A vascular lesion mimicking a primitive brain tumour in a patient examined by 18F-choline PET/CT and MRI

Cascini, G.L.; Restuccia, A.; De Vincenti, T.; Manti, F.; Calabria, F.

doi:10.1016/j.remnie.2015.07.014

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(B) The fused PET/CT coronal image confirms the FDG uptake in these lymph node locations and bone lesions in multiple lytic and blastic lesions in spine, ribs, sternum, right scapula, ilium and proximal third of the left femoral shaft. (C) The transaxial PET/CT fused images reveals mild FDG uptake in pulmonary nodules less than one centimeter in size that does not rule out pulmonary metastases." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.M. Mena, E. Carmona, F.R. Maza, M.V. Guiote, E. Moreno, J.A. Vallejo" "autores" => array:6 [ 0 => array:2 [ "nombre" => "L.M." "apellidos" => "Mena" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Carmona" ] 2 => array:2 [ "nombre" => "F.R." "apellidos" => "Maza" ] 3 => array:2 [ "nombre" => "M.V." "apellidos" => "Guiote" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Moreno" ] 5 => array:2 [ "nombre" => "J.A." 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Gungor, M. Mazican, I. Koc, H. Bal, N. Mazican" "autores" => array:5 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Gungor" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Mazican" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Koc" ] 3 => array:2 [ "nombre" => "H." "apellidos" => "Bal" ] 4 => array:2 [ "nombre" => "N." "apellidos" => "Mazican" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000877?idApp=UINPBA00004N" "url" => "/22538089/0000003400000005/v1_201508130058/S2253808915000877/v1_201508130058/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "Interesting image" "titulo" => "A vascular lesion mimicking a primitive brain tumour in a patient examined by 18F-choline PET/CT and MRI" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "335" "paginaFinal" => "336" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "G.L. Cascini, A. Restuccia, T. De Vincenti, F. Manti, F. Calabria" "autores" => array:5 [ 0 => array:3 [ "nombre" => "G.L." "apellidos" => "Cascini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Restuccia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "T." "apellidos" => "De Vincenti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "F." "apellidos" => "Manti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:4 [ "nombre" => "F." "apellidos" => "Calabria" "email" => array:1 [ 0 => "ferdinandocalabria@hotmail.it" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Diagnostic Imaging, Nuclear Medicine Unit, Magna Graecia University, Catanzaro, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Diagnostic Imaging, Radiology Unit, Magna Graecia University, Catanzaro, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology – National Research Council (IBFM; CNR), Catanzaro, Italy" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Una lesión vascular imitando un tumor cerebral primitivo en un paciente examinado con PET 18F-colina/TAC y RM" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1656 "Ancho" => 3250 "Tamanyo" => 706081 ] ] "descripcion" => array:1 [ "en" => "Whole skull images. Upper side. Initial PET, CT and PET/CT axial views (a, a′, a″) of a suspected brain lesion with high tracer uptake in the right temporal lobe. Corresponding MR T1-weighted post-contrast and T2-FLAIR axial views (b, c) show vascular lesion with blood–brain-barrier disruption and haemorrhagic transformation in the same side. Bottom side. Post-treatment PET, CT and PET/CT axial views (d, d′, d″) show reduction of the uptake in the right temporal lobe. Corresponding MR T1-weighted post-contrast and T2-FLAIR axial views (e, f) show a lacunar area, confirming the diagnosis of a vascular haemorrhagic lesion." ] ] ] "textoCompleto" => "A 67-year-old man with headache and dizziness was submitted to a contrast-enhanced CT of the brain that showed an area of non-homogeneous contrast enhancement in the right temporal lobe. Initially, the MRI was not performed, due to a metallic sliver in the skull. A PET/CT with 18F-choline, carried out to obtain a metabolic characterization of the brain, showed an area of focal uptake in the right temporal lobe (SUVmax:11) with surrounding area of oedema, as evident in axial PET (a), CT (a′) and PET/CT views (a″). Considering both the anatomic and functional findings, a neoplastic brain lesion was suspected (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Subsequently, the preoperative anti-oedema premedication allowed a significant clinical improvement; a further CT showed unexpected reduction of the size of the lesion. Therefore, in accordance with the clinicians, we supposed a vascular disease. After the surgical extraction of the sliver in the skull, the MRI was performed and the results were suggestive for a vascular lesion with blood–brain-barrier disruption and haemorrhagic transformation, in T1-weighted post-contrast (b) and T2-FLAIR axial views (c).Three months after, additional PET/CT with 18F-choline and MRI showed meaningful reduction of the uptake (SUVmax:3.1) and the oedema (d, d′, d″) and a lacunar area on T1-weighted (e) and T2-FLAIR axial views (f). Therefore, the diagnosis of a post-haemorrhagic vascular lesion was confirmed.It is well known that 18F-choline is a marker of lipogenesis and a surrogate of rapid synthesis of cell membrane in the neoplasms; nevertheless, the 18F-choline is a non-specific tumour tracer.