Differential Diagnosis Between Radiation Necrosis and Glioma Progression Using Sequential Proton Magnetic Resonance Spectroscopy and Methionine Positron Emission Tomography
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概要
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Differential diagnosis between radiation necrosis and tumor recurrence is important in the clinical management of glioma. Multi-modality imaging including proton magnetic resonance spectroscopy (1H-MRS) and positron emission tomography (PET) with L-[methyl-11C]methionine (MET) was evaluated. Eighteen patients underwent sequential 1H-MRS and MET-PET. The expressions of metabolites including choline-containing compounds (Cho), creatine phosphate (Cre), and lactate (Lac) were calculated as the ratios of Cho to Cre (Cho/Cre) and Lac to Cho (Lac/Cho). The uptake of MET was determined as the ratio of the lesion to the contralateral reference region (L/R). The final diagnoses were determined by histological examination and/or follow-up MR imaging and clinical course. The Lac/Cho ratio was 0.63 ± 0.25 (mean ± standard deviation) in recurrence (7 cases) and 2.35 ± 1.81 in necrosis (11 cases). The Lac/Cho ratio was significantly different between the two groups (p < 0.01). Consecutive investigation of 1H-MRS revealed temporary elevation of Cho in 4 of 9 cases of necrosis, which could be identified as false positive findings for recurrence. Including those cases, MET-PET demonstrated significant difference in the L/R ratio between the two groups (2.18 ± 0.42 vs. 1.49 ± 0.35, p < 0.01). According to a 2 × 2 factorial table analysis, the borderline values of Lac/Cho and L/R to differentiate recurrence from necrosis were 1.05 and 2.00, respectively. 1H-MRS is reliable and accessible for the differentiation of recurrence and necrosis, although the temporary elevation of Cho in the course of necrosis should be recognized. Additional MET-PET imaging can establish the diagnosis.
- 社団法人 日本脳神経外科学会の論文
- 2009-09-15
著者
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TOMINAGA Teiji
Department of Neurosurgery, Tohoku University Graduate School of Medicine
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SAITO Ryuta
Department of Neurosurgery, Tohoku University Graduate School of Medicine
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KUMABE Toshihiro
Department of Neurosurgery, Tohoku University Graduate School of Medicine
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KANAMORI Masayuki
Department of Neurosurgery, Tohoku University Graduate School of Medicine
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WATANABE MIKA
Department of Anatomic Pathology, Tohoku University School of Medicine
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TASHIRO Manabu
Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University
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NAKAJIMA Takeshi
Department of Pulmonary Medicine, Keio University
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Saito Ryuta
Department Of Neurosurgery Tohoku University Graduate School Of Medicine
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Saito Ryuta
Department Of Neurosurgery Iwate Prefectural Central Hospital
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Watanabe Mika
Pathological Division Tohoku University Hospital
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Watanabe Mika
Department Of Anatomic Pathology Tohoku University School Of Medicine
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Tashiro Manabu
Division Of Cyclotron Nuclear Medicine Cyclotron And Radioisotope Center Tohoku University
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Tashiro Manabu
Division Of Cyclotron Nuclear Medicine Tohoku University Cyclotron And Radioisotope Center
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Kumabe Toshihiro
Department Of Neurosurgery Tohoku University Graduate School Of Medicine
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Kanamori Masayuki
Department Of Neurosurgery Tohoku University Graduate School Of Medicine
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Tominaga Teiji
Department Of Neurosurgery Tohoku University Graduate School Of Medicine
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Tominaga Teiji
Department Of Neurosurgery Tohoku Graduate School Of Medicine
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Tominaga Teiji
Neurosurgery Tohoku University Graduate School Of Medicine
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Nakajima Takeshi
Department Of Neurosurgery Tohoku University Graduate School Of Medicine
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Nakajima Takeshi
Department Of Dermatology Osaka Kosei-nenkin Hospital
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Nakajima Takeshi
Department of Chemistry Faculty of Science Tohoku University
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