Correlation of diffusion tensor, dynamic susceptibility contrast MRI and (99m)Tc-Tetrofosmin brain SPECT with tumour grade and Ki-67 immunohistochemistry in glioma

Clin Neurol Neurosurg. 2014 Jan;116:41-5. doi: 10.1016/j.clineuro.2013.11.003. Epub 2013 Nov 16.


Objective: Assessment of the grade and type of glioma is of paramount importance for prognosis. Tumour proliferative potentials may provide additional information on the behaviour of the tumour, its response to treatment and prognosis. The purpose of this study was to investigate the correlation between diffusion tensor imaging (DTI), dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) and (99m)Tc-Tetrofosmin brain single-photon emission computed tomography (SPECT), and the tumour grade and Ki-67 labelling index in newly diagnosed gliomas.

Methods: Study was made of patients with suspected glioma on brain MRI between December 2010 and January 2012, by DTI, DSC MRI and (99m)Tc-Tetrofosmin brain SPECT. The proliferative activity of each tumour was measured by deriving the Ki-67 proliferation index from immunohistochemical staining of tumour specimens.

Results: Glioma was newly diagnosed in 25 patients (17 men, 8 women, aged 19-79 years, median 55 years). The Ki-67 index ranged from 1% to 80% (mean 19.4%). On evaluation of the relationship between the (99m)Tc-Tetrofosmin tumour uptake by gliomas was found to be significantly correlated with cellular proliferation (rho=0.924, p<0.0001). Regarding DTI, significant negative correlation was demonstrated between the apparent diffusion coefficient (ADC) ratio and the Ki-67 index (rho=-0.545, p=0.0087). Significant correlation was also observed between the fractional anisotropy (FA) ratio and the Ki-67 index (rho=0.489, p=0.02). Strong correlation was found between relative cerebral blood volume (rCBV) and Ki-67 index (rho=0.853, p<0.0001), and between the (99m)Tc-Tetrofosmin lesion-to-normal (L/N) uptake ratio and rCBV (rho=0.808, p ≤ 0.0001). Significant negative correlation was demonstrated between the (99m)Tc-Tetrofosmin L/N ratio and ADC ratio (rho=-0.513, p=0.014). These imaging techniques were able to distinguish between low-grade and high-grade gliomas.

Conclusions: Findings on DSC MRI and brain SPECT with (99m)Tc-Tetrofosmin metrics were more closely correlated with glioma cellular proliferation.

Keywords: (99m)Tc-Tetrofosmin; Diffusion tensor imaging; Glioma; Perfusion imaging; SPECT.

MeSH terms

  • Adult
  • Aged
  • Brain / pathology
  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / pathology*
  • Diffusion Tensor Imaging / methods
  • Ethylenediamines
  • Female
  • Glioma / diagnosis
  • Glioma / pathology*
  • Humans
  • Immunohistochemistry / methods
  • Ki-67 Antigen / metabolism
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Organophosphorus Compounds*
  • Organotechnetium Compounds*
  • Tomography, Emission-Computed, Single-Photon
  • Young Adult


  • Ethylenediamines
  • Ki-67 Antigen
  • Organophosphorus Compounds
  • Organotechnetium Compounds
  • technetium Tc 99m tris((2-((pyrrol-2-yl)methylamino)ethyl)amino)amine
  • technetium tc-99m tetrofosmin