18F‐choline radiotracer positron emission tomography as a new means to monitor central nervous system lymphoma
18F‐choline radiotracer positron emission tomography as a new means to monitor central nervous system lymphoma
复制标题
18F-胆碱放射性示踪剂正电子发射断层扫描作为监测中枢神经系统淋巴瘤的新手段
DOI：
10.1111/bjh.17374
复制
发表时间：
2021
影响因子：
6.5
通讯作者：
B. Sharma
中科院分区：
文献类型：
--
作者：
T. Millard;I. Chau;S. Iyengar;D. El;D. Cunningham;B. Sharma
在监测一位60岁的原发性中枢神经系统（CNS）淋巴瘤的女性患者，她在原位安装了永久性起搏器，我们发现F-胆碱正电子发射断层扫描/计算机断层扫描（PET/CT）有可能作为一种监测方式。患者最初就诊时出现右腿无力、接受性语言障碍和记忆障碍。头部增强CT显示一个大的双顶脑肿块（左图）。计划进行活检，但由于症状恶化，在手术前5天开始使用皮质类固醇。患者的临床反应极佳，活检时进一步的头部CT显示部分放射学反应。活检发现淋巴细胞浸润、B细胞增加和偶尔的非典型细胞，怀疑为治疗的淋巴瘤。脑脊液（CSF）分析正常。CNS淋巴瘤的诊断是基于最初的放射学和类固醇反应。随后的CT、磁共振成像（MRI）和F-胆碱PET/CT（中央图像）未发现复发证据。鉴于该决议，制定了一项密切临床和放射学监测而不是系统治疗的计划。鉴于需要在MRI前禁用永久性起搏器，以及随之而来的后勤和安全问题，选择F-胆碱PET/CT作为监测模式。对比增强CT没有必要的灵敏度。PET成像通常使用氟脱氧葡萄糖（FDG），但在CNS淋巴瘤成像的背景下，正常脑实质对葡萄糖的高生理摄取限制了解释。另一方面，胆碱代谢失调与肿瘤发生和癌症进展同义。将胆碱与氟-18同位素相结合得到的PET图像提供了优于常规FDG的上级CNS肿瘤显示（右图，F-胆碱PET/CT成像的CNS淋巴瘤示例）。在本例患者中，该模式允许密切监测，无需禁用起搏器进行MRI。更广泛地说，它强调了使用F-胆碱PET/CT作为新的CNS淋巴瘤监测工具的潜力（也解决了MRI钆基造影剂的肾源性和沉积问题）。
Whilst monitoring a 60-year-old woman with primary central nervous system (CNS) lymphoma who had a permanent pacemaker in situ, we found that F-choline positron emission tomography/computed tomography (PET/CT) has potential as a surveillance modality. The patient had initially attended with right-leg weakness, receptive dysphasia and memory impairment. Contrast-enhanced CT of the head demonstrated a large biparietal cerebral mass (left image). Biopsy was planned, but due to worsening symptoms corticosteroids were commenced five days before the procedure. The patient had an excellent clinical response with a further head CT at the time of biopsy showing a partial radiological response. A biopsy found lymphocytic infiltrates, increased B cells and occasional atypical cells suspicious for treated lymphoma. Cerebrospinal fluid (CSF) analysis was normal. CNS lymphoma was diagnosed based on initial radiology and steroid response. Subsequent CT, magnetic resonance imaging (MRI) and F-choline PET/CT (central image) found no evidence of recurrence. In view of the resolution, a plan was made for close clinical and radiological monitoring rather than systemic treatment. Given the need to disable the permanent pacemaker before MRI, with the consequent logistical and safety issues, F-choline PET/CT was chosen as the surveillance modality. Contrast enhanced CT does not have the requisite sensitivity. PET imaging conventionally utilises fluorodeoxyglucose (FDG) but in the context of imaging CNS lymphoma, high physiological uptake of glucose by normal brain parenchyma limits interpretation. Dysregulated choline metabolism is, on the other hand, synonymous with oncogenesis and cancer progression. Combining choline with a fluorine-18 isotope gives PET images which provide CNS tumour depiction superior to conventional FDG (right image, example of CNS lymphoma on F-choline PET/CT imaging). In the present patient, the modality allowed close monitoring without requiring pacemaker disablement for MRI. More broadly, it highlights the potential for using F-choline PET/CT as a new CNS lymphoma monitoring tool (also addressing nephrogenic and deposition concerns with MRI gadoliniumbased contrast agents).