technetium-tc-99m-gluceptate and Brain-Neoplasms

This study aimed to evaluate and compare the role of Tc-GH SPECT/CT and F-FDOPA PET/CT for diagnosing recurrence in patients with glioma.. Thirty patients with histopathologically proven glioma (glioblastoma multiforme, 14; grade III, 6; grade II, 8; and grade I, 2), who presented with clinical and/or imaging suspicion of recurrence were prospectively evaluated. They were primarily treated with surgery and radiotherapy with or without chemotherapy. Each patient underwent Tc-GH SPECT/CT and F-FDOPA PET/CT within a span of 15 days. Images were evaluated qualitatively and quantitatively by 2 experienced nuclear medicine physicians in consensus. Histopathology and/or clinical/imaging follow-up were used as reference standard.. Based on reference standard, 22 patients were positive and 8 were negative for recurrence. Tc-GH SPECT/CT was positive for recurrence in 22 and negative in 8 patients. F-FDOPA PET/CT scan was positive for recurrence in 23 and negative in 7 patients. Sensitivity, specificity, and accuracy were 86.4%, 62.5%, and 80% for Tc-GH SPECT/CT and 100%, 87.5%, and 96% for F-FDOPA PET/CT, respectively. No significant difference was found between Tc-GH SPECT/CT and F-FDOPA PET/CT overall (P = 1.00), as well as for low-grade (P = 0.250) or high-grade tumors (P = 0.50). Significant correlation was noted between tumor-brain of Tc-GH with both tumor-striatum (r = 0.371; P = 0.044) and tumor-cerebellum ratio of F-FDOPA (r = 0.369; P = 0.045).. For detection of recurrence in glioma patients, Tc-GH SPECT/CT is not inferior to F-FDOPA PET/CT and can be used as a low-cost alternative.

Topics: Brain Neoplasms; Dihydroxyphenylalanine; Female; Glioma; Humans; Male; Multimodal Imaging; Organotechnetium Compounds; Pilot Projects; Positron-Emission Tomography; Prospective Studies; Recurrence; Sugar Acids; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Thallium-201 (Tl-201) is the most commonly used tracer for functional imaging of recurrent brain tumours. However, the physical properties of Tl-201 are not particularly suitable for this application, thus, a technetium-99 (Tc99m) labelled alternative with more favourable physical properties has been sought. The aim of this study was to compare the ability of Tl-201 and Tc99m-glucoheptonate single photon emission computed tomography (SPECT) to detect viable recurrent tumour and differentiate post-radiation gliosis.. Brain SPECT with Tl-201 and Tc99m-glucoheptonate was performed in 20 patients with malignant brain tumour in whom recurrent disease was suspected. Tracer uptake in the mass was defined as high, moderate or low and was correlated with histological verification of the lesion in all cases.. Recurrent tumour was demonstrated in 17 patients by both Tl-201 and Tc99m-glucoheptonate SPECT and confirmed by surgical resection in all 17 patients. Three patients had no tracer uptake on either Tl-210 or Tc99m-glucoheptonate SPECT and surgical resection revealed only fibrotic tissue with areas of necrosis. Tc99m-glucoheptonate images were found to correlate more closely with the surgical findings with regard to the location of tumour margin, extent of tumour invasion and intratumoural necrosis.. Tc99m-glucoheptonate brain SPECT is an accurate agent for SPECT imaging of recurrent brain tumours and may provide more information about the location of the tumour margin and its extent and intratumoural necrosis than Tl-201. Tc99m-glucoheptonate may be a viable replacement for Tl-201.

