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Intraoperative tissue fluorescence using 5-aminolevolinic acid (5-ALA) is more sensitive than contrast MRI or amino acid positron emission tomography ((18)F-FET PET) in glioblastoma surgery.


Posted on: 04/06/2012

Neurol Res. 2012 Mar 1. [Epub ahead of print]

Intraoperative tissue fluorescence using 5-aminolevolinic acid (5-ALA) is more sensitive than contrast MRI or amino acid positron emission tomography ((18)F-FET PET) in glioblastoma surgery.

Roessler K, Becherer A, Donat M, Cejna M, Zachenhofer I.
Abstract
OBJECTIVE:
The sensitivity of 5-aminolevolinic acid (5-ALA) in detecting intraoperative glioblastoma (GBM) tissue compared to postoperative (18)F-fluoroethyl-L-tyrosine and T1 contrast uptake of tumor cells in positron emission tomography (PET) and magnetic resonance imaging (MRI) scans was investigated in a retrospective image correlative study.
METHODS:
Ten patients with histological verified GBM in eloquent brain regions underwent 11 surgeries with neuronavigation and 5-ALA assisted tumor resection. Residual 5-ALA fluorescence was labeled intraoperatively on the navigation MRI scans and images were fused with postoperative (18)F-FET PET and T1 contrast MRI.
RESULTS:
Intraoperatively, at the end of save resection, in all patients 2?5 faint 5-ALA positive resection planes were detected (mean 3.6), compared to 0?4 (18)F-FET positive resection planes (mean 1.4) and 0?2 positive T1 contrast MRI resection planes in postoperative scans. The difference between the number of 5- ALA and (18)F-FET positive resection planes was statistically significant (P=0.0002). The histological investigation of 5-ALA positive resection margins demonstrated infiltrative tumor in every case. Residual 5- ALA fluorescence on resection margins and postoperative (18)F-FET uptake areas or residual contrast T1 areas were colocalized in all cases, documented by pre-/postoperative image fusion.
CONCLUSION:
Residual faint 5ALA uptake is documented in large areas at the end of GBM resection and corresponds to tumor infiltration. These 5-ALA positive resection plans exceeded the (18)F-FET uptake areas in postoperative PET scans. Thus, intraoperative 5-ALA residual fluorescence seems to be a more sensitive marker than (18)F-FET PET for residual tumor in malignant gliomas.
PMID: 22449387 [PubMed - as supplied by publisher]

 

 


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