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Cobes N, Tran S, Bielle F, Touat M, Kas A, Rozenblum L. Étude de l’expression de LAT-1 et de la fixation de la 18F-FDOPA dans les tumeurs cérébrales. Illustration par une série de cas. MÉDECINE NUCLÉAIRE 2023. [DOI: 10.1016/j.mednuc.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Noureldine MHA, Shimony N, Jallo GI. Malignant Spinal Tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:565-581. [PMID: 37452954 DOI: 10.1007/978-3-031-23705-8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Malignant spinal tumors constitute around 22% of all primary spinal tumors. The most common location of metastases to the spinal region is the extradural compartment. The molecular and genetic characterization of these tumors was the basis for the updated WHO classification of CNS tumors in 2016, where many CNS tumors are now diagnosed according to their genetic profile rather than relying solely on the histopathological appearance. Magnetic resonance imaging (MRI) is the current gold standard for the initial evaluation and subsequent follow-up on intradural spinal cord tumors, and the imaging sequences must include T2-weighted images (WI), short time inversion recovery (STIR), and pre- and post-contrast T1-WI in the axial, sagittal, and coronal planes. The clinical presentation is highly variable and depends on the tumor size, growth rate, type, infiltrative, necrotic and hemorrhagic potential as well as the exact location within the spinal compartment. Surgical intervention remains the mainstay of management of symptomatic and radiographically enlarging spinal tumors, where the goal is to achieve maximal safe resection. Tumor recurrences are managed with repeat surgical resection (preferred whenever possible and safe), radiotherapy, chemotherapy, or any combination of these therapies.
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Affiliation(s)
- Mohammad Hassan A Noureldine
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Johns Hopkins University School of Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Nir Shimony
- Johns Hopkins University School of Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Geisinger Medical Center, Institute of Neuroscience, Geisinger Commonwealth School of Medicine, Danville, PA, USA
| | - George I Jallo
- Institute for Brain Protections Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA.
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Li C, Wen B, Tian Y, Chen J, He Y. 68Ga-FAPI PET/CT Findings in a Rare Presacral Myxopapillary Ependymoma. Clin Nucl Med 2022; 47:385-386. [PMID: 35020638 DOI: 10.1097/rlu.0000000000003963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Myxopapillary ependymoma is a rare tumor. Most of them occur exclusively in the conus medullaris, cauda equina, or filum terminale. Here, we present the 68Ga-FAPI PET/CT findings in a 37-year-old woman with presacral myxopapillary ependymoma.
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Affiliation(s)
- Chongjiao Li
- From the Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
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Zheng F, Wanjun X, Shuaishuai W, Tong W, Lue Z. Diagnostic value of 18F-FDG PET/CT and MRI for intraspinal lesions: A comparative study. MEDICINE INTERNATIONAL 2021; 1:23. [PMID: 36698530 PMCID: PMC9829090 DOI: 10.3892/mi.2021.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/29/2021] [Indexed: 01/28/2023]
Abstract
The aim of the present study was to investigate the value of the use of fluorine-18 (18F)-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) vs. magnetic resonance imaging (MRI) for the diagnosis of and differentiation between benign and malignant lesions in the spinal canal. For this purpose, a retrospective analysis was performed on the use of MRI and 18F-FDG PET/CT from January, 2017 to December, 2020, and the final diagnosis was obtained by performing a post-operative pathological examination or following a tissue biopsy (gold standard). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the two examination techniques were calculated and comparisons between them were made. The PET metabolic parameters, maximum standardized uptake value (SUVmax), peak standardized uptake value (SUVpeak), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in the benign and malignant groups were calculated and compared, and the corresponding ROC curves were plotted. A total of 58 patients were enrolled, including 30 patients with malignant and 28 with benign lesions. The specificity of MRI was significantly higher than that of PET/CT (P<0.05). The sensitivity and negative predictive value of PET/CT were higher than those of MRI, although with no significant difference (P>0.05). The mean ± tandard deviation values of the PET metabolic parameters, SUVmax, SUVpeak, SUVmean, MTV and TLG, were 4.27±1.25, 3.49±1.07, 2.49±0.84, 6.58±5.36 and 17.12±15.50 in the benign, and 8.99±3.75, 7.35±3.26, 5.43±2.40, 12.25±12.18 and 112.41±85.98 in the malignant groups, respectively. The SUVmax, SUVpeak, SUVmean and TLG in the malignant group were higher than those in the benign group. The differences were all statistically significant (all P<0.0001). In distinguishing benign from malignant lesions, the area under the ROC curve (AUC) for SUVmax was 0.919, which was the largest, and the Youden index was 0.762, indicating 83.3% sensitivity and 92.9% specificity. The AUC for SUVpeak was 0.905 and that for SUVmean was 0.899. The aforementioned AUCs were significantly higher than those for MTV and TLG (0.609 and 0.786, respectively) (P<0.001). On the whole, the present study demonstrates that MRI is a reliable imaging technique for the diagnosis of intravertebral lesions. 18F-FDG PET/CT, as a noteworthy supplement to MRI, has a high sensitivity and accuracy for the qualitative diagnosis and identification of lesions. The synergistic effect of the two examination techniques may be helpful for a more accurate diagnosis.
