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Minim Invasive Neurosurg 2007; 50(5): 273-280
DOI: 10.1055/s-2007-991143
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Surgical Target Selection in Cerebral Glioma Surgery: Linking Methionine (MET) PET Image Fusion and Neuronavigation

K. Roessler 1 , 6 , B. Gatterbauer 1 , A. Becherer 2 , 6 , M. Paul 2 , K. Kletter 2 , D. Prayer 4 , R. Hoeftberger 5 , J. Hainfellner 5 , S. Asenbaum 2 , 3 , E. Knosp 1
  • 1Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
  • 2Department of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
  • 3Department of Neurology, Medical University of Vienna, Vienna, Austria
  • 4Department of Radiology, Medical University of Vienna, Vienna, Austria
  • 5Neurological Institute (Neuropathology), Medical University of Vienna, Vienna, Austria
  • 6Academic Teaching Hospital Feldkirch, Feldkirch, Austria
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Publication History

Publication Date:
05 December 2007 (online)

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Abstract

Objective: The objective of this study was to investigate the histological correlate of 11C-methionine (MET) PET uptake of brain gliomas by image fusion for navigated surgery.

Methods: Twenty-seven patients (18 male, 9 female; mean age 42 years; range 11-77 years; 8 low-grade and 11 high-grade astrocytomas or mixed gliomas, 8 oligodendrogliomas) underwent MET PET studies preoperatively.

Results: MET PET tumor uptake was detected in 26 of 27 patients (96.3%). The quantitative MET tumor standardized uptake value (SUV) ratio was significantly higher in malignant gliomas and oligodendrogliomas than in low-grade gliomas (2.76/2.62 vs. 1.67, p=0.03). Generally, qualitative visual grading of MET uptake revealed 2 main patterns: focal MET uptake in 12 and uniform global MET uptake in 11 patients. Focal uptake corresponded to malignant glioma histology in 66.7%, and uniform global uptake to oligodendroglial histology in 72.7%. In oligodendrogliomas, global MET uptake constituted 81.5% (range 53.8-135%) of the MRI T1 tumor volume on average and was limited to the MRI FLAIR tumor volume in 86% (7/8) of patients. Tissue samples of focal MET uptake areas correlated with histological anaplasia in 66.6% (8/12 glioma patients), although 62.5% (5/8 patients) lacked MRI contrast enhancement.

Conclusion: MET PET image fusion may facilitate the targeting of anaplastic foci in homogeneous MRI non-enhancing gliomas for biopsy, may identify oligodendroglial histology preoperatively as well as characterize biologically active tumor volumes within MRI T1/FLAIR tumor areas of candidate patients for resection.

Key words

glioma surgery - image fusion - MET PET - neuronavigation

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Correspondence

K. RoesslerMD 

Department of Neurosurgery

Academic Teaching Hospital Feldkirch

Carinagasse 47

6807 Feldkirch

Austria

Phone: +43/5522/303 19 00

Fax: +43/5522/303 75 15

Email: Karl.Roessler@lkhf.at

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