1
|
Brain Metastasis from Unknown Primary Tumour: Moving from Old Retrospective Studies to Clinical Trials on Targeted Agents. Cancers (Basel) 2020; 12:cancers12113350. [PMID: 33198246 PMCID: PMC7697886 DOI: 10.3390/cancers12113350] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Brain metastases (BMs) are the most common intracranial tumours in adults and occur up to 3–10 times more frequently than primary brain tumours. In up to 15% of patients with BM, the primary tumour cannot be identified. These cases are known as BM of cancer of unknown primary (CUP) (BM-CUP). The understanding of BM-CUP, despite its relative frequency and unfavourable outcome, is still incomplete and clear indications on management are missing. The aim of this review is to summarize current evidence on the diagnosis and treatment of BM-CUP. Abstract Brain metastases (BMs) are the most common intracranial tumours in adults and occur up to 3–10 times more frequently than primary brain tumours. BMs may be the cause of the neurological presenting symptoms in patients with otherwise previously undiagnosed cancer. In up to 15% of patients with BMs, the primary tumour cannot be identified. These cases are known as BM of cancer of unknown primary (CUP) (BM-CUP). CUP has an early and aggressive metastatic spread, poor response to chemotherapy, and poor prognosis. The pathogenesis of CUP seems to be characterized by a specific underlying pro-metastatic signature. The understanding of BM-CUP, despite its relative frequency and unfavourable outcome, is still incomplete and clear indications on management are missing. Advances in diagnostic tools, molecular characterization, and target therapy have shifted the paradigm in the approach to metastasis from CUP: while earlier studies stressed the importance of finding the primary tumour and deciding on treatment based on the primary diagnosis, most recent studies focus on the importance of identifying targetable molecular markers in the metastasis itself. The aim of this review is to summarize current evidence on BM-CUP, from the diagnosis and pathogenesis to the treatment, with a focus on available studies and ongoing clinical trials.
Collapse
|
2
|
Guo L, Wang G, Feng Y, Yu T, Guo Y, Bai X, Ye Z. Diffusion and perfusion weighted magnetic resonance imaging for tumor volume definition in radiotherapy of brain tumors. Radiat Oncol 2016; 11:123. [PMID: 27655356 PMCID: PMC5031292 DOI: 10.1186/s13014-016-0702-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 09/13/2016] [Indexed: 12/12/2022] Open
Abstract
Accurate target volume delineation is crucial for the radiotherapy of tumors. Diffusion and perfusion magnetic resonance imaging (MRI) can provide functional information about brain tumors, and they are able to detect tumor volume and physiological changes beyond the lesions shown on conventional MRI. This review examines recent studies that utilized diffusion and perfusion MRI for tumor volume definition in radiotherapy of brain tumors, and it presents the opportunities and challenges in the integration of multimodal functional MRI into clinical practice. The results indicate that specialized and robust post-processing algorithms and tools are needed for the precise alignment of targets on the images, and comprehensive validations with more clinical data are important for the improvement of the correlation between histopathologic results and MRI parameter images.
Collapse
Affiliation(s)
- Lu Guo
- Department of Biomedical Engineering, Tianjin University, Tianjin, 300072, China
| | - Gang Wang
- Department of Biomedical Engineering, Tianjin University, Tianjin, 300072, China
| | - Yuanming Feng
- Department of Biomedical Engineering, Tianjin University, Tianjin, 300072, China. .,Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China. .,Department of Radiation Oncology, East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA.
| | - Tonggang Yu
- Department of Radiology, Huashan hospital, Fudan University, Shanghai, 200040, China
| | - Yu Guo
- Department of Biomedical Engineering, Tianjin University, Tianjin, 300072, China
| | - Xu Bai
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China
| |
Collapse
|
3
|
Salvatore B, Caprio M, Fonti R, D’Amico D, Fraioli F, Salvatore M, Pace L. Is 2-deoxy-2-[(18)F]fluoro-D-glucose PET/CT acquisition from the upper thigh to the vertex of skull useful in oncological patients? Transl Med UniSa 2014; 11:34-8. [PMID: 25674547 PMCID: PMC4309653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM To assess whether performing routinely 2-deoxy-2-[(18)F]fluoro-D-glucose PET/CT ((18)FDG PET/CT) scan from the upper thigh to the vertex of skull is clinically relevant. MATERIALS AND METHODS 3502 (1634 female; mean-age 60+16) consecutive patients undergoing (18)FDG PET/CT were retrospectively analyzed. Patients were divided in 10 groups according to primary malignancy. Chi-square analysis was used to assess differences among proportions. A p value < 0.05 was considered significant. RESULTS (18)FDG PET/CT was positive in head district in 130/3502 (3,7%) patients. In all patients lesions were unknown before PET/CT examination. PET/CT showed 158 positive brain/head uptake in the 130 patients. The 158 lesions were localized in: brain (43/158; 27%), bone (52/158; 33%), lymph node (1/158; 0,6%), soft tissue (55/158; 35%) and other sites (7/158; 4,4%). According to each group, patients were positive in the head district in 1.0% for Gastrointestinal Cancer (7/690), 3.0 % for Genitourinary Cancer (3/101), 3.7 % for Haemathologic Cancer (59/1590), 2.7 % for Gynaecologic Cancer (3/112), 7.8% for Head-Neck-Thyroid and Parathyroid Cancer (26/331), 3.5% for Breast Cancer (7/200), 2.6% for Lung Cancer (7/271), 3.4% for Melanoma (2/59), 7.4% for Sarcoma (2/27), 11.6% for Unknown Primary Tumour (14/121). CONCLUSION Our data show a relatively high incidence of brain/head lesion in patients with Unknown Primary Tumour.
