Clinical impact of integrating positron emission tomography during surgery in 85 children with brain tumors

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>In this paper, the authors' goal was to evaluate the impact of PET information on brain tumor surgery in children.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Between 1995 and 2007, 442 children were referred to the authors' institution for a newly diagnosed brain lesion. Of these, 85 were studied with FDG-PET and/or L-(methyl-<jats:sup>11</jats:sup>C)-methionine –PET in cases in which MR images were unable to assist in selecting accurate biopsy targets (35 patients) or to delineate tumors for maximal resection (50 patients). In surgical cases, PET and MR images were combined in image fusion planning for stereotactic biopsies or navigation-based resections. The preoperative planning images were compared postoperatively with MR imaging and PET findings and histological data for evaluating the clinical impact on the diagnostic yield and tumor resection.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The PET data influenced surgical decisions or procedures in all cases. The use of PET helped to better differentiate indolent from active components in complex lesions (in 12 patients); improved target selection and diagnostic yield of stereotactic biopsies without increasing the sampling; provided additional prognostic information; reduced the amount of tissue needed for biopsy sampling in brainstem lesions (in 20 cases); better delineated lesions that were poorly delineated on MR imaging and that infiltrated functional cortex (in 50 cases); significantly increased the amount of tumor tissue removed in cases in which total resection influenced survival (in 20 cases); guided resection in hypermetabolic areas (in 15 cases); improved early postoperative detection of residual tumor (in 20 cases); avoided unnecessary reoperation (in 5 cases); and supported the decision to undertake early second-look resection (in 8 cases).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The authors found that PET has a significant impact on the surgical decisions and procedures for managing pediatric brain tumors. Further studies may demonstrate whether PET improves outcomes in children.</jats:p></jats:sec>

Impact of 3,4-Dihydroxy-6-18F-Fluoro-l-Phenylalanine PET/CT on Managing Patients with Brain Tumors: The Referring Physician's Perspective

“…The latter was explained by false-negative scan findings. Another study in 85 pediatric patients revealed a significant impact of 18 F-FDG or 11 C-methionine PET on surgical decisions in all patients (39). Our study differs from these reports in that it was prospective, used 18 F-DOPA as a probe of amino acid transport, and determined whether intended management changes were in fact implemented.…”

Value of 18F-3,4-Dihydroxyphenylalanine PET/MR Image Fusion in Pediatric Supratentorial Infiltrative Astrocytomas: A Prospective Pilot Study

“…Prior research demonstrates that 18 F-FDG and 11 C-MET improve the quality of therapeutic management of pediatric brain tumors at the diagnostic, surgical, and postoperative level, particularly in ill-defined infiltrative tumors. 18 F-FDG presents some limitations in defining targets for biopsy in low-grade pediatric tumors, whereas 11 C-MET appears also to be a better tracer than 18 F-FDG for delineating tumor boundaries and for residual tumor detection (25,26). Other studies found a correlation between 18 F-FDG uptake and tumor malignancy; however, there was significant overlap between different grades of malignancy (27,28).…”

Cost-Effectiveness Analysis of Amino Acid PET–Guided Surgery for Supratentorial High-Grade Gliomas

“…However, studies have demonstrated a high sensitivity and specificity of 90% for 11 C-methionine PET to detect tumor tissue and a better ability to detect tumor tissue than other diagnostic means such as CT or MRI (12). Additionally, in a recent study on gliomas in children, postoperative 11 C-methionine PET presented as neither falsepositive nor false-negative and was significantly better than MRI (P , 0.05) (41).…”