Abstract
Gamma Knife treatment is an alternative to traditional brain surgery and whole-brain radiation therapy for treating cancers that are inaccessible via conventional treatments. To assess the effectiveness of Gamma Knife treatments, functional imaging can play a crucial role. The aim of this study is to evaluate new prognostic indices to perform an early assessment of treatment response to therapy using positron emission tomography imaging. The parameters currently used in nuclear medicine assessments can be affected by statistical fluctuation errors and/or cannot provide information on tumor extension and heterogeneity. To overcome these limitations, the Cumulative standardized uptake value (SUV) Histogram (CSH) and Area Under the Curve (AUC) indices were evaluated to obtain additional information on treatment response. For this purpose, the absolute level of [11C]-Methionine (MET) uptake was measured and its heterogeneity distribution within lesions was evaluated by calculating the CSH and AUC indices. CSH and AUC parameters show good agreement with patient outcomes after Gamma Knife treatments. Furthermore, no relevant correlations were found between CSH and AUC indices and those usually used in the nuclear medicine environment. CSH and AUC indices could be a useful tool for assessing patient responses to therapy.
Highlights
The Leksell Gamma Knife (GK) is a stereotactic radio surgical device capable of treating brain tumors inaccessible to conventional surgery by allowing accurate target irradiation
Levivier et al [19] found that positron emission tomography (PET) conveys complementary information to information derived from computerized tomography (CT) or Magnetic resonance (MR) imaging in brain disorders
All subjects were treated with the Leksell Gamma Knife Model C and they underwent PET/CT Discovery 690 with time of flight (TOF)
Summary
The Leksell Gamma Knife (GK) is a stereotactic radio surgical device capable of treating brain tumors inaccessible to conventional surgery by allowing accurate target irradiation. The first parameter introduced for the evaluation of PET studies is the maximum standardized uptake value (SUVmax ), which provides punctual information of the voxel showing the highest uptake value within the tumor. This parameter can be affected by statistical fluctuation errors and cannot provide information on the extent of the tumor [20]. For this reason, other quantitative indices have been introduced, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) [21]
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