Sequential scintigraphic strategy for the differentiation of brain tumours

Both thallium-201 and iodine-123 alpha-methyltyrosine (I-123-IMT) have been shown to be useful in the diagnostic evaluation of brain rumours. The aim of this study was to investigate the respective contributions of Tl-201 and I-123-IMT single-photon emission tomography (SPET) in the non-invasive evaluation of intracerebral rumours, We analysed 65 patients with the following brain rumours: 8 non-neoplastic lesions, 4 meningiomas, 12 low-grade gliomas, 28 high-grade gliomas, 11 metastases and 2 high-grade lymphomas. Tl-201 SPET and I-123-IMT SPET were performed [start of Tl-201 SPET: 15 min p.i. (early) and 180 min p.i. (delayed); start of I-123-IMT SPET: 15 min p.i.]. The intensity of uptake was quantified as the ratio between tracer accumulation in the tumour and in the contralateral hemisphere. None of the non-neoplastic lesions or low-grade gliomas expressed mal ked Tl-201 uptake. All malignant tumours except one small metastasis and all meningiomas except one small, cystic and degenerated lesion showed significant Tl-201 accumulation [Tl(15')>2.0]; I-123-IMT uptake was either absent or intermediate in non-malignant lesions except in two low-grade gliomas; the highest levels were observed in high-grade gliomas followed by metastases and lymphomas (mean IMT: 2.7 vs 2.1 vs 1.8), with metastases showing a high variability in I-123-IMT uptake (range: 0.8-3.6), Using Tl-201 to distinguish non-neoplastic lesions from malignant tumours and meningiomas, 63 of 65 patients were characterised correctly. In the latter group, high-grade gliomas were correctly identified in 37 of 28 cases by their amino acid uptake, It is concluded that the combination of Tl-201 and I-123-IMT surpasses the accuracy of each single test in the differentiation of space-occupying lesions of the brain. Based on these preliminary results, a sequential strategy is proposed involving an initial Tl-201 SPET study and an additional I-123-IMT SPET study in the event of positive Tl-201 up take.