[C-methionine PET in assessment of brain lesions in patients with glial tumors after combined treatment]. / PÉT s S-metioninom v otsenke porazhenii golovnogo mozga u bol'nykh s glial'nymi opukholiami posle kombinirovannogo lecheniia.

Positron emission tomography (PET) with amino acid-based radiopharmaceuticals is considered as an effective method to diagnose continued growth of cerebral gliomas, but the variability of 11C-methionine uptake by brain lesions of different genesis after combined treatment still remains poorly understood. The aim of this study was to explore the information value of 11C-methionine PET in delimitating progression of cerebral gliomas and stable disease and to assess the risk of tumor recurrence at different values of the 11C-methionine uptake index. MATERIAL AND METHODS: We performed a retrospective analysis of the results of 11C-methionine PET or PET/CT in 324 patients suspected for continued growth of cerebral tumor based on magnetic resonance imaging (MRI) findings. A quantitative analysis of the results included calculation of the 11C-methionine uptake index (UI). RESULTS: A ROC analysis revealed that the specificity of PET in the diagnosis of continued tumor growth (CTG) was 98%, and the sensitivity was 71% for a UI of more than 1.9. We found that 98% of lesions with a negative level of RP uptake were related to radiation brain lesions (RBLs) or residual tumors combined with radiation pathomorphims. The UI in a range of 1.2-1.6 in 75% of lesions characterized a stable disease, but 25.5% of the lesions represented continued glioma growth. The proportion of recurrences increased to 40% in a UI range of 1.6-1.9, and 95.5% of brain lesions with a UI of more than 1.9 were tumor recurrences. Therefore, high 11C-methionine uptake with the UI above 1.9 in brain lesions characterized by radiological signs of disease progression is a highly specific indicator of CTG; however, the UI may significantly vary during tumor growth, and a substantial fraction of recurrent gliomas may have lower radiopharmaceutical uptake. In the case of borderline UI values, early dynamic control or complementary additional MRI or CT techniques should be used.

[PET using 11C-methionine in recognition of pseudoprogression in cerebral glioma after combined treatment].

The purpose of the study was to evaluate the value of PET using 11C-methionine (PET-Met) for distinction between true glioma progression and pseudoprogression (PsPr). 72 patients with treated cerebral glioma investigated by PET-Met were identified from prospective database. Entry criteria included new or progressive MR imaging enhancing lesions within first 6 months after irradiation and definite final diagnosis on the basis of the pathological study (n=17) or clinical-radiological follow-up on an average 16 months. PET examinations were assessed by visual inspection and calculating 11C-methionine uptake index (UI). Results. Pseudoprogression was defined as early radiological progression with subsequent regress or stabilization, without salvage therapy. 42 patients were considered to exhibit PsPr and 30 patients had true glioma progression. In PsPr group PET scans were either negative (n=6) or slightly increased tracer uptake (UI range 1.2-2.14) was seen in the site of contrast-enhanced lesion. The UI was 1.48±0.39 (mean±SD). In comparison with pretreatment PET 15 patients showed decrease 11C-methionine uptake on an average by 26%. In recurrence group PET-Met showed abnormal high focal 11C-methionine uptake in the lesion. The UI was 2.54±0.84 (range 1.54-5.4). An UI threshold value of greater than 1.9 optimized differentiation between glioma progression and PsPr with sensitivity of 83.5% and specificity of 97.0%. Conclusion. Metabolic characteristics of PsPr included negative tracer accumulation or slightly increased 11C-methionine uptake in the contrast-enhancing lesion with UI less than 1.9.

[Current possibilities of the comprehensive diagnostic assessment in the differential diagnosis of inflammation and tumors of the spine cord].

The article discusses the differential diagnosis of transverse myelitis. An algorithm for the assessment of patients was given. The authors present two clinical examples demonstrating the role of the integrated neuroradiological approach in the differential diagnosis of difficult cases.

[Prognostic value of PET using 11C-methionine in patients with untreated cerebral gliomas].

We evaluated the prognostic role of positron emission tomography (PET) with 11C-methionine in adults with untreated supratentorial glioma. Histopathologic grading and clinical follow-up data were available from 147 patients with low-grade (n=74) and high-grade gliomas (n=73). Follow-up was conducted until the last clinical contact (n=79) or until death (n=68). The 11C-methionine uptake index (UI) was calculated as the tumor hot spot-to-normal cortex uptake ratio. In the univariate analysis the statistical support from clinical, histological, and PET parameters was estimated using Kaplan-Meier method and log-rank test. For all glioma patients age (<40 or > or = 40 years), astrocytoma histopathology and WHO grading class (low versus high), extent of the increased 11C-methionine uptake (<6 cm or > or = 6), were found to be significant predictors of survival by univariate analysis. For all grades of gliomas UI higher than 2.0 was statistically associated with a shorter survival (p=0.00001). Patient sex, glioma location, pattern of the 11C-methionine uptake were not significantly predictive. In the most patients UI was closely associated with glioma histopathology. However separate analysis of astrocytoma subgroups showed that PET with "C-methionine was a more reliable prognostic factor in case of conflict between metabolic characteristic and histopathology findings. A high uptake of 11C-methionine and large extent of increased 11C-methionine accumulation were statistically associated with a poor survival time. Results showed that PET with 11C-methionine may be useful for determinating the prognosis of patients with primary glioma and this information can provide aid in making treatment decision.