Collapse
Affiliation(s)
- B. Salvatore
- Consiglio Nazionale delle Ricerche–Istituto di Biostrutture e Bioimmagini, Napoli, Italy
| | - M.G. Caprio
- Dipartimento ad attività integrate di Diagnostica Morfologica e Funzionale, Radioterapia, Medicina Legale. Università degli Studi di Napoli Federico II, Italy
| | - R. Fonti
- Consiglio Nazionale delle Ricerche–Istituto di Biostrutture e Bioimmagini, Napoli, Italy
| | | | - F. Fraioli
- Dipartimento ad attività integrate di Diagnostica Morfologica e Funzionale, Radioterapia, Medicina Legale. Università degli Studi di Napoli Federico II, Italy
| | - M. Salvatore
- Dipartimento ad attività integrate di Diagnostica Morfologica e Funzionale, Radioterapia, Medicina Legale. Università degli Studi di Napoli Federico II, Italy,Corresponding author:
| | - L. Pace
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Salerno, Italy
| |
Collapse
|
4
|
Abdelmalik AG, Alenezi S, Muzaffar R, Osman MM. The Incremental Added Value of Including the Head in (18)F-FDG PET/CT Imaging for Cancer Patients. Front Oncol 2013; 3:71. [PMID: 23577325 PMCID: PMC3616260 DOI: 10.3389/fonc.2013.00071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 03/18/2013] [Indexed: 11/17/2022] Open
Abstract
Purpose: To assess the value of extending the routinely used base-of-skull (BOS) to upper-thigh field of view (FOV) to include the head on 18F-FDG PET/CT in cancer patients. Methods: We retrospectively reviewed 1000 consecutive top-of-head to foot PET/CT studies. Abnormalities above BOS were categorized as unsuspected or known and were correlated with pathology, MRI/CT, and clinical follow-up. Results: Of the 1000 patients, 102 (10.2%) had potentially significant findings above BOS. Of these, 70/102 (69%) were known and 32/102 (31%) were unsuspected. Of the patients with unsuspected findings, follow-up data was unavailable in 7/32 (22%) and abnormalities were confirmed in 25/32 (78%). Of the 25 confirmed unsuspected findings, 4/25 (16%) were false positives and 21/25 (84%) were true positives. Of these, 13/21 (62%) were confirmed metastatic, and 8/21 (38%) were benign. Unsuspected finding of brain metastasis changed the management in 11/13 (85%) and staging in 4/13 (31%). Conclusion: Including the head in PET/CT FOV incidentally detected clinically significant findings in 2.1% (21/1000) of patients. The detection of previously unsuspected metastasis had significant impact on patient management and provided more accurate staging.
