Cicone Francesco, Clerico Anna, Minniti Giuseppe, Paiano Milena, Carideo Luciano, Scaringi Claudia, Langen Karl-Josef, Scopinaro Francesco
Unit of Nuclear Medicine, Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" University of Rome, Rome, Italy.
Unit of Pediatric Oncology, Department of Paediatrics and Infantile Neuropsychiatry, "Sapienza" University of Rome, Rome, Italy.
World Neurosurg. 2016 Sep;93:490.e7-490.e11. doi: 10.1016/j.wneu.2016.06.058. Epub 2016 Jun 21.
Medulloblastoma (MDB) is an aggressive embryonal brain tumor, with underlying altered genetics and biological pathways that account for very heterogeneous natural histories and clinical behaviors. Positron emission tomography (PET) using radiolabeled amino acids provides important metabolic information for the diagnosis of cerebral glioma but only a few data are available on amino acid PET in MDB. In particular, no cases of MDB imaging with 6-[(18)F]-fluoro-L-3,4-dihydroxyphenylalanine (F-DOPA) have previously been described.
Two patients with different histologic subtypes of MDB were referred for F-DOPA PET to define the extent and metabolic degree of their diseases. The patients had a newly diagnosed large-cell/anaplastic MDB and a fourth relapse of classic MDB, respectively. F-DOPA PET was unremarkable in the first case; F-DOPA uptake was low in the second patient with the tumor/background ratio as high as 1.29. Comparison was made with magnetic resonance imaging, which showed fluid-attenuated inversion recovery positive diseases. Aggressive tumor growth was shown in the clinical course of both patients.
The 2 cases reported here suggest that sensitivity of F-DOPA PET in MDB can be low. However, more comprehensive data are needed to conclude on the overall accuracy of F-DOPA PET in MDB.
髓母细胞瘤(MDB)是一种侵袭性胚胎性脑肿瘤,其潜在的基因改变和生物学途径导致了非常异质的自然病史和临床行为。使用放射性标记氨基酸的正电子发射断层扫描(PET)为脑胶质瘤的诊断提供了重要的代谢信息,但关于MDB中氨基酸PET的可用数据很少。特别是,以前没有描述过用6-[(18)F]-氟-L-3,4-二羟基苯丙氨酸(F-DOPA)对MDB进行成像的病例。
两名患有不同组织学亚型MDB的患者被转诊进行F-DOPA PET检查,以确定其疾病的范围和代谢程度。这两名患者分别患有新诊断的大细胞/间变性MDB和经典MDB的第四次复发。第一例患者的F-DOPA PET检查无异常;第二例患者的F-DOPA摄取较低,肿瘤/背景比值高达1.29。与磁共振成像进行了比较,磁共振成像显示液体衰减反转恢复阳性疾病。两名患者的临床病程均显示肿瘤生长活跃。
这里报告的2例病例表明,F-DOPA PET在MDB中的敏感性可能较低。然而,需要更全面的数据才能得出F-DOPA PET在MDB中的总体准确性结论。