Neurological Surgery 脳神経外科45巻11号

2017年11月発行

連載 脳神経外科診療に役立つPETによる診断法

（4）PETの脳腫瘍への応用

著者： 山口秀¹

所属機関： ¹北海道大学大学院医学研究科脳神経外科

ページ範囲：P.1015 - P.1024

Ⅰ．はじめに
　脳腫瘍の診断や治療において，magnetic resonance imaging（MRI）を中心とした形態学的画像が重要であることは言うまでもないが，近年positron emission tomography（PET）検査を中心とした代謝情報の有用性も認識されている．しかしながら，腫瘍に対するPET検査が依然として¹⁸F-fluorodeoxyglucose（FDG）のみしか保険で認められていないため，FDGが生理的に集積してしまう脳実質内に存在する脳腫瘍に対しては，一般的な検査としては認識されていないことも事実である．本稿では，FDGのみではなく，現在臨床の現場で実際に使用されているPET核種を紹介するとともに，その有用性に関して，特に¹¹C-methionine（MET）を中心に述べる．

参考文献

F-fluorodeoxyglucose positron-emission tomography. J Neurooncol 107：379-386, 2012

C-methionine-positron emission tomography on gross tumor volume delineation in stereotactic radiotherapy of skull base meningiomas. Int J Radiat Oncol Biol Phys 72：1161-1167, 2008

C］methionine. Eur J Nucl Med Mol Imaging 30：1561-1567, 2003

F-fluoromisonidazole PET：toward clinical translation. Semin Nucl Med 45：136-150, 2015

5) Goldman S, Levivier M, Pirotte B, Brucher JM, Wikler D, Damhaut P, Dethy S, Brotchi J, Hildebrand J：Regional methionine and glucose uptake in high-grade gliomas：a comparative study on PET-guided stereotactic biopsy. J Nucl Med 38：1459-1462, 1997

F-Fluoromisonidazole positron emission tomography may differentiate glioblastoma multiforme from less malignant gliomas. Eur J Nucl Med Mol Imaging 39：760-770, 2012

7) Iuchi T, Hatano K, Uchino Y, Itami M, Hasegawa Y, Kawasaki K, Sakaida T, Hara R：Methionine uptake and required radiation dose to control glioblastoma. Int J Radiat Oncol Biol Phys 93：133-140, 2015

8) Jager PL, Vaalburg W, Pruim J, de Vries EG, Langen KJ, Piers DA：Radiolabeled amino acids：basic aspects and clinical applications in oncology. J Nucl Med 42：432-445, 2001

9) Kaschten B, Stevenaert A, Sadzot B, Deprez M, Degueldre C, Del Fiore G, Luxen A, Reznik M：Preoperative evaluation of 54 gliomas by PET with fluorine-18-fluorodeoxyglucose and/or carbon-11-methionine. J Nucl Med 39：778-785, 1998

C-methionine positron emission tomography in basal germinoma：assessment of treatment response and residual tumor. Childs Nerv Syst 25：845-853, 2009

and VEGF in newly diagnosed and recurrent malignant gliomas. Eur J Nucl Med Mol Imaging 41：1870-1878, 2014

F-FDG PET. Eur J Nucl Med Mol Imaging 32：52-59, 2005

C-methionine PET in glioma patients. Eur J Nucl Med Mol Imaging 42：1071-1080, 2015

C]L-methionine positron emission tomography：local comparison with stereotactic histopathology. Clin Cancer Res 10：7163-7170, 2004

15) Manabe O, Hattori N, Yamaguchi S, Hirata K, Kobayashi K, Terasaka S, Kobayashi H, Motegi H, Shiga T, Magota K, Oyama-Manabe N, Nishijima K, Kuge Y, Tamaki N：Oligodendroglial component complicates the prediction of tumour grading with metabolic imaging. Eur J Nucl Med Mol Imaging 42：896-904, 2015

