Stereotactic Comparison among Cerebral Blood Volume, Methionine Uptake, and Histopathology in Brain Glioma
N. Sadeghia,
I. Salmonb,
C. Decaesteckere,
M. Levivierc,
T. Metensa,
D. Wiklerc,d,
V. Denolina,
S. Roriveb,
N. Massagerc,
D. Baleriauxa and
S. Goldmand
a Department of Radiology, Hôpital Erasme, Brussels, Belgium
b Department of Pathology, Hôpital Erasme, Brussels, Belgium
c Department of Neurosurgery, Hôpital Erasme, Brussels, Belgium
d PET/Biomedical Cyclotron Unit, Hôpital Erasme, Brussels, Belgium
e Laboratory of Toxicology, Université Libre de Bruxelles, Boulevard du Triomphe, Brussels, Belgium
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Fig 1. Image processing in the case of a 67-year-old woman with left parietal mass lesion corresponding to a low-grade astrocytoma (patient 7).
A, One of the 3 biopsy trajectories (trajectory 2) is projected into 3DT1-weighted image (TE, 20 ms; TR, 4.6 ms; flip angle, 25°; section thickness, 1.3 mm) with contrast. Note that the lesion is not enhancing.
B–D, On coregistered FLAIR images (TR, 6500 ms; TE, 150 ms; TI, 2200 ms), the lesion is better defined as an area of high signal intensity. Biopsy trajectory 2 is shown, and the point at which the red lines cross shows the area of biopsy at the target (B) and the 2 other samples at 1 (C) and 2 (D) cm from the target.
E-F, The position of the 3 biopsy areas at the target (0) as well as at 1 cm from the target (–10) and at 2 cm from the target (–20) are shown on both the coregistered CBV map (E) and the PET-MET image (F).
G–I, Photomicrographs (H&E coloration; original magnification, 400x) show the corresponding histologic characteristics of each biopsy specimen. The biopsy specimen from the target (0) corresponded to "bulk tumor" (G) where vessels with endothelial cell proliferation can be identified (arrows). The biopsy specimen from point (–10) corresponded to "infiltrated tissue" (H) where 1 mitosis (small arrow) and 1 vessel without endothelial cell proliferation (large arrow) are identified. The biopsy specimen from point (–20) corresponded to "peritumoral tissue" (I), where no tumor cell could be identified and vessels show a normal shape (arrow).
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Fig 2. A, Scatterplot shows significant positive correlation between CBV ratios and MET uptake ratios (r = 0.65, P < .001). Measurements corresponding to "peritumoral tissue," "infiltrated tissue," and "bulk tumor" can also be identified.
B, Graph shows the relation between both CBV and MET uptake ratios and the histologic categorization of samples as "peritumoral tissue" (n = 10), "infiltrated tissue" (n = 32), and "bulk tumor" (n = 23). Median values increase significantly from "peritumoral tissue" to "bulk tumor" for both CBV and MET uptake ratios. The difference was also statistically significant between "infiltrated tissue" and "bulk tumor" for MET uptake ratios. Values are presented as minimum-maximum range (whiskers), 25th–75th percentile range (box), and median (open symbols). *, P = .01; ***, P < .001.
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Fig 3. Graphs show the distribution of CBV ratios (A) and MET uptake ratios (B), respectively, in those patients with low-grade (patients 1–8) and or high-grade gliomas (patients 9–14). All samples are presented with different symbols depending on their category ( , "peritumoral tissue";  , "infiltrated tissue";  , "bulk tumor"), and different colors depending on their score on the semiquantitative scale of malignancy (blue = 1, green = 2, yellow = 3, orange = 4, red = 5; see text for details).
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Fig 4. A, Graph shows the relation between both CBV and MET uptake ratios and the endothelial cell proliferation. The median values for both CBV and MET uptake ratios were statistically significantly higher in those areas with presence of endothelial cell proliferation (n = 18) compared with the areas without endothelial cell proliferation (n = 47).
B, Graph shows the relation between both CBV and MET uptake ratios and mitotic activity. The median values for both CBV and MET uptake ratios were statistically significantly higher in those areas with presence of mitosis (n = 39) compared with the areas without mitosis (n = 26). Values are presented as minimum-maximum range (whiskers), 25th–75th percentile range (box), and median (open symbols). **, P = .01; ***, P < .001.
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