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Avid Uptake of Technetium-99m-HMPAO by an Intracranial Plasmacytoma during Carotid Balloon Test Occlusion

Division of Nuclear Medicine, Department of Radiology and Departments of Neurosurgery and Diagnostic Radiology, Mount Sinai School of Medicine, New York, New York

Correspondence: For correspondence or reprints contact: Mordechai Lorberboym, MD, Department of Nuclear Medicine, Mount Sinai Medical Center, One Gustave L. Levy Pl., New York, NY 10029.

ABSTRACT

A 56-yr-old woman was evaluated for removal of a tumor at the base of the skull. A test to determine the risk of carotid artery sacrifice was performed prior to surgery using carotid balloon occlusion of the left internal carotid artery and ^99mTc-HMPAO perfusion scintigraphy during the occlusion. An unusual intense focus of increased uptake was seen at the site of the primary tumor in the left cavernous sinus. The tumor, found to be plasmacytoma at surgery, demonstrated only mild washout from 30 min to 2 hr after administration of ^99mTc-HMPAO, with a tumor-to-cerebellum ratio of 1.6 and 1.5, respectively, and a tumor-to-contralateral cranial ratio of 2.5 and 2.4, respectively. Intracranial plasmacytoma shows good response to radiation therapy, and the differentiation of this tumor from other neoplasms is pertinent to the mode of treatment and surgical approach. Technetium-99m-HMPAO SPECT imaging may be a useful tool in distinguishing these tumors from other neoplasms at the base of the skull.

Key Words: technetium-99m-HMPAO • carotid artery • occlusion • intracranial plasmacytoma • single-photon emission computed tomography