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Journal of Craniovertebral Junction and Spine
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LETTER TO EDITOR
Year : 2014  |  Volume : 5  |  Issue : 3  |  Page : 139-140  

Spinal molecular imaging by (68) Ga-DOTATATE-positron emission tomography


University of Southampton, Southampton, United Kingdom

Date of Web Publication7-Oct-2014

Correspondence Address:
Bernhard Schaller
University of Southampton, Southampton
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-8237.142311

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How to cite this article:
Sandu N, Schaller B. Spinal molecular imaging by (68) Ga-DOTATATE-positron emission tomography . J Craniovert Jun Spine 2014;5:139-40

How to cite this URL:
Sandu N, Schaller B. Spinal molecular imaging by (68) Ga-DOTATATE-positron emission tomography . J Craniovert Jun Spine [serial online] 2014 [cited 2020 Feb 23];5:139-40. Available from: http://www.jcvjs.com/text.asp?2014/5/3/139/142311

Sir,

We have read with interest the article of Slotty et al. [1] about spinal molecular imaging (MI) by (68) Ga-DOTATATE-positron emission tomography (PET) of a spinal meningioma. The authors describe herein a new diagnostic method for the spine. As recently stated by us, such reports about MI of spinal tumors are relatively rare in the literature. [2] The interesting key question remains not only whether the magnitude of biochemical alterations demonstrated by spinal MI reveals prognostic value with respect to survival, but also whether it identifies early disease and differentiates benign from malignant lesions. In the current case of Slotty et al. [1] MI helped a dear identification of treatment failure and significantly influenced patient management by providing more objective decision criteria for evaluation of specific therapeutic strategies.

In general, the diagnosis of spinal tumors has developed enormously in the recent few years. The principal improvement in this context is achieved by MI, that is nowadays more than only an option to detect spinal tumors. [2],[3],[4] Recent spinal MI have combined histological [5],[6],[7] assessments with a multimodal neuroimaging approach [4],[8] to further uncover our preoperative understanding of the pathological basis as well as pathophysiologic architecture of the underlying spinal tumor. Spinal meningiomas, as mentioned by Slotty et al., [1] are of special interest in this context, as different histological subtypes alter surgical outcome. [5] Such noninvasive preoperative information during the diagnostic work-up gives important additional information to decide better about the appropriate treatment options. [3]

Not at least, spinal MI has a very high positive predictive value (>98%). [4] In the case of operation, the improvement of microsurgery and minimally invasive surgery, also of the spine, needs nowadays detailed preoperative planning to narrow the surgical field for the desired successful less invasive neurosurgery. [9]

In the present case of Slotty et al., [1] it is noteworthy that not only spinal tumor itself can be assessed by MI as discussed by the authors. Recently, it has been found that focal glucose hypermetabolism at the level of spinal cord compression predicts an improved surgical outcome suggesting a reversible functional damage of the underlying myelopathy. [10] These findings would favor a multi-tracer PET rather than a single tracer PET as suggested by the authors. However, such additional molecular information substantially helps to select those patients during the diagnostic work out who will profit from a neurosurgical operation. Somatostatin receptor ligands, as described by Slotty et al., [1] are one possibility among others [4],[11] to achieve this goal. However, the detailed indication of each tracer has still to be found for spinal MI [4] instead of cerebral MI, where this is already more established. [8],[12]

Supplementary imaging tools like spinal MI that was previously introduced by our group, [4] represent a promising diagnostic tool to visualize spinal tumor but also spinal cord tissue and underlining therefore a molecular based preoperative diagnostic work-up.

 
   References Top

1.Slotty PJ, Behrendt FF, Langen KJ, Cornelius JF. (68)Ga-DOTATATE-positron emission tomography imaging in spinal meningioma. J Craniovertebr Junction Spine 2014;5:44-6.  Back to cited text no. 1
    
2.Sandu N, Schaller B. Commentary. J Neurosci Rural Pract 2014;5:159-60.  Back to cited text no. 2
  Medknow Journal  
3.Sandu N, Pöpperl G, Toubert ME, Arasho B, Spiriev T, Orabi M, et al. Molecular imaging of potential bone metastasis from differentiated thyroid cancer: A case report. J Med Case Rep 2011;5:522.  Back to cited text no. 3
    
4.Sandu N, Pöpperl G, Toubert ME, Spiriev T, Arasho B, Orabi M, et al. Current molecular imaging of spinal tumors in clinical practice. Mol Med 2011;17:308-16.  Back to cited text no. 4
    
5.Schaller B. Spinal meningioma: Relationship between histological subtypes and surgical outcome? J Neurooncol 2005;75:157-61.  Back to cited text no. 5
[PUBMED]    
6.Schaller B, Kruschat T, Schmidt H, Brück W, Buchfelder M, Ludwig HC. Intradural, extramedullary spinal sarcoidosis: Report of a rare case and review of the literature. Spine J 2006;6:204-10.  Back to cited text no. 6
    
7.Fili S, Karalaki M, Schaller B. Mechanism of bone metastasis: The role of osteoprotegerin and of the host-tissue microenvironment-related survival factors. Cancer Lett 2009;283:10-9.  Back to cited text no. 7
    
8.Schaller B. Usefulness of positron emission tomography in diagnosis and treatment follow-up of brain tumors. Neurobiol Dis 2004;15:437-48.  Back to cited text no. 8
[PUBMED]    
9.Schaller BJ, Gruber R, Merten HA, Kruschat T, Schliephake H, Buchfelder M, et al. Piezoelectric bone surgery: A revolutionary technique for minimally invasive surgery in cranial base and spinal surgery? Technical note. Neurosurgery 2005;57(4 Suppl):E410.  Back to cited text no. 9
    
10.Floeth FW, Galldiks N, Eicker S, Stoffels G, Herdmann J, Steiger HJ, et al. Hypermetabolism in 18F-FDG PET predicts favorable outcome following decompressive surgery in patients with degenerative cervical myelopathy. J Nucl Med 2013;54:1577-83.  Back to cited text no. 10
    
11.Schaller B, Cornelius JF, Sandu N. Molecular medicine successes in neuroscience. Mol Med 2008;14:361-4.  Back to cited text no. 11
    
12.Schaller BJ, Modo M, Buchfelder M. Molecular imaging of brain tumors: A bridge between clinical and molecular medicine? Mol Imaging Biol 2007;9:60-71.  Back to cited text no. 12
    




 

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