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Neurological Surgery No Shinkei Geka Volume 32, Issue 8 （August 2004）

Neurological Surgery 脳神経外科 32巻8号（2004年8月発行）

Japanese English

症例

FDG-PETにて治療効果の評価を行った中枢神経系悪性リンパ腫の3例 Usefulness of FDG-PET in Monitoring Therapeutic Effects on a Central Nervous System Malignant Lymphoma : Report of Three Cases 政田哲也 ¹ , 松本義人 ¹ , 河井信行 ¹ , 田宮隆 ¹ , 長尾省吾 ¹ Tetsuya MASADA ¹ , Yoshihito MATSUMOTO ¹ , Nobuyuki KAWAI ¹ , Takashi TAMIYA ¹ , Seigo NAGAO ¹ ¹香川大学医学部脳神経外科 ¹Department of Neurological Surgery,Kagawa University School of Medicine キーワード： lymphoma , PET , FDG , MRI , methotrexate Keyword: lymphoma , PET , FDG , MRI , methotrexate pp.859-864

発行日 2004年8月1日 Published Date 2004/8/1

DOI https://doi.org/10.11477/mf.1436100472

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Abstract 文献概要
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　Ⅰ．はじめに

　中枢神経系悪性リンパ腫に対しmethotrexateの大量療法とCHOP（cyclophosphamide, adriamycin, vincristine, predonine）療法を組み合わせたM-CHOP療法が行われるようになり効果をあげている³⁾．治療の評価としては，一般に造影MRIが用いられるが，脳血液関門の障害および血管床をみているもので，腫瘍自体を評価しているわけではない．

　[¹⁸F] FDG（fluorodeoxyglucose）を用いたPET（positron emission tomography）検査は，糖代謝を評価することが可能であり，腫瘍の悪性度および治療効果の判定に有用であると報告されている⁵⁾．悪性リンパ腫に対する治療効果の判定にFDG-PETの有用性が報告されているが⁵⁾，造影MRIの所見との違いについて検討された報告はない．

　今回われわれは，悪性リンパ腫の3例に対しM-CHOP療法および放射線治療を施行し，その治療効果の判定にFDG-PETを用い，造影MRIの所見と比較検討したので文献的考察を加えて報告する．

　We have reported three cases of central nervous system malignant lymphoma in which FDG-PET was useful in monitoring therapeutic effects. Case 1 : A 53-year-old man complained of gait and memory disturbance. An MRI of the patient's brain showed enhanced mass lesions in the bifrontal lobe. An FDG-PET showed markedly high uptake of the tracer,which means a higher metabolism of glucose. The tumor was biopsied and the histological diagnosis was diffuse B cell lymphoma. The patient received chemotherapy and external irradiation therapy. Case 2 : A 64-year-old woman suffered memory disturbance and left hemiparesis. An MRI showed a right frontal mass lesion,and FDG-PET showed high uptake of glucose. After the histological diagnosis was determined as diffuse large B cell lymphoma,the patient received the same therapy as case 1. Case 3 : A 55-year-old woman suffered right hemianopsia. An MRI showed an enhanced lesion in the right basal ganglia and an FDG-PET showed high uptake of glucose. After the histological diagnosis was determined as diffuse large B cell lymphoma,the patient received the same therapy as case 1 and 2. In all cases,high uptake of glucose disappeared on the PET after initial chemotherapy,although an enhanced lesion continued on MRI even after radiation. FDG-PET was useful in monitoring the therapeutic effects of malignant lymphoma. These results indicate that we were able to confirm the effectiveness of the therapy in the early stage.