Role of post-therapy 99mTc-MIBI single-photon emission computed tomography/computed tomography scan in predicting survival in patients with high-grade glioma

Abstract

Objective High-grade gliomas (HGGs) carry dismal prognosis with survival typically reported as less than a year. We explored the predictive value of qualitative and quantitative evaluations of post-treatment 99m-technetium-labelled methoxyisobutylisonitrile (99mmTc-MIBI) brain single-photon emission computed tomography-computed tomography (SPECT/CT) tumor uptake in relation to overall survival (OS) in patients with HGG. Methods Thirty patients with pathologically or radiologically documented high-grade glioma (HGG) were prospectively recruited for this study (24 male, 6 female; mean age 43\u2009±\u200914\u2009years). All patients had a clinical or radiological suspicion of residual/recurrent tumor after initial therapy. 99mTc-MIBI brain SPECT/CT scanning was performed, and the scans were evaluated qualitatively on a five-point probability score (1–5, scores ≥3 considered positive for residual/recurrent tumor); and quantitively via drawing volumes of interest (VOI) on the suspected lesions and normal contralateral brain tissue. All patients were followed up for 1\u2009year or till death. Results Positive visual MIBI results were associated with poor survival. Among 10 patients with negative MIBI scores, only two patients died (OS\u2009=\u200975%), while 11/20 patients reported positive on MIBI died, with a median survival of 9\u2009months (OS\u2009=\u200914.5%; P\u2009=\u20090.03). All patients with active isocontour volume ≤1.96\u2009cm3 were alive at the end of the study, compared to a median survival of 9\u2009months and OS of 12% for patients with an isocontour volume of >1.97% (P\u2009=\u20090.003). Conclusion In patients with HGG, post-therapy brain SPECT/CT with 99mTc-MIBI can provide useful prognostic information.