Perioperative single photon emission computed tomography in predicting survival of malignant glioma patients

Single photon emission computed tomography (SPECT) is widely used in the evaluation of glioma patients and has been demonstrated to correlate with glioma malignancy and proliferation indexes. The aim of this study was to evaluate the association between perioperative technetium-99m-methoxyisobutylisonitrile (Tc-99m-MIBI) uptake on SPECT scans and survival of malignant glioma patients. A total of 17 patients (11 males and 6 women; mean age, 62.2 +/- 8.4 years) with histologically confirmed malignant gliomas (16 glioblastoma multi forme and 1 gliosarcoma) underwent Tc-99m-MIBI SPECT scans 2.8 +/- 1.9 days before surgery and 9.8 +/- 1.5 days after surgery. The total intensity index (TII) that corresponds to the area and intensity of tracer uptake was calculated before and after surgery. In addition, the change of TII before versus after surgery (Delta TII) was calculated. The overall survival (OS) was defined as the period between the date of surgery and the date of death. The median overall survival time was 12.4 months, ranging from 1.4 to 88 months; there were nine (45%) 12-month survivors. In univariate analyses using a log-rank test, worse OS was significantly associated with higher preoperative TII (>= 12), higher postoperative TII (>= 6), lower Delta TII (<50%) and higher number of neurological symptoms prior to surgery (>= 4). In multivariate analyses, higher postoperative TII, a greater number of neurological symptoms and female gender were found to be factors with independent prognostic value of OS. Patients who survived more than 12 months following surgery had a significantly lower postoperative TII, higher Delta TII and greater rate of gross total resection compared to patients who survived less than 12 months following surgery. Higher per-operative tracer uptake and lower decrease of tracer uptake following surgery (suggesting less radical resection) were associated with worse OS of malignant glioma patients. Our results suggest that SPECT may be used to predict survival of malignant glioma patients; however, further studies using larger samples are required.