Topics: Adolescent; Adult; Brain Neoplasms; Cerebral Angiography; Child; Data Interpretation, Statistical; Female; Gadolinium; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Organotechnetium Compounds; Radiopharmaceuticals; Sugar Acids; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Blood-brain barrier imaging of brain tumours is fast attracting interest now that it has been demonstrated that disruption of the blood-brain barrier is essential for uptake of all tumour-seeking agents. The aim of the present study was to differentiate recurrent tumour from post-radiation gliosis using (99m)technetium-glucoheptonate ((99m)Tc-GHA) as a tumour-seeking agent. Brain single photon emission computed tomography (SPECT) with (99m)Tc-GHA was performed in 73 patients with primary malignant brain tumours after radiotherapy, and the results were correlated with the clinical behaviour of the disease on follow up. The SPECT was suggestive of recurrent tumour in 55 patients. The clinical course was consistent with recurrence in 51 of the 55 patients. The clinical course was consistent with radiation necrosis in the remaining 21 patients, which included 17 patients with a negative SPECT and four patients with a positive SPECT study. Mean GHA index in recurrent tumour and post-radiation gliosis was 7.04 +/- 4.35 and 1.88 +/- 1.70, respectively (P = 0.0001). Mean GHA index in high-grade and low-grade glioma was 7.78 +/- 4.73 and 3.15 +/- 2.44, respectively (P = 0.001). (99m)Technetium-glucoheptonate brain SPECT is a sensitive and reliable diagnostic modality to differentiate recurrent tumour from post-radiation gliosis.

Topics: Adolescent; Adult; Aged; Brain; Brain Neoplasms; Child; Child, Preschool; Diagnosis, Differential; Female; Gliosis; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Organotechnetium Compounds; Radiopharmaceuticals; Radiotherapy; Sensitivity and Specificity; Sugar Acids; Tomography, Emission-Computed, Single-Photon

Osmotic blood-brain barrier (BBB) disruption induced by intraarterial infusion of mannitol is used in conjunction with chemotherapy to treat human brain tumors. The time course to barrier closure, or the so-called therapeutic window, has been examined in animals but little information is available in humans. The authors, therefore assessed the time course to barrier closure after osmotic BBB disruption in humans.. Disruption of the BBB was demonstrated using 99mTc-glucoheptonate (TcGH) single-photon emission computerized tomography (SPECT) scanning in 12 patients who were treated monthly with combination chemotherapy in conjunction with BBB disruption. The primary diagnosis was primary central nervous system lymphoma in seven patients and primitive neuroectodermal tumors in five. The TcGH (20 mCi) was injected at 1- to 480-minute intervals after osmotic BBB disruption, and patients underwent SPECT scanning after 4 hours. A total of 38 studies was performed. Good-to-excellent BBB disruption was obtained in 29 procedures and poor-to-moderate disruption was seen in the other nine studies. The TcGH indices correlated with the degree of BBB disruption as measured postprocedure on contrast-enhanced CT scans (r = 0.852). Mean baseline TcGH indices were 1.02+/-0.07. For the group of patients with good-to-excellent disruptions the mean indices at 1 minute postdisruption measured 2.19+/-0.18. After 40 minutes no significant change was noted (mean index 2.13+/-0.2). Then the indices declined more steeply and at 120 minutes after the disruption the index was 1.36+/-0.02. A very slow decline was noted between 120 and 240 minutes after mannitol infusion. At 240 minutes the barrier was still open for all good-to-excellent disruptions (index 1.33+/-0.08) but at 480 minutes the mean indices had returned to the baseline level.. Results of these in vivo human studies indicate that the time course to closure of the disrupted BBB for low-molecular-weight complexes is longer than previously estimated. The barrier is widely open during the first 40 minutes after osmotic BBB disruption and returns to baseline levels only after 6 to 8 hours following the induction of good or excellent disruption. These findings have important clinical implications for the design of therapeutic protocols.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Blood-Brain Barrier; Brain; Brain Neoplasms; Contrast Media; Diuretics, Osmotic; Female; Humans; Infusions, Intra-Arterial; Lymphoma; Male; Mannitol; Middle Aged; Molecular Weight; Neuroectodermal Tumors; Organotechnetium Compounds; Osmosis; Permeability; Radiopharmaceuticals; Sugar Acids; Time Factors; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Iodine-131 3F8, a murine IgG3 monoclonal antibody that targets to GD2-bearing tumors, was administered intravenously to 12 patients with brain tumors. Six patients received 2 mCi (0.74 Bq) of 131I-3F8, five patients 10 mCi (3.7 Bq)/1.73 m2 of 131I-3F8, and one patient 2.6 mCi (0.96 Bq) of 124I-3F8, with no side-effects. Nine of 11 malignant gliomas and the single metastatic melanoma showed antibody localization, with the best tumor delineation on single-photon emission tomography (SPET) following 10 mCi (3.7 Bq)/1.73 m2 dose. No nonspecific uptake in the normal craniospinal axis was detected. There was no difference in the pharmacokinetics of low-dose versus the higher-dose antibody groups; plasma and total-body half-lives were 18 h and 49 h, respectively. Surgical sampling and time-activity curves based on quantitative imaging showed peak uptake in high-grade glioma at 39 h, with a half-life of 62 h. Tumor uptake at time of surgery averaged 3.5 x 10(-3) %ID/g and peak activity by the conjugate view method averaged 9.2 x 10(-3) %ID/g (3.5-17.8). Mean radiation absorption dose was 3.9 rad per mCi injected (range 0.7-9.6) or 10.5 cGy/Bq (range 1.9-26). There was agreement on positive sites when immunoscintigraphy was compared with technetium-99m glucoheptonate/diethylene triamine penta-acetic acid planar imaging, thallium-201 SPET, and fluorine-18 fluorodeoxyglucose positron emission tomography. Taken together, these data suggest that quantitative estimates of antibody targeting to intracranial tumors can be made using the modified conjugate view method.