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Affiliation(s)
- Fan Zheng
- Department of Orthopedics, The 4th People's Hospital of Shenyang, Liaoning, 110031, P.R. China,Correspondence to: Dr Fan Zheng, Department of Orthopedics, The 4th People's Hospital of Shenyang, 20 Huanghe South Street, Shenyang, Liaoning 110031, P.R. China
| | - Xiao Wanjun
- Department of Orthopedics, The 4th People's Hospital of Shenyang, Liaoning, 110031, P.R. China
| | - Wang Shuaishuai
- Department of Radiology, The 4th People's Hospital of Shenyang, Liaoning, 110031, P.R. China
| | - Wang Tong
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Zou Lue
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
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Kiamanesh Z, Banezhad F, Nasiri Z, Emami F, Treglia G, Sadeghi R. Physiological distribution of 18F-FDG in the spinal cord: A systematic review. J Spinal Cord Med 2021; 44:517-524. [PMID: 31682787 PMCID: PMC8288118 DOI: 10.1080/10790268.2019.1672954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Context: The importance of physiologic distribution of 18F-FDG in the spinal cord.Objective: The recognition of the physiologic distribution of 18F-FDG in the spinal cord is pivotal for accurate PET/CT imaging interpretation, especially in oncologic patients. Therefore, we performed a systematic review to investigate the normal distribution of 18F-FDG throughout the spinal cord.Methods: Data sources: We carried out a comprehensive search of the literature on the physiologic patterns of 18F-FDG distribution in the spinal cord. PubMed and Scopus databases were searched using the following keywords: "spinal cord" AND "FDG". Data extraction: Findings of the selected articles were described.Results: Thirteen studies comprising 24,125 patients entered the systematic review. These investigations showed discrepancies in location, size, number, and intensity of 18F-FDG uptake throughout the spinal cord. However, cumulative results showed that 18F-FDG uptake was higher in the lower thoracic portion of spinal cord (T11-T12). Moreover, a decreasing trend in 18F-FDG uptake was observed from cervical to lumbar levels. Low maximal standardized uptake values, female sex, and higher body weight seem to be related to the physiological spinal cord 18F-FDG uptake.Conclusions: On 18F-FDG PET/CT imaging, focal hypermetabolism of the spinal cord at the level of lower thoracic and lower cervical vertebrae should be considered physiological until proven otherwise.
