Usefulness of 11C-methionine-positron emission tomography for the diagnosis of progressive multifocal leukoencephalopathy.
Usefulness of 11C-methionine-positron emission tomography for the diagnosis of progressive multifocal leukoencephalopathy.
复制标题
11C-蛋氨酸-正电子发射断层扫描在诊断进行性多灶性白质脑病中的有用性。
DOI：
10.1007/s00415-014-7500-y
复制
发表时间：
2014
期刊：
影响因子：
6
通讯作者：
Sasaki H.
中科院分区：
文献类型：
--
作者：
Shirai S;Yabe I;Kano T;Shimizu Y;Sasamori T;Sato K;Hirotani M;Nonaka T;Takahashi I;Matsushima M;Minami N;Nakamichi K;Saijo M;Hatanaka KC;Shiga T;Tanaka S;Sasaki H.
进行性多灶性白质脑病(PML)是一种由JC病毒引起的亚急性脑脱髓鞘疾病，主要发生在免疫功能低下的患者中。预后很差。由于病变看起来像非特异性白质脑病，早期诊断非常困难。我们报告三个PML病例，其中11C-蛋氨酸正电子发射断层扫描(MET-PET)摄取与18F-脱氧葡萄糖正电子发射断层扫描(FDG-PET)摄取不匹配。3例均显示病灶周围MET高摄取，病灶内FDG摄取低。我们推测，感染已在这些患者的白质病变内结束，而JC病毒感染仍在病变周围进行，导致蛋氨酸代谢增加，由于炎细胞很少渗入PML病变，导致糖代谢降低或中间。两名在脑脊液中JC病毒水平较低时被诊断并接受甲氟喹治疗的患者仍然活着。提示MET-PET在PML的早期诊断和甲氟喹的早期治疗中有一定的应用价值。
Progressive multifocal leukoencephalopathy (PML) is a subacute demyelinating disease of the brain caused by the JC virus that occurs mainly in immunocompromised patients. The prognosis is very poor. As the lesion looks like non- specific leukoencephalopathy, making a diagnosis at the early stage is very difficult. We report three PML cases in which there was a mismatch between11C-methionine-positron emission tomography (MET-PET) uptake and18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) uptake. All three cases demonstrated the hyper-uptake of MET around the white matter lesions and hypo-uptake of FDG inside the lesions. We speculate that the infection had ended inside the white matter lesions of these patients, while JC virus infection was ongoing around the lesions, resulting in the increase of methionine metabolism, and the glucose metabolism was reduced or intermediate because inflammatory cells infiltrate PML lesions rarely. Two patients who were diagnosed and treated with mefloquine while the JC virus was at a low level in the cerebrospinal fluid are still alive. We suggest the usefulness of MET-PET for the early diagnosis of PML and early treatment with mefloquine.