Topics: Adolescent; Adult; Aged; Brain Neoplasms; Child; Deoxyglucose; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Glioblastoma; Humans; Iodine Radioisotopes; Male; Middle Aged; Organotechnetium Compounds; Radioimmunodetection; Sugar Acids; Technetium Tc 99m Pentetate; Thallium Radioisotopes; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

To compare CT and radionuclide imaging of osmotic blood-brain barrier disruption. To develop a quantitative method for imaging osmotic blood-brain barrier disruption and to see if iopamidol could be safely given intravenously in conjunction with blood-brain barrier disruption.. Forty-five blood-brain barrier disruption procedures were imaged with CT and radionuclide scans. The scans were evaluated with visual and quantitative scales. Patients were observed for adverse effects after blood-brain barrier disruption.. There was a 4% rate of seizures in this study. There was good agreement between visual CT and radionuclide grading systems. Quantitative methods to grade disruption did not add useful information to visual interpretations.. Nonionic iodine-based contrast medium has a lower incidence of seizures when injected intravenously in conjunction with osmotic blood-brain barrier disruption than ionic contrast material. Contrast-enhanced CT is the preferred method to image disruption because it has better spatial resolution than radionuclide techniques.

Topics: Adolescent; Adult; Aged; Blood-Brain Barrier; Brain Neoplasms; Female; Humans; Iopamidol; Male; Middle Aged; Organotechnetium Compounds; Osmosis; Radionuclide Imaging; Sugar Acids; Tomography, X-Ray Computed

Experimental gliomas were induced in rats by prenatal exposure to ethyl nitrosourea. Changes in the blood-brain barrier were determined by the uptake of a water-soluble compound, 99mTc-glucoheptonate. Increased uptake of 99mTc-glucoheptonate was measured in intact tumors and in various sectors of dissected tumors. The extent of 99mTc-glucoheptonate uptake greatly varied among different tumors and among different sectors of the same tumor. Ultrastructural and cytochemical analysis of the capillary endothelial wall revealed major alterations in tight junctions, which became permeable to horseradish peroxidase. In brain tissue around the tumors, uptake of 99mTc-glucoheptonate and ultrastructure of tight junctions were comparable to normal brain capillaries. The results of the present study indicate that altered endothelial tight junctions may provide the main route of transport of 99mTc-glucoheptonate through the endothelial wall.

