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Free Content Neuro-Oncology Single-Photon Emission CT: A Current Overview

There is increasing need for noninvasive biomarkers for glioma treatment-response evaluation and for distinguishing tumor progression and recurrence from treatment-related changes. Here, SPECT, particularly 201Tl SPECT, plays an important role. SPECT takes advantage of glioma cellular make-up. Specifically, Na+/K+ pump expression, mitochondrial attenuation, and amino acid transporter expression are probed with 201Tl, 99mTc-MIBI, and 123IMT radiotracers respectively. 201Tl can be used to distinguish brain tumors and nontumors and to determine brain tumor type and grade gliomas. However, it is especially valuable in the detection of tumor recurrence in patients treated with radiation therapy for supratentorial glioma. Similarly, 99mTc-MIBI can be used to distinguish recurrence from treatment residua. 99mTc-TF is comparable with 99mTc-MIBI, and both may allow clear identification of tumor boundaries. 123IMT appears to be superior to 99mTc-MIBI in determining tumor recurrence and is particularly promising in detecting LGG recurrence. Additionally, 123IMT shows promise in treatment planning where there is a survival advantage. LGGs frequently express somatostatin receptors; however, because radiolabeled somatostatin analogs do not cross the BBB and because LGGs frequently do not disturb the BBB, somatostatin-receptor imaging is limited in glioma imaging. Among the non-natural amino acid class, 123IPA is not preferable to the more established 123IMT. In summary, most international experience by using SPECT is with 201Tl; however, other radiotracers are used with good effect in some clinics.
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