceMRI and 18F-FLT PET Imaging: Initial Results. (October 2015)

• Record Type: Journal Article
• Authors: Singh, Baljinder; Kumar, Narendra; Sharma, Sarika; Watts, Ankit; Hazari, Puja P.; Rani, Nisha; Vyas, Sameer; Anish, Bhattacharya; Mishra, Anil K.
• Is Part Of: Clinical nuclear medicine. Volume 40:Number 10(2015)
• Publication Date: 2015-10
• Subjects: 99mTc-Methionine SPECT -- gliomas -- 18F-FLT PET -- ceMRI; Nuclear medicine -- Periodicals; Radioisotope scanning -- Periodicals; Nuclear Medicine -- Periodicals; 616.07575
• DOI: 10.1097/RLU.0000000000000881
• Languages: English
• ISSNs: 0363-9762

Abstract

Abstract : Purpose: To evaluate the diagnostic use of an indigenously developed single vial ready to label (with 99m Tc) kit preparation of bis-methionine-DTPA ( 99m Tc-MDM) for the detection of recurrent/residual glioma. Materials and Methods: We prospectively studied 32 patients (21 male and 11 female subjects aged 43.0±16.0 years) with clinical suspicion of postoperative recurrent/residual glioma. After radical radiotherapy (54.0–60.0 Gy) with or without concurrent temozolomide as indicated, 99m Tc-MDM SPECT and ceMRI of the brain was performed in all the patients and 18 F-FLT-PET imaging in 16 of 32 patients. Results: MDM SPECT and ceMRI findings were concordant in 28 patients (15 positive and 13 negative). The findings were discordant in the remaining 5 patients, with positive ceMRI and negative MDM-SPECT in 2 patients and negative ceMRI and positive MDM-SPECT in 3 patients. 99m Tc-MDM-SPECT, 18 F-FLT PET, and ceMRI scan findings were positive in 9 of 16 and negative in 5 of 16 patients. In the remaining 2 of 16 patients, both 18 F-FLT-PET and 99m Tc-MDM-SPECT were positive, but ceMRI was negative. Sensitivity, specificity, PPV, NPV, and DA of 99m Tc-MDM-SPECT for diagnosing recurrent/residual glioma were 88.24%, 81.25%, 83.3%, 86.7%, and 84.8%, respectively. Conclusions: The diagnostic accuracy of 99m Tc-bis-methionine (MDM)–SPECT imaging was comparable with that of ceMRI and 18 F-FLT-PET and may be useful in the management of glioma patients in the postsurgical follow-up period. This imaging technique may be of special interest in peripheral hospitals/developing countries lacking access to expensive PET/cyclotron technology. However, comparison with the existing "gold standard" PET tracers, especially with C-11-methionine-PET imaging and histopathological correlation, is warranted in a large cohort of glioma patients through multicentric studies.