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Affiliation(s)
- Zahra Kiamanesh
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farnaz Banezhad
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zakieh Nasiri
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farshad Emami
- Nuclear Medicine & Molecular Imaging Department, Imam Reza International University, Mashhad, Iran
| | - Giorgio Treglia
- Clinic of Nuclear Medicine and PET/CT Center, Ente Ospedaliero Cantonale, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland,Health Technology Assessment Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland,Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran,Correspondence to: Ramin Sadeghi, Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; +985138012794. ;
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Jeon I, Choi JH. Isolated thoracic intramedullary Erdheim-Chester disease presenting with paraplegia: a case report and literature review. BMC Musculoskelet Disord 2021; 22:270. [PMID: 33711983 PMCID: PMC7955615 DOI: 10.1186/s12891-021-04061-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/08/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Erdheim-Chester disease (ECD) is a rare, idiopathic, systemic non-Langerhans cell histiocytosis involving long bone and visceral organs. Central nervous system (CNS) involvement is uncommon and most cases develop as a part of systemic disease. We present a rare case of variant ECD as an isolated intramedullary tumor. CASE PRESENTATION A 75-year-old female patient with a medical history of diabetes and hypertension presented with sudden-onset flaccid paraparesis for 1 day. Neurological examination revealed grade 2-3 weakness in both legs, decreased deep tendon reflex, loss of anal tone, and numbness below T4. Leg weakness deteriorated to G1 before surgery. Preoperative magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) showed an intramedullary mass lesion at T2-T4 with no systemic lesion, which was heterogeneous enhancement pattern with cord swelling and edema from C7 to T6. Gross total removal was achieved for the white-gray-colored and soft-natured intramedullary mass lesion with an ill-defined boundary. Histological finding revealed benign histiocytic proliferation with foamy histiocytes and uniform nuclei. We concluded it as an isolated intramedullary ECD. The patient showed self-standing and walkable at 18-month with no evidence of recurrence and new lesion on spine MRI and whole-body FDG-PET/CT until sudden occurrence of unknown originated thoracic cord infarction. CONCLUSIONS We experienced an extremely rare case of isolated intramedullary ECD, which was controlled by surgical resection with no adjuvant therapy. Histological examination is the most important for final diagnosis, and careful serial follow-up after surgical resection is required to identify the recurrence and progression to systemic disease.
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Affiliation(s)
- Ikchan Jeon
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Hyeonchung street 170, 42415, Daegu, South Korea.
| | - Joon Hyuk Choi
- Department of Pathology, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea
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Arima H, Naito K, Yamagata T, Kawahara S, Ohata K, Takami T. Quantitative Analysis of Near-Infrared Indocyanine Green Videoangiography for Predicting Functional Outcomes After Spinal Intramedullary Ependymoma Resection. Oper Neurosurg (Hagerstown) 2020; 17:531-539. [PMID: 30888018 DOI: 10.1093/ons/opz040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 02/14/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND One of the most critical steps in surgery for spinal intramedullary ependymomas is the resection of small feeding arteries from the anterior spinal artery with anatomical preservation of the normal circulation of the ventral spinal cord. OBJECTIVE To quantitatively analyze the microcirculation of the ventral spinal cord by near-infrared indocyanine green videoangiography (ICG-VA) after the spinal intramedullary ependymoma resection. METHODS This retrospective study included 12 patients (7 male and 5 female; average age 55.2 years, range 36-79 years). Patients' neurological conditions were assessed based on the modified McCormick functional schema of grade 1 (neurologically normal) to 5 (severe deficit). Postoperative functional assessment was conducted at least 3 months after surgery. Quantitative analysis of vascular flow dynamics was carried out following spinal intramedullary ependymoma resection. Fluorescence intensities were measured and the indocyanine green (ICG) intensity-time curves were analyzed and compared with the functional outcomes after surgery. RESULTS Microscopically total or subtotal resection of the intramedullary ependymoma was achieved in all cases. Average peak time on ICG-VA was significantly shorter in the postoperative functional grade 1 to 2 group than in the postoperative functional grade 3 to 5 group, but there was no significant difference in average peak intensity between the 2 groups. Postoperative functional grade and the peak time of ICG, but not peak intensity, appeared correlated. CONCLUSION To the best of our knowledge, this is the first report showing that quantitative analysis of ICG-VA may predict functional outcomes after spinal intramedullary ependymoma resection.
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Affiliation(s)
- Hironori Arima
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kentaro Naito
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toru Yamagata
- Department of Neurosur-gery, Osaka City General Hospital, Osaka, Japan
| | - Shinichi Kawahara
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Abstract
Glioblastoma is the most common primary malignant tumor of the central nervous system, most of which occur in the brain. Primary spinal cord glioblastoma is extremely rare. A 47-year-old woman presented with recurrent and progressive paresthesia and paralysis of right lower extremity. MR examination revealed a marked nodular enlargement of spinal cord at the T12 level, showing heterogeneous enhancement. FDG PET/CT showed this intraspinal lesion with high FDG uptake. Imaging findings indicated a possible diagnosis of malignant neoplasm. Surgical resection was performed, and the pathologic results confirmed a primary spinal cord glioblastoma.
