Kim D G, Kim C Y, Paek S H, Lee D S, Chung J K, Jung H W, Cho B K
Department of Neurosurgery, Seoul National University College of Medicine, Korea.
Acta Neurochir (Wien). 1998;140(7):665-73; discussion 673-4. doi: 10.1007/s007010050161.
To determine its roles in the diagnosis and the systemic evaluation of metastatic brain tumours, whole-body positron emission tomography (PET) using [18F]FDG was performed in 20 consecutive patients.
All patients were thought to be suffering or needing to be differentiated from metastatic brain tumours. Nine patients had multiple brain lesions; six were older and showed a rim-enhancing lesion with surrounding oedema; seven had homogeneously enhancing periventricular lesion(s) on computed tomography (CT) and/or magnetic resonance (MR) imaging, thought to be central nervous system lymphomas. Two patients had skull mass(es) and two patients had a solid mass suspected to be, respectively, a haemorrhagic metastasis and a metastatic malignant melanoma. All of them received whole-body [18F]FDG PET and conventional systemic work-up for metastasis in order to compare the results of the two methods.
Metastatic brain tumours were diagnosed on whole-body [18F]FDG PET in eleven patients who had extracranial and intracranial hypermetabolic lesions. In nine of these, a conventional work-up also detected primary lesions which on whole-body [18F]FDG PET were seen to be hypermetabolic foci. Systemic lymph node metastases were detected by whole-body [18F]FDG PET only in two patients and histological diagnosis was possible by biopsy of lymph nodes rather than of brain lesions. In the remaining nine patients who had only intracranial hypermetabolic foci, histological diagnosis was made by craniotomy or stereotactic biopsy. It was confirmed that seven of nine patients were suffering from a primary brain tumour and two from metastatic carcinoma. None of the nine showed evidence of systemic cancer on conventional work-up. Histological diagnoses of the primary brain tumours were four cases of primary central nervous system lymphoma and one each of multifocal glioblastoma, Ewing's sarcoma, and cavernous angioma. Patients felt no discomfort during the whole-body [18F]FDG PET procedure and there were no complications. The false negative rate in [18F]FDG PET and in conventional work-up was 15.4% and 30.7% respectively. There were no false positives on either [18F]FDG PET or conventional work-up.
It is suggested that whole-body [18F]FDG PET is a safe, reliable, and convenient method for the diagnosis and systemic evaluation of patients thought to be suffering or needing to be differentiated from a metastatic brain tumour.
为确定全身正电子发射断层扫描（PET）在转移性脑肿瘤诊断及全身评估中的作用，对20例连续患者进行了[18F]FDG全身正电子发射断层扫描。
所有患者被认为患有或需要与转移性脑肿瘤相鉴别。9例患者有多发脑病变；6例年龄较大，表现为边缘强化伴周围水肿的病变；7例在计算机断层扫描（CT）和/或磁共振成像（MR）上有均匀强化的脑室周围病变，考虑为中枢神经系统淋巴瘤。2例患者有颅骨肿块，2例患者有实性肿块，分别怀疑为出血性转移瘤和转移性恶性黑色素瘤。所有患者均接受了全身[18F]FDG PET检查及常规的转移灶全身检查，以比较两种检查方法的结果。
11例患者在全身[18F]FDG PET上被诊断为转移性脑肿瘤，这些患者有颅外和颅内高代谢病变。其中9例患者，常规检查也检测到了原发灶，在全身[18F]FDG PET上表现为高代谢灶。仅2例患者通过全身[18F]FDG PET检测到全身淋巴结转移，通过淋巴结活检而非脑病变活检可进行组织学诊断。其余9例仅有颅内高代谢灶的患者，通过开颅手术或立体定向活检进行组织学诊断。证实9例患者中有7例患有原发性脑肿瘤，2例患有转移性癌。9例患者在常规检查中均未显示全身癌症迹象。原发性脑肿瘤的组织学诊断为4例原发性中枢神经系统淋巴瘤，1例多灶性胶质母细胞瘤、1例尤因肉瘤和1例海绵状血管瘤。患者在全身[18F]FDG PET检查过程中未感到不适，也无并发症发生。[18F]FDG PET和常规检查的假阴性率分别为15.4%和30.7%。[18F]FDG PET和常规检查均无假阳性。
提示全身[18F]FDG PET是一种安全、可靠且便捷的方法，可用于对被认为患有或需要与转移性脑肿瘤相鉴别的患者进行诊断及全身评估。
