PET imaging in the surgical management of pediatric brain tumors

Benoit Pirotte, Francesco Acerbi, Alphonse Lubansu, Serge Goldman, Jacques Brotchi, Marc Levivier

Research output: Contribution to journalArticle

Abstract

Objective: The present article illustrates whether positron-emission tomography (PET) imaging may improve the surgical management of pediatric brain tumors (PBT) at different steps. Materials and methods: Among 400 consecutive PBT treated between 1995 and 2005 at Erasme Hospital, Brussels, Belgium, we have studied with 18F-2-fluoro-2-deoxy-D-glucose (FDG)-PET and/or L-(methyl-11C)methionine (MET)-PET and integrated PET images in the diagnostic workup of 126 selected cases. The selection criteria were mainly based on the lesion appearance on magnetic resonance (MR) sequences. Cases were selected when MR imaging showed limitations for (1) assessing the evolving nature of an incidental lesion (n=54), (2) selecting targets for contributive and accurate biopsy (n=32), and (3) delineating tumor tissue for maximal resection (n=40). Whenever needed, PET images were integrated in the planning of image-guided surgical procedures (frame-based stereotactic biopsies (SB), frameless navigation-based resections, or leksell gamma knife radiosurgery). Results: Like in adults, PET imaging really helped the surgical management of the 126 children explored, which represented about 30% of all PBT, especially when the newly diagnosed brain lesion was (1) an incidental finding so that the choice between surgery and conservative MR follow-up was debated, and (2) so infiltrative or ill-defined on MR that the choice between biopsy and resection was hardly discussed. Integrating PET into the diagnostic workup of these two selected groups helped to (1) take a more appropriate decision in incidental lesions by detecting tumor/evolving tissue; (2) better understand complex cases by differentiating indolent and active components of the lesion; (3) improve target selection and diagnostic yield of stereotactic biopsies in gliomas; (4) illustrate the intratumoral histological heterogeneity in gliomas; (5) provide additional prognostic information; (6) reduce the number of trajectories in biopsies performed in eloquent areas such as the brainstem or the pineal region; (7) better delineate ill-defined PBT infiltrative along functional cortex than magnetic resonance imaging (MRI); (8) increase significantly, compared to using MRI alone, the number of total tumor resection and the amount of tumor tissue removed in PBT for which a total resection is a key-factor of survival; (9) target the resection on more active areas; (10) improve detection of tumor residues in the operative cavity at the early postoperative stage; (11) facilitate the decision of early second-look surgery for optimizing the radical resection; (12) improve the accuracy of the radiosurgical dosimetry planning. Conclusions: PET imaging may improve the surgical management of PBT at the diagnostic, surgical, and post-operative steps. Integration of PET in the clinical workup of PBT inaugurates a new approach in which functional data can influence the therapeutic decision process. Although metabolic information from PET are valid and relevant for the clinical purposes, further studies are needed to assess whether PET-guidance may decrease surgical morbidity and increase children survival.

Original languageEnglish
Pages (from-to)739-751
Number of pages13
JournalChild's Nervous System
Volume23
Issue number7
DOIs
Publication statusPublished - Jul 2007

Fingerprint

Brain Neoplasms
Positron-Emission Tomography
Pediatrics
Biopsy
Magnetic Resonance Spectroscopy
Magnetic Resonance Imaging
Neoplasms
Glioma
Second-Look Surgery
Incidental Findings
Radiosurgery
Belgium
Fluorodeoxyglucose F18
Patient Selection
Brain Stem
Morbidity
Brain

Keywords

  • Functional imaging
  • Image-guidance
  • Infiltrative tumors
  • Navigation
  • Pediatric brain tumors
  • Positron-emission tomography
  • Stereotactic biopsy
  • Tumor resection

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Pirotte, B., Acerbi, F., Lubansu, A., Goldman, S., Brotchi, J., & Levivier, M. (2007). PET imaging in the surgical management of pediatric brain tumors. Child's Nervous System, 23(7), 739-751. https://doi.org/10.1007/s00381-007-0307-8

PET imaging in the surgical management of pediatric brain tumors. / Pirotte, Benoit; Acerbi, Francesco; Lubansu, Alphonse; Goldman, Serge; Brotchi, Jacques; Levivier, Marc.

In: Child's Nervous System, Vol. 23, No. 7, 07.2007, p. 739-751.

