Imaging Malignant Gliomas with 99mTc-MIBI Brain Single-Photon Emission Computed Tomography

Malignant glioma, the main primary brain tumor, has a dismal prognosis. Current therapies extend a patient's survival (usually 2-3 months) by only about 9 months to 1 year on average. Early and reliable assessment of an individual patient's prognosis and response to therapeutics is therefore essential to determine whether continued therapies are beneficial. Functional imaging methods have been proposed for the evaluation of treatment efficacy and are claimed to be more specific than are conventional radiological investigations. Yet the question remains as to how best to incorporate this newly acquired insight into the clinical context. SPECT and PET assess tumor viability by specific intracellular uptake in malignant cells. TI-201thallium SPECT accuracy is similar to that of 18FDG PET. 99mTc-MIBI is used as an alternative to TI- 201thallium for the study of myocardial perfusion and has also been proposed as an imaging agent for various tumors such as gliomas. MIBI brain SPECT has shown more specificity and sensitivity than TI-201thallium brain SPECT. MIBI brain SPECT may help in differentiating a high grade glioma recurrence from a radiation necrosis. In this review, we describe the roles of MIBI SPECT in the management and follow up of malignant glioma patients.