| Stereotactic Biopsy with Multiple Modalities for the Better Therapeutic Approach in the Glioma |
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Gang-Hyuk Park, Tae-Kyu Lee, Jong-Hyun Kim, Sang-Bok Lee, Do-Sung Yoo, Pil-Woo Huh, Kung-Souk Cho |
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Department of Neurosurgery, Uijeongbu St Mary's Hospital, The Catholic University of Korea, College of Medicine, Uijeongbu, Korea |
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| Abstract |
Purpose
The exact histopathologic diagnosis is needed in order for the proper treatment of a brain tumor. Stereotactic biopsy
should be done as the part of the descriptive characteristics of a brain tumor. This study offers the efficacy of stereotactic biopsy
utilizing multiple imaging modalities in patients with glioma.
Methods
and Materials: In this study, 25 patients with glioma were performed the frameless stereotactic biopsy with FDG PET
and 1H-MRS since March 2010, The age distribution was from 44 to 74 years old (average age 59). 14 were male and 11 were female. FDG uptake in PET and value of Cho, Cr and NAA in 1
H-MRS was obtained before the biopsy and Ki-67 cell proliferation index was evaluated postoperatively from tissues by biopsy. Target for stereotactic biopsy was determined according to T1 MRI images and frameless navigation guided biopsy was performed. Histopathologic grade of glioma was decided according to WHO
grading system. In this study, quantitative data is expressed by Mean±S.D. and data. Analysis was done with unpaired t-test
and statistical significance was evaluated at p-value＜0.05.
Results
Tumor histopathologic diagnosis was classified grade I (3), grade II (5), grade III (8) and grade IV (9) according to the WHO
grade. The uptake of FDG in PET compared with MRI for diagnosis of tumor reached 92% in identifying the presence or absence
of the lesion. The higher value of Cho/Cr and Lac/Cr in 1
H-MRS was observed in higher grade tumors by WHO grade. Ki-67 index was statistically significantly increased in higher grade tumors. Sensitivity (77%) and specificity (100%) in FDG PET is higher
than 56% and 67% of the 1
H-MRS in WHO grade IV glioma.
Conclusion
In this study, we report preoperative FDG PET and 1
H-MRS prior to stereotactic biopsy is useful for the correct diagnosis and evaluation of malignant potential of the target lesion for selection of proper treatment. |
| Key Words:
Glioma, Stereotactic biopsy, PET, MRS. |
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