Topics: Animals; Blood-Brain Barrier; Brain Neoplasms; Glioma; Intercellular Junctions; Neoplasms, Experimental; Organotechnetium Compounds; Pinocytosis; Rats; Rats, Inbred F344; Sugar Acids

A newly developed and validated noninvasive quantitative SPECT method was used to measure the in vivo uptake of [57Co]bleomycin (Co-bleo) in 13 human brain tumors and the uptake of [99mTc]glucoheptonate (GH) in 23 brain tumors. Significant differences in tumor uptake were found. The tumor concentration over time, the tumor to blood radio at 30 min and the tumor cumulative concentration of radioactivity showed marked differences even between tumors with the same histology. Only a weak correlation was found between tumor concentration of Co-bleo and of GH. Therefore a simple imaging agent such as GH cannot, at the present time, serve as an indicator of individual tumor uptake and further experience with other agents is still necessary. Contrary to the generally held view, no correlation was found between the concentration of drug in the blood and its tumor concentration. It is suggested therefore that the level of a drug in the blood cannot be used as a criterion of the amount that will penetrate the tumor. Direct SPECT measurement of the concentration of the drug in the tumor itself should be performed. The bioavailability of a drug is critical in order for it to exert it tumoricidal effect. The results, showing marked differences in uptake between brain tumors, suggest that before chemotherapy is administered, uptake of the chemotherapeutic drug in the individual tumor to be treated should be assessed and comparisons should be made between the uptake of a series of drugs to determine which drug would be most efficacious on the basis of its uptake as well as its tumor cell killing potential.

Topics: Biological Availability; Bleomycin; Brain Neoplasms; Cobalt Radioisotopes; Humans; Organotechnetium Compounds; Sugar Acids; Technetium; Tomography, Emission-Computed

Intracerebral lesions demonstrated by computerized tomography usually require histological confirmation to determine subsequent management. Tissue samples are generally obtained by craniotomy or burr hole biopsy; either procedure can prove negative if a lesion is small, deep, or very superficial. Pre-operative imaging and localization reduce biopsy failures. Before the introduction of this straight forward radionuclide technique, our biopsy success rate using conventional localization methods was 88%. In a 5-year period, 200 patients underwent pre-operative radionuclide localization, with an improvement in the overall biopsy success rate to 92.7% (95.5% for lesions which took up radionuclide). Patients have benefitted from reduced operating time and improved post-operative recovery rates. About 85% of all intracerebral lesions may be expected to accumulate radionuclide. However in our series, 93.2% were sufficiently well visualized for a siting marker to be placed with confidence. Within this group, low grade astrocytomas (Kernohan Grades I and II) showed a predictably low incidence of imaging (30.8%). For the majority of lesions which present difficulties in biopsy due to size or site, the radionuclide method is a simple procedure which increases the chance of obtaining positive tissue with the minimum of surgical intervention.

Topics: Biopsy; Brain; Brain Diseases; Brain Neoplasms; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Preoperative Care; Radionuclide Imaging; Sugar Acids; Technetium

The variable penetration of chemotherapeutic drugs into brain and tumor is more dependent upon lipid solubility than upon size. In contrast, the molecular weight of virus- and tumor-specific monoclonal antibodies appears to limit uptake. The authors have studied eight patients with malignant brain tumors in order to compare tumor uptake of an iodinated contrast agent evaluated by computerized tomography scanning with uptake of the low and high molecular weight imaging agents technetium-99m (99mTc)-glucoheptonate and 99mTc-albumin, respectively, measured by radionuclide brain scanning. The agent 99mTc-labeled albumin was chosen for evaluation because its molecular weight (68,000) is similar to that of the most clinically promising monoclonal antibody fragment, the immunoglobulin (Ig) G Fab monomeric fragment. The radionuclide brain scans in the eight patients showed highly variable permeability of brain tumor to these markers, with uptake of the high molecular weight marker in the tumor being much less than that of the low molecular weight radionuclide. A clinical implication of these studies is that the success of monoclonal antibody therapy in the treatment of malignant brain tumors may require techniques to increase permeability of the blood-brain barrier and blood-tumor barrier to protein.

