Integration of functional imaging in radiosurgery: the example of PET scan

Radiosurgery relies critically on the imaging modalities that are used for targeting. Leksell Gamma Knife (LGK) radiosurgery presents the highest requirements in terms of imaging accuracy as the treatment is applied in a single high-dose session with no other spatial control than medical imaging. The advent of functional imaging modalities opens new challenges for LGK planning strategies. The integration of stereotactic PET in LGK represents an example of such application of modern multimodality imaging in radiosurgery. Our experience consists of 130 patients treated with the combination of MR/CT and PET guidance. In order to analyze the specific contribution of PET, we developed a classification reflecting the strategy used to define the target volume. When combining PET and MR information, 149 target volumes were defined, because some patients presented with multiple lesions or multifocal tumor areas. Abnormal PET uptake was found in 88% of the lesions; using the classification, we found that the information provided by PET altered significantly the MR-based definition of the tumor in 73%. In conclusion, integration of PET in radiosurgery provides additional functional information opening new perspectives for the treatment of brain tumors. The use of a standardized classification allows to assess the relative role of PET. A similar approach could be useful and may serve as a template for the evaluation of the integration of other new imaging modalities in radiosurgery.