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Endo T, Inoue T, Sugiyama S, Saito R, Tominaga T. Regression of Recurrent Spinal Cord High-Grade Glioma After Convection-Enhanced Delivery of Nimustine Hydrochloride: Case Reports and Literature Review. Oper Neurosurg (Hagerstown) 2020; 18:451-459. [PMID: 31414134 DOI: 10.1093/ons/opz172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 04/11/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Spinal cord high-grade glioma has poor prognosis. Especially, no treatment protocols have been established for recurrent cases. OBJECTIVE To apply a novel treatment method, convection-enhanced delivery (CED), for recurrent high-grade glioma. CED can deliver chemotherapeutic agents directly into the intramedullary lesion and possibly lead to remarkable regression of enlarging tumors that are, otherwise, difficult to control. METHODS Two patients developed high-grade glioma in the thoracic spinal cord. Partial resection and chemotherapy and radiotherapy induced remission of the disease. However, following the initial treatment, recurrence was noted in the spinal cord at 6 and 12 mo, respectively. No effective treatment was available for these recurrent lesions. Therefore, the authors decided to use CED to infuse nimustine hydrochloride (ACNU) directly into the spinal cord. During the procedure, the infusion cannula was inserted into the spinal cord lesion under intraoperative computed tomography scan. RESULTS After ACNU CED, successive magnetic resonance imaging confirmed remarkable shrinkages of the tumors in both cases. However, the patient's preinfusion symptoms, including bilateral lower extremity weakness, did not change after the treatment. Importantly, overall survivals of the 2 patients were as long as 67 and 33 mo. CONCLUSION The authors report the first 2 cases of recurrent spinal cord high-grade glioma. ACNU CED dramatically regressed enhanced mass lesions and provided local tumor controls in the spinal cord.
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Affiliation(s)
- Toshiki Endo
- Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Tomoo Inoue
- Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Shinichiro Sugiyama
- Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi, Japan
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Aggressive Focal Therapy. Int J Radiat Oncol Biol Phys 2019; 103:546. [DOI: 10.1016/j.ijrobp.2018.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 10/23/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
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Pineal Anaplastic Ependymoma With Multifocal Intradural Extramedullary Metastases on MRI and 18FDG-PET. Clin Nucl Med 2018; 43:e319-e321. [DOI: 10.1097/rlu.0000000000002194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nakajima R, Kimura K, Abe K, Sakai S. 11C-methionine PET/CT findings in benign brain disease. Jpn J Radiol 2017; 35:279-288. [PMID: 28421396 DOI: 10.1007/s11604-017-0638-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/27/2017] [Indexed: 11/29/2022]
Abstract
11C-methionine (MET) is one of the most commonly used positron emission tomography (PET) tracers for evaluation of malignant brain tumor, with MET-PET being a sensitive technique for visualization of primary and recurrent malignant brain tumors. However, previous reports have demonstrated MET uptake in lesions associated with benign brain diseases. These diseases usually show an increase in MET uptake similar to that of malignant tumors. This pitfall in MET-PET image interpretation is important not only for nuclear medicine professionals, but also for radiologists. In this review, we demonstrate the imaging characteristics of MET uptake in benign brain disease, and recommend physician interpretation of imaging findings and disease characteristics for optimal patient management. Benign uptake must be identified to prevent misdiagnosis and unnecessary surgical operations.
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Affiliation(s)
- Reiko Nakajima
- Departments of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Ken Kimura
- Departments of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Koichiro Abe
- Departments of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shuji Sakai
- Departments of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Chandra P, Purandare N, Shah S, Agrawal A, Rangarajan V. "Drop" Metastases from an Operated Case of Intracranial Anaplastic Ependymoma Identified on Fluoro-2-deoxyglucose Positron Emission Tomography/Computed Tomography. Indian J Nucl Med 2017; 32:68-70. [PMID: 28242994 PMCID: PMC5317079 DOI: 10.4103/0972-3919.198492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The seeding of tumor through cerebrospinal fluid (CSF) from primary intracranial tumors is very rare, often goes undetected, and is usually identified only on autopsy. CSF cytology along with magnetic resonance imaging constitutes the standard approach of diagnosing this grave condition. Use of fluoro-2-deoxyglucose positron emission tomography/computed tomography (PET/CT) in indentifying spinal metastases from primary intracranial malignancies is very limited and has been reported in patients with metastatic glioblastoma multiforme and medulloblastomas. We present a rare case of metastatic anaplastic ependymoma to show the potentially clinically utility of PET/CT in diagnosing leptomeningeal or the so-called “drop” metastases.
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Affiliation(s)
- Piyush Chandra
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nilendu Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
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