Collapse
Affiliation(s)
- Amir G Abdelmalik
- Division of Nuclear Medicine, Department of Radiology, Saint Louis University Saint Louis, MO, USA
| | | | | | | |
Collapse
|
5
|
Focal cerebral hypermetabolism due to nonconvulsive status epilepticus mimicking metastasis in staging a patient with lung cancer by FDG PET/CT. Clin Nucl Med 2011; 36:394-6. [PMID: 21467865 DOI: 10.1097/rlu.0b013e31820ade69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
6
|
McCarthy M, Yuan JB, Campbell A, Lenzo NP, Butler-Henderson K. 18F-fluorodeoxyglucose positron emission tomography imaging in brain tumours: the Western Australia positron emission tomography/cyclotron service experience. J Med Imaging Radiat Oncol 2009; 52:564-9. [PMID: 19178630 DOI: 10.1111/j.1440-1673.2008.02019.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
(18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) scans in the first 49 patients referred with either possible brain tumour or brain tumour recurrence were reviewed. FDG-PET imaging was reported with reference to anatomical imaging. Based on the report the FDG study was classified as either positive or negative for the presence of tumour. Thirty-eight cases were included in the analysis, 21 having pathological data and 17 with diagnostic clinical follow up. Eleven were excluded, as they had inadequate follow-up data. Of the 21 cases with pathology, 18 were shown to have tumour. In this group there were five false-negative scans and two false-positive PET scans. Seventeen cases were assessed by clinical follow up, nine were considered to have been tumour. There were two false negatives with one false positive. The overall sensitivity, specificity and positive and negative predictive values were 74, 73, 87 and 53% respectively. This is similar to figures previously quoted in published work. Despite relatively limited numbers, the utility of FDG PET imaging in our hands is similar to published reports. With a positive predictive value of 87%, a positive FDG study indicates a high likelihood that there is brain tumour present. A negative study does not exclude the presence of tumour.
Collapse
Affiliation(s)
- M McCarthy
- Department of Nuclear Medicine, Division of Medical Imaging, Royal Perth Hospital, Perth, Australia.
| | | | | | | | | |
Collapse
|
7
|
Garin E, Lesimple T. Intérêt de la tomographie d’émission de positons au 18F-fluorodésoxyglucose (TEP-FDG) dans la prise en charge des syndromes CAPI. ONCOLOGIE 2008. [DOI: 10.1007/s10269-008-0988-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
8
|
|
9
|
The Relevance of PET in Diagnostic Oncology. Clin Nucl Med 2008. [DOI: 10.1007/978-3-540-28026-2_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Garin E, Prigent-Lejeune F, Lesimple T, Barge ML, Rousseau C, Devillers A, Bouriel C, Habiba MT, Bernard AM, Bridji B, Resche I. Impact of PET-FDG in the diagnosis and therapeutic care of patients presenting with metastases of unknown primary. Cancer Invest 2007; 25:232-9. [PMID: 17612933 DOI: 10.1080/07357900701206331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We carried out a study to evaluate the contribution of positron emission tomography with (18)F-fluorodeoxyglucose (PET-FDG) in the diagnosis and therapeutic care of patients presenting with metastases of unknown primary. PET-FDG was prospectively performed in 51 patients. The PET-FDG data were confirmed histologically or by a follow-up on average at 13 months. PET-FDG identified the primary in 24 percent of cases, and detected the presence of additional metastases in 41 percent of cases. PET-FDG led to a therapeutic modification for 12 patients (24 percent). Furthermore, the therapeutic impact seems more marked in localized forms than in the multifocal. This broad exploratory study confirms the important role of PET-FDG in the diagnosis and therapeutic management of patients with metastases of unknown primary.
Collapse
Affiliation(s)
- Etienne Garin
- UPRES EA 3890/Department of Medical Imagery, Centre Eugène Marquis, Rennes, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Fencl P, Belohlavek O, Skopalova M, Jaruskova M, Kantorova I, Simonova K. Prognostic and diagnostic accuracy of [18F]FDG-PET/CT in 190 patients with carcinoma of unknown primary. Eur J Nucl Med Mol Imaging 2007; 34:1783-92. [PMID: 17541584 DOI: 10.1007/s00259-007-0456-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Accepted: 03/13/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the study was to determine the accuracy of [(18)F]fluorodeoxyglucose (FDG) PET/CT in the search for the primary and the presence of a malignancy. The prognostic value of FDG-PET/CT information was tested. METHODS A total of 190 patients were retrospectively analysed: 82 with histologically proven metastases (HPM) and 108 with clinical suspicion of the presence of a malignancy (CSM). The sensitivity and specificity were determined. Overall survival was calculated to evaluate the prognostic value of the FDG-PET/CT findings. RESULTS In the search for the primary, the sensitivity and specificity were 62.0% and 81.9%, respectively. In the search for the presence of a malignancy, the sensitivity and specificity were 93.6% and 85.7%, respectively. Between the HPM and CSM groups, no significant difference in sensitivity and specificity was found either in the search for the primary or in the search for the presence of a malignancy. No significant difference in the sensitivity and specificity was found between 78 patients who were investigated by contrast-enhanced FDG-PET/CT and the remaining patients. A significantly shorter overall survival was found among patients with positive FDG-PET/CT findings compared with patients with negative findings (p = 0.00001); no significant difference in survival was found between the HPM and the CSM group (p = 0.770). CONCLUSION FDG-PET/CT imaging is very helpful in the search for the presence of a malignancy in patients with carcinoma of unknown primary syndrome. FDG-PET/CT is less accurate in identifying exactly the site of a primary. Discovery of a hypermetabolic lesion was associated with the worst survival rate.