[Metastatic glioblastoma in a submandibular lymph node (a rare case)].

Extraneural metastases from glioblastoma are rare. A case of metastatic right parietal lobe glioblastoma in cervical node after repeat craniotomy is presented.

[Positron emission tomography in the diagnosis of recurrent growth of brain tumors].

The authors analyzed the results of 11C-methionine positron emission tomography (PET) in 101 patients with suspected recurrent brain tumor. The diagnosis was confirmed in 72 patients. The increased 11C-methionine uptake in the initial tumor area is considered to be a crucial PET evidence of a recurrent tumor. On the other hand, brain tissue histological changes associated with surgery, radiation, and chemotherapy were characterized by the low uptake of the tracer. The sensitivity and specificity of PET scanning in detecting tumor recurrence were found to be 95.8 and 96.5%, respectively. 11C-methionine PET is proposed as a reliable technique for early differentiating between a recurrent brain tumor and treatment-induced nonneoplastic changes.

[New criteria for positron emission tomographic diagnosis of brain glioma using 11C-methionine]. / Novye kriterii v positronno-émissionno-tomograficheskoi diagnostike gliom golovnogo mozga s ispol'zovaniem 11C-metionina.

The study was based on the data of positron emission tomography (PET) and L-[methyl]-[11C]-methionine used in 117 patients with suspected brain tumor. PET data on 74 patients with histologically verified cerebral tumors were analyzed in detail. New additional criteria for assessing PET scans, which formed the PET syndromes of astrocytomas, anaplastic astrocytomas, and glioblastomas. Operative and histological verification confirmed the high validity of the proposed criteria for defining the type of a tumor.

[Dynamics of mental disorders after extracerebral implantation of embryonal nervous tissue in epilepsy]. / Dinamika psikhicheskikh narushenii posle ékstratserebral'noi implantatsii émbrional'noi nervnoi tkani pri épilepsii.

The paper presents the method elaborated by the authors for production, storage and implantation of embryonal nervous tissue (ENT). Extracerebral implantation was performed in 33 epileptic patients aged 2-58 years. Clinical state of the patients and EEG alterations were studied. Before treatment the patients' mental status was characterized by affective disorders, dysphoria, depression, exhaustion of mental processes, varying intellectual-mnestic decrease and behavioral disinhibition. Oligophrenia as of debility was observed in several cases. After implantation the pronounced positive changes in both paroxysmal states and overall mental status were observed in all the cases irrespective of their age of the patients. These clinical changes correlated with the dynamics of EEG changes (EEG changes were not observed in 2 individuals with positive clinical effects).

[The collateral venous blood flow and the surgical procedure in parasagittal meningiomas]. / Kollateral'nyi venoznyi krovotok i khirurgicheskaia taktika pri parasagittal'nykh meningiomakh.

Peculiarities of the collateral venous bloodflow were analysed in 242 cases of parasagittal meningiomas (PM). The cerebral veins participated in collateral bloodflow in 52.1% of cases with tumours of the anterior third of the superior sagittal sinus (SSS), whereas in 39% of such cases the retrograde flow through proximal SSS have been found. Neoplasms of the middle/posterior third of SSS led to the collateral venous bloodflow through the anastomoses of the cerebral veins in 67% of cases. In 56% of patients the collateral flow was through extracerebral veins. The absence of strict conformities in the development of the collateral venous bloodflow leads to necessity of its intraoperative control by EEG monitoring. Severe changes of bioelectrical activity (14.9% of cases) are an indication for division of the surgical procedure into several stages.

[The surgical treatment of meningiomas of the superior sagittal sinus (the surgical approach and technic)]. / Khirurgicheskoe lechenie meningiom verkhnego sagittal'nogo sinusa (taktika i tekhnika operatsii).

The authors analyze the results of surgical management of 242 patients with upper sagittal sinus meningiomas who have been treated in the past 20 years. All the patients were divided into 3 groups in accordance with the surgical policy and techniques of interventions and anesthesiological support. The type of sinus wall tumor lesion and its associated cerebral blood outflow disorders detected by electrophysiological studies in pre- and intraoperative periods determined surgical policy which along with microsurgical technique of recovery of the intact sinus and superficial veins of the brain enhanced the efficiency of operations up to 92.2% and reduced fatal outcomes to zero.