Diagnostic performance of 99mTc-MDM brain SPECT in Glioma:  A comparison with contrast enhanced MRI Imaging for diagnostic workup of primary/ residual/recurrent glioma  — ASN Events
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  3. Diagnostic performance of 99mTc-MDM brain SPECT in Glioma:  A comparison with contrast enhanced MRI Imaging for diagnostic workup of primary/ residual/recurrent glioma 

Diagnostic performance of 99mTc-MDM brain SPECT in Glioma:  A comparison with contrast enhanced MRI Imaging for diagnostic workup of primary/ residual/recurrent glioma  (#120)

Nisha Rani 1 , Baljinder Prof. Singh 1 , Narender Dr. Kumar 1 , Anil Kumar Dr. Mishra 2 , Paramjeet Prof. Singh 1
  1. Postgraduate Institute of Medical Education and research, Chandigarh, CHANDIGARH, India
  2. PET-Cyclotron Centre, Institute of Nuclear Medicine & Allied Sciences (INMAS), Defense Research Development Organization (DRDO),, Delhi, India

OBJECTIVES:   To evaluate the diagnostic utility of bis-methionine-DTPA (99mTc-MDM) and its comparative evaluation with contrast-enhanced magnetic resonance Imaging (ceMRI) for the detection of primary/recurrent/residual glioma.
METHODS: This prospective study included 55 patients (36M: 19F, mean age= 42.3 ±15.03yrs; range=8-72 yrs) having post-operative clinical suspicion of recurrent/residual glioma (35- Glioblastoma Multiforme-G-IV; 07-Astrocytoma/Oligodendroglioma-G-I/G-II; 09-Anaplastic Oligodendroglioma/Oligoastrocytoma-G-III; 04-Pilocytic astrocytoma-G-I) referred for 99mTc-MDM-SPECT and ceMRI at PGIMER, Chandigarh. 99mTc-MDM-SPECT and ceMRI was done in 41patients out of 53 after radical radiotherapy (RT) (54.0-60.0 Gy) with or without concurrent temozolomide and one patient was followed at 3-months. Twelve (14/53) patients underwent 99mTc-MDM-SPECT and ceMRI before RT and 2 before surgery and in which five patients underwent follow-up 99mTc-MDM-SPECT and ceMRI after 3-months post RT for RT response evaluation and one patient also underwent 99mTc-MIBI SPECT.
RESULTS: The mean radio labeling efficiency of 99mTc labeled MDM was reserved to be 96.7± 1.6 %( n=64). MDM SPECT and ceMRI finding were concordant in 50 scans (27 positive & 23 negative). The findings were discordant in the remaining 9 patients, with positive ceMRI & negative MDM-SPECT in 5- scans and negative ceMRI & positive MDM-SPECT in 4-scans respectively. We also observed that in one patient both 99mTc-MDM-SPECT and 99mTc-MIBI-SPECT was positive but ceMRI was negative for the evidence of recurrent/remnant disease. 99mTc-MDM-SPECT showed overall sensitivity, specificity, PPV, NPV and DA of 83.33% 85.19%, 86.21%, 82.14% & 84.2% respectively for the detection of recurrent/residual glioma.
CONCLUSION:  The diagnostic utility of 99mTc-MDM-SPECT imaging was comparable with that of ceMRI. The development of amino-acid based ‘SPECT’ radiotracers may offer an economical and reliable substitute to expensive PET/cyclotron technology. However, head to head comparison with gold standard 18F-FET-PET tracer and long-term follow-up will be useful for further validation of this SPECT tracer.