201Tl-SPECTが疾患活動性の評価に有用であった肥厚性硬膜炎の1例

Clinical Usefulness of Thallium-201 Single-photon Emission CT in the Patient with Hypertrophic Cranial Pachymeningitis

　要旨　リウマチ因子陽性の肥厚性硬膜炎の54歳女性例を報告した。肥厚性硬膜炎の再燃時に髄膜炎様の症状を呈し，臨床的には原疾患の再燃か感染性髄膜炎の合併か判断に迷ったが，²⁰¹Tl-SPECTを用いて肥厚性硬膜炎の増悪であることが確認された。肥厚性硬膜炎の画像診断において，MRIは硬膜の肥厚を検出するためには有用であるが，再燃などの際に硬膜病変の微妙な変化をとらえることは困難である。それに対して²⁰¹Tl-SPECTは肥厚性硬膜炎の疾患活動性を反映する検査として有用であると考えられた。

　We report a 54-year-old female with rheumatoid factor-positive hypertrophic cranial pachymeningitis. At age of 51 years she developed headache, hearing loss, right vagal nerve palsy, and right accessory nerve palsy. MRI revealed thickening and gadolinium-enhancement of the cranial dura mater. The initial symptoms significantly improved with corticosteroid therapy. Two years later, she presented with severe headache and neck pain. Although gadolinium-enhanced MR images failed to show any change compared with those before recurrence, ²⁰¹T1 single-photon emission CT (SPECT) showed a remarkable accumulation of thallium-201 in the dura mater. Furthermore, the abnormal uptake of thallium-201 returned to normal after treatment with corticosteroid. ²⁰¹T1-SPECCT was a useful tool for the evaluation of disease activity in the patient with hypertrophic pachymeningitis.

(Recerived : October 21, 2003)