Quantification of SPECT with 99m Tc-technetryl and of contrast-enhanced MRI scans in survival prognosis of patients with glial brain tumors after combined chemo – radiation treatment

Purpose of study . The possibility of simultaneous and combined use of magnetic resonance imaging (MRI) with paramagnetic contrast enhancement (CE-MRI) and single-photon emission computed tomography (SPECT) with 99m Tc-MIBI in assessing the prognosis in patients with glial brain tumors after complex chemo – and radiotherapy treatment was studied. Material and methods . Contrast-enhanced MRI of the brain and SPECT with 99m Tc-Technetril were performed in 19 patients who were observed after complex chemoradiotherapy of brain tumors (gliomas of grade 3 and 4). The treatment included remote gamma irradiation and chemotherapy with temozolomide. The radiation dose was 60 Gy (30 fractions of 2 Gy × 1 once a day). The drug Temodal was prescribed in a single dose of 75 mg/sq. m. (120–140 mg) an hour before gamma therapy for up to 40 days (in a total dose of 5000–5900 mg) and in the post – radiation period according to the scheme – 6 courses of the drug for 5 days every 23 days in a single dose of 200 mg/sq.m. (280–400 mg). The total dose of Temodal for 1 course was 1400–2000 mg. In everybody, after the study, the time period of subsequent survival of patients was registered from to the primary health care data. Results . The survival time was over 20 months in case of patients after surgical removal of glial tumor and with subsequent adjuvant chemotherapy if simultaneous low values of “Tumor-to Normal Tissue” index for both 99m Tc-Technetryl SPECT and CE-MRI were met, i.e. if 1,25 99m Tc-Technetryl SPECT and > 1,35 for CE-MRI then the survival time was below one year. If the “Tumor-to Normal Tissue”ratio on 99m Tc-Technetryl SPECT scan was in benefit ranges whereas the on CE-MRI kept itself in high pathologic ranges the survival time was also over 19 months. Conclusion . Thus, the concomitant quantification and fusion of uptake of 99m Tc-Technetryl and paramagnetic contrast agents on SPECT and MRI scans provides prognostic data on survival of patients and is worth routine use for therapy control.