Interesting image
A vascular lesion mimicking a primitive brain tumour in a patient examined by 18F-choline PET/CT and MRI
Una lesión vascular imitando un tumor cerebral primitivo en un paciente examinado con PET 18F-colina/TAC y RM
a Department of Diagnostic Imaging, Nuclear Medicine Unit, Magna Graecia University, Catanzaro, Italy
b Department of Diagnostic Imaging, Radiology Unit, Magna Graecia University, Catanzaro, Italy
c Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology – National Research Council (IBFM; CNR), Catanzaro, Italy
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"apellidos" => "Cascini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Restuccia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "T." "apellidos" => "De Vincenti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "F." "apellidos" => "Manti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:4 [ "nombre" => "F." "apellidos" => "Calabria" "email" => array:1 [ 0 => "ferdinandocalabria@hotmail.it" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "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 <span class="elsevierStyleSup">18</span>F-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" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">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 <span class="elsevierStyleSup">18</span>F-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>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">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).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Three months after, additional PET/CT with <span class="elsevierStyleSup">18</span>F-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.</p><p id="par0020" class="elsevierStylePara elsevierViewall">It is well known that <span class="elsevierStyleSup">18</span>F-choline is a marker of lipogenesis and a surrogate of rapid synthesis of cell membrane in the neoplasms; nevertheless, the <span class="elsevierStyleSup">18</span>F-choline is a non-specific tumour tracer.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">As known in literature, caution is mandatory when we diagnose neoplastic lesions <span class="elsevierStyleSup">18</span>F-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"><span class="elsevierStyleSup">1</span></a> and benign tumours, especially in the brain.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, <span class="elsevierStyleSup">18</span>F-choline PET/CT seems not suitable for characterization of suspected brain lesions. The necessary correlation with MRI is of the utmost importance.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">The 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.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "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" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] ] "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" => "<span class="elsevierStyleSup">18</span>F-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" => "<p id="par0050" class="elsevierStylePara elsevierViewall">The authors thank Stefania Barbiere and Valentina K. Setzu for the assistance in editing the manuscript.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003400000005/v1_201508130058/S2253808915000889/v1_201508130058/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003400000005/v1_201508130058/S2253808915000889/v1_201508130058/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000889?idApp=UINPBA00004N" ]
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