Research output: Contribution to journalArticle

Pirotte, B, Acerbi, F, Lubansu, A, Goldman, S, Brotchi, J & Levivier, M 2007, 'PET imaging in the surgical management of pediatric brain tumors', Child's Nervous System, vol. 23, no. 7, pp. 739-751. https://doi.org/10.1007/s00381-007-0307-8
Pirotte, Benoit ; Acerbi, Francesco ; Lubansu, Alphonse ; Goldman, Serge ; Brotchi, Jacques ; Levivier, Marc. / PET imaging in the surgical management of pediatric brain tumors. In: Child's Nervous System. 2007 ; Vol. 23, No. 7. pp. 739-751.
@article{3aa1eebbd2b14343bdbfe2caec6d2749,
title = "PET imaging in the surgical management of pediatric brain tumors",
abstract = "Objective: The present article illustrates whether positron-emission tomography (PET) imaging may improve the surgical management of pediatric brain tumors (PBT) at different steps. Materials and methods: Among 400 consecutive PBT treated between 1995 and 2005 at Erasme Hospital, Brussels, Belgium, we have studied with 18F-2-fluoro-2-deoxy-D-glucose (FDG)-PET and/or L-(methyl-11C)methionine (MET)-PET and integrated PET images in the diagnostic workup of 126 selected cases. The selection criteria were mainly based on the lesion appearance on magnetic resonance (MR) sequences. Cases were selected when MR imaging showed limitations for (1) assessing the evolving nature of an incidental lesion (n=54), (2) selecting targets for contributive and accurate biopsy (n=32), and (3) delineating tumor tissue for maximal resection (n=40). Whenever needed, PET images were integrated in the planning of image-guided surgical procedures (frame-based stereotactic biopsies (SB), frameless navigation-based resections, or leksell gamma knife radiosurgery). Results: Like in adults, PET imaging really helped the surgical management of the 126 children explored, which represented about 30{\%} of all PBT, especially when the newly diagnosed brain lesion was (1) an incidental finding so that the choice between surgery and conservative MR follow-up was debated, and (2) so infiltrative or ill-defined on MR that the choice between biopsy and resection was hardly discussed. Integrating PET into the diagnostic workup of these two selected groups helped to (1) take a more appropriate decision in incidental lesions by detecting tumor/evolving tissue; (2) better understand complex cases by differentiating indolent and active components of the lesion; (3) improve target selection and diagnostic yield of stereotactic biopsies in gliomas; (4) illustrate the intratumoral histological heterogeneity in gliomas; (5) provide additional prognostic information; (6) reduce the number of trajectories in biopsies performed in eloquent areas such as the brainstem or the pineal region; (7) better delineate ill-defined PBT infiltrative along functional cortex than magnetic resonance imaging (MRI); (8) increase significantly, compared to using MRI alone, the number of total tumor resection and the amount of tumor tissue removed in PBT for which a total resection is a key-factor of survival; (9) target the resection on more active areas; (10) improve detection of tumor residues in the operative cavity at the early postoperative stage; (11) facilitate the decision of early second-look surgery for optimizing the radical resection; (12) improve the accuracy of the radiosurgical dosimetry planning. Conclusions: PET imaging may improve the surgical management of PBT at the diagnostic, surgical, and post-operative steps. Integration of PET in the clinical workup of PBT inaugurates a new approach in which functional data can influence the therapeutic decision process. Although metabolic information from PET are valid and relevant for the clinical purposes, further studies are needed to assess whether PET-guidance may decrease surgical morbidity and increase children survival.",
keywords = "Functional imaging, Image-guidance, Infiltrative tumors, Navigation, Pediatric brain tumors, Positron-emission tomography, Stereotactic biopsy, Tumor resection",
author = "Benoit Pirotte and Francesco Acerbi and Alphonse Lubansu and Serge Goldman and Jacques Brotchi and Marc Levivier",
year = "2007",
month = "7",
doi = "10.1007/s00381-007-0307-8",
language = "English",
volume = "23",
pages = "739--751",
journal = "Child's Nervous System",
issn = "0256-7040",
publisher = "Springer Verlag",
number = "7",