Topics: Antibodies, Monoclonal; Blood-Brain Barrier; Brain; Brain Neoplasms; Humans; Molecular Weight; Organotechnetium Compounds; Permeability; Radionuclide Imaging; Sugar Acids; Technetium; Technetium Tc 99m Aggregated Albumin

Neurologic history and examination, radionuclide brain scans (RN), and computed tomographic brain scans (CT) were performed at diagnosis and sequentially in 153 consecutive patients with small cell lung cancer (SCLC) to assess the sensitivity and accuracy of these screening methods and to determine whether the early detection of brain metastases influences survival. CT scans (sensitivity, 98%; positive predictive accuracy, 98%) were superior to RN scans (sensitivity, 71%; positive predictive accuracy, 86%) in patients with or without neurologic signs or symptoms. However, CT scans were positive in only 6% of asymptomatic patients at diagnosis and 13% of asymptomatic patients after systemic therapy. Brain metastases detected by CT scan were the sole site of extensive-stage disease in 6% of patients at diagnosis. Despite the enhanced ability of CT scans to detect asymptomatic lesions, survival after therapeutic cranial irradiation was similar for asymptomatic and symptomatic patients. The results suggest that CT brain scans should be used routinely in SCLC patients with neurologic signs or symptoms, at diagnosis (when treatment decisions are based on stage), and at six-month intervals in patients with prior brain metastases and in whom erratic follow-up is likely.

Topics: Actuarial Analysis; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Carcinoma, Small Cell; Diagnostic Errors; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Technetium; Tomography, X-Ray Computed

Over the past decade, many of the prime indications for radionuclide brain scanning have become instead indications for CCT, and nuclear medicine studies of the brain have assumed more of a complementary, supportive role. However, there is great promise for improvement in central nervous system radionuclide applications with advances anticipated in both radiopharmaceuticals and instrumentation. Nuclear medicine is continuing to function as a powerful research tool and, in the relatively near future, may regain its role as a major clinical test of the central nervous system.

Topics: Brain Abscess; Brain Death; Brain Diseases; Brain Injuries; Brain Neoplasms; Cerebrospinal Fluid Shunts; Cerebrovascular Disorders; Diagnosis, Differential; Humans; Hydrocephalus; Intracranial Arteriovenous Malformations; Meningitis; Organotechnetium Compounds; Pentetic Acid; Radionuclide Imaging; Sinus Thrombosis, Intracranial; Spinal Cord Diseases; Sugar Acids; Technetium; Technetium Tc 99m Pentetate

Radionuclide and computed tomographic (CT) scanning was performed for the long-term follow-up of 63 patients who had been treated for primary intracranial central nervous system tumors. This group included 23 children with supratentorial lesions and 40 with infratentorial lesions. The results of imaging were correlated with clinical assessment and the results of cytologic evaluation of the cerebrospinal fluid and, when available, surgical or autopsy findings. The sensitivity, specificity, and positive predictive value of both CT and radionuclide scanning were evaluated for each type of tumor. These two modalities play a complementary role in the long-term follow-up of children with primary intra-axial neoplasms.

Topics: Adolescent; Astrocytoma; Brain Neoplasms; Child; Child, Preschool; Diatrizoate Meglumine; Ependymoma; False Negative Reactions; False Positive Reactions; Female; Follow-Up Studies; Glioma; Humans; Infant; Male; Medulloblastoma; Organotechnetium Compounds; Pentetic Acid; Sugar Acids; Technetium; Technetium Tc 99m Pentetate; Time Factors; Tomography, Emission-Computed; Tomography, X-Ray Computed

Sixteen patients with known cerebral disease had one- and two-hour delayed brain scans following intravenous injection of 15 mCi of technetium-99m glucoheptonate. No abnormalities were seen on the two-hour images that were not detected on the one-hour delayed scan. There were two false negative scans. Of the 14 true positives, 10 were visualized equally well in the one-and two-hour delayed images, two were better seen on two-hour images, and two were better on one-hour scans. As no difference in lesion detection was found, consideration of reducing the post-dose delay time two hours to one seems warranted.

Topics: Brain; Brain Diseases; Brain Neoplasms; Evaluation Studies as Topic; False Negative Reactions; Humans; Intracranial Arteriovenous Malformations; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Technetium; Time Factors

Topics: Brain Neoplasms; Diagnosis, Differential; Humans; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Technetium; Tomography, X-Ray Computed

Topics: Brain; Brain Abscess; Brain Diseases; Brain Neoplasms; Cerebrovascular Disorders; Glioblastoma; Humans; Meningioma; Organotechnetium Compounds; Pentetic Acid; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Sugar Acids; Technetium; Tomography, X-Ray Computed; Wounds and Injuries