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Combined201Tl and67Ga brain SPECT in patients with suspected central nervous system lymphoma or germinoma: Clinical and economic value

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Abstract

Background: Surgical resection is costly and an unfavorable prognostic factor for primary central nervous system (CNS) lymphoma and germinoma patients.Objective: To assess the diagnostic and economic impact of combined201TI and67Ga brain SPECT on the management of patients suspected of having CNS lymphoma or germinoma.Methods: Sequential201TI and67Ga brain SPECT was performed in 40 patients with cranial tumorts to assess the diagnostic and economic impact of combined201TI and67GA SPECT on the management of patients suspected of having CNS lymphoma or germinoma. All intracranial masses were pathologically confirmed. The final diagnoses of a total of 47 foci were: 11 non-Hodgkin's lymphomas in 10 patients, 3 germinomas in 2 patients, 10 glioblastomas in 9 patients, 10 cerebral metastases in 8 patients, 13 meningiomas in 11 patients. Decision-tree sensitivity analysis for pretest probability regarding expected cost saving was performed for introduction of the combined study.Results: All but one focus of CNS lymphomas or germinomas (92.9%, 13/14) exhibited more intense uptake of67Ga than of201TI (p<0.001). All foci of glioblastomas (10/10) and meningiomas (13/13), and 60% of metastatic foci (6/10) exhibited higher uptake of201TI than of67Ga (p<0.035). Expected cost saving in the 1% to 50% range of pretest probability of CNS lymphoma or germinoma would be from minus $842US to plus $2,047US per patient for introduction of the combined study, because of substitution of stereotactic biopsy for craniotomy. The pretest probability was the key factor for cost saving of the combined study.Conclusions: A67Ga-positive and201TI-positive pattern with more intense uptake of67Ga than201TI probably suggests CNS lymphoma or germinoma. This combination study appears to be cost-effective only in patients highly suspected of having CNS lymphoma or germinoma.

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Authors and Affiliations

  1. Department of Radiology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Japan

    Shigeru Kosuda & Shoichi Kusano

  2. Department of Neurosurgery, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Japan

    Shoichiro Ishihara, Hiroshi Nawashiro & Katsuji Shima

  3. Department of Radiology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

    Noriko Kamata & Kenzo Suzuki

  4. Department of Health, Yamaguchi University School of Medicine, Yamaguchi, Japan

    Kiyoshi Ichihara

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  1. Shigeru Kosuda
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Correspondence to Shigeru Kosuda.

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Kosuda, S., Kusano, S., Ishihara, S. et al. Combined201Tl and67Ga brain SPECT in patients with suspected central nervous system lymphoma or germinoma: Clinical and economic value. Ann Nucl Med 17, 359–367 (2003). https://doi.org/10.1007/BF03006602

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  • DOI: https://doi.org/10.1007/BF03006602

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