}

TY - JOUR

T1 - PET imaging in the surgical management of pediatric brain tumors

AU - Pirotte, Benoit

AU - Acerbi, Francesco

AU - Lubansu, Alphonse

AU - Goldman, Serge

AU - Brotchi, Jacques

AU - Levivier, Marc

PY - 2007/7

Y1 - 2007/7

N2 - Objective: The present article illustrates whether positron-emission tomography (PET) imaging may improve the surgical management of pediatric brain tumors (PBT) at different steps. Materials and methods: Among 400 consecutive PBT treated between 1995 and 2005 at Erasme Hospital, Brussels, Belgium, we have studied with 18F-2-fluoro-2-deoxy-D-glucose (FDG)-PET and/or L-(methyl-11C)methionine (MET)-PET and integrated PET images in the diagnostic workup of 126 selected cases. The selection criteria were mainly based on the lesion appearance on magnetic resonance (MR) sequences. Cases were selected when MR imaging showed limitations for (1) assessing the evolving nature of an incidental lesion (n=54), (2) selecting targets for contributive and accurate biopsy (n=32), and (3) delineating tumor tissue for maximal resection (n=40). Whenever needed, PET images were integrated in the planning of image-guided surgical procedures (frame-based stereotactic biopsies (SB), frameless navigation-based resections, or leksell gamma knife radiosurgery). Results: Like in adults, PET imaging really helped the surgical management of the 126 children explored, which represented about 30% of all PBT, especially when the newly diagnosed brain lesion was (1) an incidental finding so that the choice between surgery and conservative MR follow-up was debated, and (2) so infiltrative or ill-defined on MR that the choice between biopsy and resection was hardly discussed. Integrating PET into the diagnostic workup of these two selected groups helped to (1) take a more appropriate decision in incidental lesions by detecting tumor/evolving tissue; (2) better understand complex cases by differentiating indolent and active components of the lesion; (3) improve target selection and diagnostic yield of stereotactic biopsies in gliomas; (4) illustrate the intratumoral histological heterogeneity in gliomas; (5) provide additional prognostic information; (6) reduce the number of trajectories in biopsies performed in eloquent areas such as the brainstem or the pineal region; (7) better delineate ill-defined PBT infiltrative along functional cortex than magnetic resonance imaging (MRI); (8) increase significantly, compared to using MRI alone, the number of total tumor resection and the amount of tumor tissue removed in PBT for which a total resection is a key-factor of survival; (9) target the resection on more active areas; (10) improve detection of tumor residues in the operative cavity at the early postoperative stage; (11) facilitate the decision of early second-look surgery for optimizing the radical resection; (12) improve the accuracy of the radiosurgical dosimetry planning. Conclusions: PET imaging may improve the surgical management of PBT at the diagnostic, surgical, and post-operative steps. Integration of PET in the clinical workup of PBT inaugurates a new approach in which functional data can influence the therapeutic decision process. Although metabolic information from PET are valid and relevant for the clinical purposes, further studies are needed to assess whether PET-guidance may decrease surgical morbidity and increase children survival.

AB - Objective: The present article illustrates whether positron-emission tomography (PET) imaging may improve the surgical management of pediatric brain tumors (PBT) at different steps. Materials and methods: Among 400 consecutive PBT treated between 1995 and 2005 at Erasme Hospital, Brussels, Belgium, we have studied with 18F-2-fluoro-2-deoxy-D-glucose (FDG)-PET and/or L-(methyl-11C)methionine (MET)-PET and integrated PET images in the diagnostic workup of 126 selected cases. The selection criteria were mainly based on the lesion appearance on magnetic resonance (MR) sequences. Cases were selected when MR imaging showed limitations for (1) assessing the evolving nature of an incidental lesion (n=54), (2) selecting targets for contributive and accurate biopsy (n=32), and (3) delineating tumor tissue for maximal resection (n=40). Whenever needed, PET images were integrated in the planning of image-guided surgical procedures (frame-based stereotactic biopsies (SB), frameless navigation-based resections, or leksell gamma knife radiosurgery). Results: Like in adults, PET imaging really helped the surgical management of the 126 children explored, which represented about 30% of all PBT, especially when the newly diagnosed brain lesion was (1) an incidental finding so that the choice between surgery and conservative MR follow-up was debated, and (2) so infiltrative or ill-defined on MR that the choice between biopsy and resection was hardly discussed. Integrating PET into the diagnostic workup of these two selected groups helped to (1) take a more appropriate decision in incidental lesions by detecting tumor/evolving tissue; (2) better understand complex cases by differentiating indolent and active components of the lesion; (3) improve target selection and diagnostic yield of stereotactic biopsies in gliomas; (4) illustrate the intratumoral histological heterogeneity in gliomas; (5) provide additional prognostic information; (6) reduce the number of trajectories in biopsies performed in eloquent areas such as the brainstem or the pineal region; (7) better delineate ill-defined PBT infiltrative along functional cortex than magnetic resonance imaging (MRI); (8) increase significantly, compared to using MRI alone, the number of total tumor resection and the amount of tumor tissue removed in PBT for which a total resection is a key-factor of survival; (9) target the resection on more active areas; (10) improve detection of tumor residues in the operative cavity at the early postoperative stage; (11) facilitate the decision of early second-look surgery for optimizing the radical resection; (12) improve the accuracy of the radiosurgical dosimetry planning. Conclusions: PET imaging may improve the surgical management of PBT at the diagnostic, surgical, and post-operative steps. Integration of PET in the clinical workup of PBT inaugurates a new approach in which functional data can influence the therapeutic decision process. Although metabolic information from PET are valid and relevant for the clinical purposes, further studies are needed to assess whether PET-guidance may decrease surgical morbidity and increase children survival.

KW - Functional imaging

KW - Image-guidance

KW - Infiltrative tumors

KW - Navigation

KW - Pediatric brain tumors

KW - Positron-emission tomography

KW - Stereotactic biopsy

KW - Tumor resection

UR - http://www.scopus.com/inward/record.url?scp=34249878469&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34249878469&partnerID=8YFLogxK

U2 - 10.1007/s00381-007-0307-8

DO - 10.1007/s00381-007-0307-8

M3 - Article

C2 - 17356889

AN - SCOPUS:34249878469

VL - 23

SP - 739

EP - 751

JO - Child's Nervous System

JF - Child's Nervous System

SN - 0256-7040

IS - 7

ER -