title: Usefulness of 11C-methionine-positron emission tomography for the diagnosis of progressive multifocal leukoencephalopathy.
abstract: Progressive multifocal leukoencephalopathy (PML) is a subacute demyelinating disease of the brain caused by the JC virus that occurs mainly in immunocompromised patients. The prognosis is very poor. As the lesion looks like non- specific leukoencephalopathy, making a diagnosis at the early stage is very difficult. We report three PML cases in which there was a mismatch between (11)C-methionine-positron emission tomography (MET-PET) uptake and (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) uptake. All three cases demonstrated the hyper-uptake of MET around the white matter lesions and hypo-uptake of FDG inside the lesions. We speculate that the infection had ended inside the white matter lesions of these patients, while JC virus infection was ongoing around the lesions, resulting in the increase of methionine metabolism, and the glucose metabolism was reduced or intermediate because inflammatory cells infiltrate PML lesions rarely. Two patients who were diagnosed and treated with mefloquine while the JC virus was at a low level in the cerebrospinal fluid are still alive. We suggest the usefulness of MET-PET for the early diagnosis of PML and early treatment with mefloquine.
authors.affiliation: Department of Neurology, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo, 060-8638, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Shirai
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yabe
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kano
authors.forename: Yuka
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Toru
authors.initials: T
authors.lastname: Sasamori
authors.forename: Kazunori
authors.initials: K
authors.lastname: Sato
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirotani
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nonaka
authors.forename: Ikuko
authors.initials: I
authors.lastname: Takahashi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Matsushima
authors.forename: Naoya
authors.initials: N
authors.lastname: Minami
authors.forename: Kazuo
authors.initials: K
authors.lastname: Nakamichi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Saijo
authors.forename: Kanako C
authors.initials: KC
authors.lastname: Hatanaka
authors.forename: Tohru
authors.initials: T
authors.lastname: Shiga
authors.forename: Shinya
authors.initials: S
authors.lastname: Tanaka
authors.forename: Hidenao
authors.initials: H
authors.lastname: Sasaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007577:JC Virus / Q000472:pathogenicity; D007968:Leukoencephalopathy, Progressive Multifocal / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology / Q000821:virology; D008297:Male; D015767:Mefloquine / Q000627:therapeutic use; D008715:Methionine; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D019788:Fluorodeoxyglucose F18; C086242:carbon-11 methionine; D008715:Methionine; D015767:Mefloquine