<a class="elsevierStyleCrossRef" href="#bib0020">1</a>As known in literature, caution is mandatory when we diagnose neoplastic lesions 18F-choline avid, because of a large amount of false positive cases and pitfalls with high tracer uptake, as well described for inflammation<a class="elsevierStyleCrossRef" href="#bib0020">1</a> and benign tumours, especially in the brain.<a class="elsevierStyleCrossRef" href="#bib0025">2</a>In our report, the uptake of the tracer was associated to a vascular lesion, mimicking the metabolic activity of a tumour, consequent to the damage of the blood–brain-barrier and the activation of some cellular types such as macrophages and fibroblasts (with an high rate of lipogenesis). Moreover, similar false positive findings are already known for other radiopharmaceuticals.<a class="elsevierStyleCrossRef" href="#bib0030">3</a>In conclusion, 18F-choline PET/CT seems not suitable for characterization of suspected brain lesions. The necessary correlation with MRI is of the utmost importance.FundingThe authors declare that they did not receive funding for this work by any of the following organizations: National Institutes of Health (NIH), Wellcome Trust, Howard Hughes Medical Institute (HHMI), or others.Conflict of interestThe authors declare that they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:2 [ "identificador" => "xack183048" "titulo" => "Acknowledgements" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1656 "Ancho" => 3250 "Tamanyo" => 706081 ] ] "descripcion" => array:1 [ "en" => "Whole skull images. Upper side. Initial PET, CT and PET/CT axial views (a, a′, a″) of a suspected brain lesion with high tracer uptake in the right temporal lobe. Corresponding MR T1-weighted post-contrast and T2-FLAIR axial views (b, c) show vascular lesion with blood–brain-barrier disruption and haemorrhagic transformation in the same side. Bottom side. Post-treatment PET, CT and PET/CT axial views (d, d′, d″) show reduction of the uptake in the right temporal lobe. Corresponding MR T1-weighted post-contrast and T2-FLAIR axial views (e, f) show a lacunar area, confirming the diagnosis of a vascular haemorrhagic lesion." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "18F-choline PET/CT pitfalls in image interpretation: an update on 300 examined patients with prostate cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Calabria" 1 => "A. Chiaravalloti" 2 => "O. Schillaci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RLU.0000000000000303" "Revista" => array:6 [ "tituloSerie" => "Clin Nucl Med" "fecha" => "2014" "volumen" => "39" "paginaInicial" => "122" "paginaFinal" => "130" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24368525" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of intracranial meningioma detected by (18)F-choline PET/CT and examined by PET/MRI fusion imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Calabria" 1 => "E. Calabria" 2 => "A. Chiaravalloti" 3 => "M. Barbarisi" 4 => "O. Schillaci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.remn.2013.06.006" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Med Nucl Imagen Mol." "fecha" => "2014" "volumen" => "33" "paginaInicial" => "306" "paginaFinal" => "307" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25017381" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The current status of novel PET radio-pharmaceuticals in radiotherapy treatment planning of glioma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Marvaso" 1 => "A. Barone" 2 => "N. Amodio" 3 => "G.L. Cascini" 4 => "V. Scotti" 5 => "C. Bianco" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Pharm Biotechnol" "fecha" => "2014" "volumen" => "14" "paginaInicial" => "1099" "paginaFinal" => "1104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24725130" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack183048" "titulo" => "Acknowledgements" "texto" => "The authors thank Stefania Barbiere and Valentina K. Setzu for the assistance in editing the manuscript." 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The Revista Española de Medicina Nuclear e Imagen Molecular (Spanish Journal of Nuclear Medicine and Molecular Imaging), was founded in 1982, and is the official journal of the Spanish Society of Nuclear Medicine and Molecular Imaging, which has more than 700 members. The Journal, which publishes 6 regular issues per year, has the promotion of research and continuing education in all fields of Nuclear Medicine as its main aim. For this, its principal sections are Originals, Clinical Notes, Images of Interest, and Special Collaboration articles. The works may be submitted in Spanish or English and are subjected to a peer review process. In 2009, it became the leading Spanish journal in the field of Medical Imaging on having an Impact Factor , awarded by the Journal Citation Reports.

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