Collapse
Affiliation(s)
- Pavel Fencl
- PET Center, Na Homolce Hospital, Roentgenova 2, 150 30 Prague 5, Czech Republic.
| | | | | | | | | | | |
Collapse
|
12
|
Sève P, Billotey C, Broussolle C, Dumontet C, Mackey JR. The role of 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography in disseminated carcinoma of unknown primary site. Cancer 2007; 109:292-9. [PMID: 17167760 DOI: 10.1002/cncr.22410] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The authors conducted a comprehensive review of the efficacy of 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography (FDG-PET) in the detection of primary tumors in patients with disseminated carcinoma of unknown primary site. METHODS Ten studies (involving a total of 221 patients) tat were published between 1998 and 2006 were reviewed. Each study evaluated the role of FDG-PET in the detection of unknown primary tumors after a conventional diagnostic workup. Although 94% of patients had a single site of metastases, the studies otherwise were very heterogeneous in the studied population, study design, and additional diagnostic workup. RESULTS In 41% of patients, FDG-PET detected primary tumors that were not apparent after conventional workup. In this group of patients, the overall sensitivity, specificity, and accuracy rates of FDG-PET in detecting unknown primary tumors were 91.9%, 81.9%, and 80.5%, respectively. FDG-PET imaging also led to the detection of previously unrecognized metastases in 37% of patients. Lung cancers represented 59% of the detected tumors. FDG-PET had a notably high false-positive rate (58.3%) in tumors of the lower digestive tract. FDG-PET altered the clinical management in 34.7% of patients. Most of those patients (53%) received specific chemotherapy for lung and pancreatic cancers; whereas 12% received specific therapy for breast, ovarian, and prostate cancers; and 14% underwent surgery with curative intent. CONCLUSIONS FDG-PET was an efficient method for detecting primary tumors that were undetected by other modalities and was sensitive for the detection of previously unrecognized metastases. FDG-PET significantly changed clinical management in approximately one-third of the patients studied.
Collapse
Affiliation(s)
- Pascal Sève
- Department of Internal Medicine, Hôtel Dieu, Hospices Civils de Lyon, Lyon, France.
| | | | | | | | | |
Collapse
|
13
|
Abstract
One of the most pertinent applications of the principle primum non nocere (first do no harm) is in the optimization of neurosurgical procedures for patients with resectable lesions. The gold standard for identifying eloquent areas of the brain to be avoided in resections is direct cortical stimulation and somatosensory evoked potential monitoring, which is itself an invasive, cumbersome and difficult technique for mapping these areas. Functional magnetic resonance imaging shows great promise as a viable noninvasive alternative to invasive mapping as well as significant current clinical utility in cases in which it cannot yet fully supplant cortical stimulation methods. Ongoing work is directed toward overcoming technical limitations, improved mapping of complex functions such as language and memory, and mapping of white matter tracts.
Collapse
Affiliation(s)
- Paul E Kim
- Department of Neuroradiology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
| | | |
Collapse
|
14
|
Blake P, Johnson B, VanMeter JW. Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT): Clinical Applications. J Neuroophthalmol 2003; 23:34-41. [PMID: 12616088 DOI: 10.1097/00041327-200303000-00009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Positron emission tomography and single-photon emission computed tomography are nuclear imaging modalities that excel in depicting the biological function of tissue. Unlike structural imaging methods, they provide functional diagnostic information about brain neoplasms, stroke, neurodegenerative disorders, epilepsy, cortical visual loss, and migraine.
Collapse
Affiliation(s)
- Pamela Blake
- Department of Neurology, Center for the Study of Learning, Georgetown University Medical Center, Washington, USA.
| | | | | |
Collapse
|
15
|
Klee B, Law I, Højgaard L, Kosteljanetz M. Detection of unknown primary tumours in patients with cerebral metastases using whole-body 18F-flouorodeoxyglucose positron emission tomography. Eur J Neurol 2002; 9:657-62. [PMID: 12453082 DOI: 10.1046/j.1468-1331.2002.00467.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Identification of the unknown primary tumours in patients presenting with cerebral metastasis is a continued diagnostic challenge. Despite extensive and lengthy diagnostic work-up, the primary tumours will remain obscure in a significant proportion of the patients. The aim of this study was to evaluate the use of whole-body 18-F-fluorodeoxyglucose positron emission tomography (18FDG PET) scanning in this pursuit. Sixteen patients aged 34-74 years, with histologically confirmed metastatic brain tumours, were included in the study. Whole-body 18FDG PET identified pulmonary foci of probable primary tumours in all patients. Subsequent confirmation of tumour tissue was determined either by direct histological verification or indirectly by the observation of lesion appearance or lesion growth on structural imaging. This could only be obtained in eight of 16 patients, all defined as true positive. Of the remaining eight, a biopsy could not be sampled from seven patients, because of death or limited follow-up investigations, and one patient had pulmonary malignant melanoma metastases. Whole-body 18FDG PET scanning is a sensitive tool in the search for unknown primary tumours of patients with confirmed cerebral metastases allowing early and focused histological confirmation from suspicious lesions.