C］methionine positron emission tomography for target definition of glioblastoma multiforme in radiation therapy planning. Int J Radiat Oncol Biol Phys 82：83-89, 2012

17) Menegakis A, Eicheler W, Yaromina A, Thames HD, Krause M, Baumann M：Residual DNA double strand breaks in perfused but not in unperfused areas determine different radiosensitivity of tumours. Radiother Oncol 100：137-144, 2011

C-methionine PET：visual assessment versus quantitative assessment. PLoS One 10：e0132515, 2015

C］methionine-positron emission tomography as a biological monitoring tool in the treatment of glioma. J Neurosurg 103：498-507, 2005

C］methionine into astrocytomas and oligodendrogliomas. J Neurooncol 93：233-241, 2009

21) Okamoto S, Shiga T, Hattori N, Kubo N, Takei T, Katoh N, Sawamura Y, Nishijima K, Kuge Y, Tamaki N：Semiquantitative analysis of C-11 methionine PET may distinguish brain tumor recurrence from radiation necrosis even in small lesions. Ann Nucl Med 25：213-220, 2011

distribution and bioreductive enzymes in human malignant brain tumors. Int J Radiat Oncol Biol Phys 29：427-431, 1994

23) Rasey JS, Nelson NJ, Chin L, Evans ML, Grunbaum Z：Characteristics of the binding of labeled fluoromisonidazole in cells in vitro. Radiat Res 122：301-308, 1990

C-methionine positron emission tomography. J Neurosurg 114：1640-1647, 2011

25) Stockham AL, Tievsky AL, Koyfman SA, Reddy CA, Suh JH, Vogelbaum MA, Barnett GH, Chao ST：Conventional MRI does not reliably distinguish radiation necrosis from tumor recurrence after stereotactic radiosurgery. J Neurooncol 109：149-158, 2012

C-methionine positron emission tomographic scan of basal ganglia germinoma with cerebral hemiatrophy. AJNR Am J Neuroradiol 24：1909-1911, 2003

27) Tanaka Y, Nariai T, Momose T, Aoyagi M, Maehara T, Tomori T, Yoshino Y, Nagaoka T, Ishiwata K, Ishii K, Ohno K：Glioma surgery using a multimodal navigation system with integrated metabolic images. J Neurosurg 110：163-172, 2009

C-methionine PET for differentiation of recurrent brain tumors from radiation necrosis after radiotherapy. J Nucl Med 49：694-699, 2008

F-fluoromisonidazole positron emission tomography can predict pathological necrosis of brain tumors. Eur J Nucl Med Mol Imaging 43：1469-1476, 2016

30) Toyonaga T, Yamaguchi S, Hirata K, Kobayashi K, Manabe O, Watanabe S, Terasaka S, Kobayashi H, Hattori N, Shiga T, Kuge Y, Tanaka S, Ito YM, Tamaki N：Hypoxic glucose metabolism in glioblastoma as a potential prognostic factor. Eur J Nucl Med Mol Imaging 44：611-619, 2017

C］methionine uptake in brain tumours：initial results of a comparative study. Eur J Nucl Med 27：542-549, 2000

C-methionine：report of two cases. J Neurooncol 101：335-341, 2011

F-FDG PET for primary central nervous system lymphoma. Ann Nucl Med 28：603-609, 2014

34) Yamaguchi S, Hirata K, Kaneko S, Kobayashi H, Shiga T, Kobayashi K, Onimaru R, Shirato H, Tamaki N, Terasaka S, Houkin K：Combined use of 18 F-FDG PET and corticosteroid for diagnosis of deep-seated primary central nervous system lymphoma without histopathological confirmation. Acta Neurochir（Wien）157：187-194, 2015

F-fluoromisonidazole PET is an early predictor of the prognosis in the patients with recurrent high-grade glioma receiving bevacizumab treatment. PLoS One 11：e0167917, 2016

C-methionine PET on expected management of patients with brain neoplasm. Eur J Nucl Med Mol Imaging 37：685-690, 2010