Kimura H, Takeno Y, Fukushima T
Department of Neurosurgery, Fukuoka Red Cross Hospital, Japan.
Neurol Med Chir (Tokyo). 1995 May;35(5):317-20. doi: 10.2176/nmc.35.317.
A 63-year-old female presented with recurrent glioblastoma at the site of a right parietal glioblastoma which was diagnosed 1 year before. She was treated at that time by total removal of the tumor, irradiation, and chemotherapy. Four months after the initial treatment, serial thallium-201 single photon emission computed tomography (201Tl SPECT) showed increased uptake at the edge of the original tumor site. The index, the ratio of 201Tl uptake in the lesion to the normal brain, was 2.9 which suggested a recurrent tumor. Magnetic resonance images with gadolinium over the next 7 months demonstrated an enhanced mass lesion at the site of primary tumor resection and a new enhanced mass in the right temporal lobe. The lesion in the right parietal lobe had a 201Tl uptake index of 2.5, while the lesion in the right temporal lobe had an index of 1.5. Re-craniotomy and total resection of the tumors in the right parietal and temporal lobes were performed. The histological diagnosis of both tumors was glioblastoma. The proposed use of 201Tl SPECT for the differential diagnosis of recurrent glioma and radiation necrosis should be carefully considered because the 201Tl uptake index can vary in tumor with the same malignancy grade.
一名63岁女性，在1年前被诊断为右顶叶胶质母细胞瘤的部位出现复发性胶质母细胞瘤。她当时接受了肿瘤全切、放疗和化疗。初始治疗4个月后，连续的铊-201单光子发射计算机断层扫描（201Tl SPECT）显示原肿瘤部位边缘摄取增加。病变部位铊-201摄取与正常脑摄取的比值即指数为2.9，提示肿瘤复发。在接下来的7个月里，钆增强磁共振成像显示在原发肿瘤切除部位有强化的肿块病变，并且在右颞叶有一个新的强化肿块。右顶叶病变的铊-201摄取指数为2.5，而右颞叶病变的指数为1.5。对右顶叶和颞叶肿瘤进行了再次开颅并全切。两个肿瘤的组织学诊断均为胶质母细胞瘤。由于相同恶性程度的肿瘤其铊-201摄取指数可能不同，因此对于将201Tl SPECT用于复发性胶质瘤与放射性坏死的鉴别诊断应谨慎考虑。