Collapse
Affiliation(s)
- B Klee
- PET and Cyclotron Unit, Department of Clinical Physiology and Nuclear Medicine, The National University Hospital, Tigshospitalet, Denmark
| | | | | | | |
Collapse
|
16
|
Sabbah P, Foehrenbach H, Dutertre G, Nioche C, DeDreuille O, Bellegou N, Mangin JF, Leveque C, Faillot T, Gaillard JF, Desgeorges M, Cordoliani YS. Multimodal anatomic, functional, and metabolic brain imaging for tumor resection. Clin Imaging 2002; 26:6-12. [PMID: 11814745 DOI: 10.1016/s0899-7071(01)00313-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Improvement of neurosurgical techniques with a more detailed description of brain tumors and their functional environment. METHODS We performed: (1) anatomical magnetic resonance imaging (MRI) for reference, (2) functional sequences dedicated to the adjacent cortical structures (sensorimotor, visual, language paradigms), and (3) thallium 201 cerebral tomoscintigraphy to visualize active tumor invasion. Data were transferred to a workstation for automatic registration. RESULTS All data were combined into one synthetic image showing the foci of high proliferative activity, which have to be completely resected, and the peritumoral functional structures, which have to be spared in order to minimize postoperative sequelae. This trimodal image is entered into a surgical neuronavigation computer for preoperative planning in order to outline tumoral target and functional risk areas. All this information is displayed in the operative microscope (Zeiss MKM) optically linked to MR images. This multimodality technique diminishes operative time by reducing electrocorticography and improves the operative short-term outcome. CONCLUSION Multimodal imaging is useful for optimization of neurosurgical tumor resection.
Collapse
Affiliation(s)
- P Sabbah
- Radiology, Hôpital du Val de Grâce, 74 Bd Port Royal, 75230 Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Braun V, Dempf S, Tomczak R, Wunderlich A, Weller R, Richter HP. Multimodal cranial neuronavigation: direct integration of functional magnetic resonance imaging and positron emission tomography data: technical note. Neurosurgery 2001; 48:1178-81; discussion 1181-2. [PMID: 11334290 DOI: 10.1097/00006123-200105000-00050] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This is the first report of the direct integration of functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) data into cranial neuronavigation. METHODS In a patient with a left precentral oligodendroglioma (World Health Organization Grade III), the Zeiss MKM system (Carl Zeiss Co., Oberkochen, Germany) was used for navigation based on thin-slice, T1-weighted, contrast-enhanced magnetic resonance imaging (MRI) scans. fMRI and methionine PET data were integrated by landmark matching, with reference to skin fiducials. RESULTS The inaccuracy of the image fusion between fMRI and T1-weighted MRI data was 1.7 mm, that between PET and T1-weighted MRI data was 4.3 mm, and that for the subsequent registration of the navigation was 1.2 mm. The correct fMRI localization of the precentral gyrus was intraoperatively verified by cortical somatosensory evoked potential (phase-reversal) monitoring. Although the tumor was not clearly defined in the MRI scans, [11C]methionine PET demonstrated a clear tumor border, enabling us to achieve gross total tumor removal without postoperative functional deficits. CONCLUSION Functional neuronavigation permits observation and preservation of relevant brain areas. Other functional areas (such as short-term memory areas) that can be detected only by fMRI might also warrant future monitoring. The simultaneous integration of fMRI and PET data adds a new dimension to cranial neuronavigation, enabling the observation of tumors in relation to functional cortical areas (in our case, the motor strip).
Collapse
Affiliation(s)
- V Braun
- Department of Neurosurgery, University of Ulm, Günzburg, Germany.
| | | | | | | | | | | |
Collapse
|
18
|
Braun V, Dempf S, Tomczak R, Wunderlich A, Weller R, Richter HP. Multimodal Cranial Neuronavigation: Direct Integration of Functional Magnetic Resonance Imaging and Positron Emission Tomography Data: Technical Note. Neurosurgery 2001. [DOI: 10.1227/00006123-200105000-00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|