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Noninvasive Grading of Untreated Gliomas: A Comparative Study of MR Imaging and 3-(Iodine 123)-L--methyltyrosine SPECT¹

¹ From the Departments of Nuclear Medicine (B.R., M.W., P.M., O.S.), Clinical Radiology (K.P., W.H.), and Neurosurgery (N.H., H.W.), University of Münster, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany; and Department of Nuclear Medicine, University of Erlangen-Nürnberg, Germany (T.K.). Received August 27, 2001; revision requested October 17; final revision received April 8, 2002; accepted April 26. Address correspondence to B.R. (e-mail: riemanb@uni-muenster.de).

PURPOSE: To compare the accuracy of magnetic resonance (MR) imaging scores with that of 3-(iodine 123)-L--methyltyrosine (¹²³I-IMT) single photon emission computed tomography (SPECT) in the noninvasive grading of untreated gliomas.

MATERIALS AND METHODS: The study comprised 15 patients with low-grade gliomas (grades I-II, according to World Health Organization criteria) and 33 patients with high-grade gliomas (grades III-IV). The lesions were evaluated by using an MR imaging score based on nine criteria. The ¹²³I-IMT uptake was quantified as the ratio between the amino acid uptake in the tumor and that in the contralateral hemisphere. To test for potentially significant differences in diagnostic performance between contrast material–enhanced MR imaging and ¹²³I-IMT SPECT, binormal receiver operating characteristic curves were fitted to the data and compared by using the area test.

RESULTS: The accuracy of MR imaging in the noninvasive grading of untreated gliomas was higher than that of ¹²³I-IMT SPECT (88% vs 79%). However, the difference in diagnostic performance was not significant on the basis of findings at receiver operating characteristic analysis (P > .2). Neither MR imaging nor ¹²³I-IMT SPECT allowed differentiation between high-grade gliomas (grades III and IV).

CONCLUSION: Although ¹²³I-IMT uptake is significantly higher in high-grade gliomas than in low-grade gliomas, the performance of ¹²³I-IMT SPECT adds little to the accuracy of determining tumor grade when MR imaging is performed.

© RSNA, 2002

Index terms: Brain neoplasms, 10.363 • Brain neoplasms, MR, 10.12143, 10.12146 • Brain neoplasms, radionuclide studies, 10.12162 • Brain neoplasms, SPECT, 10.12162

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