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Hyperperfusion and Hypermetabolism in Brain Radiation Necrosis with Epileptic Activity

Departments of Radiology and Neurosurgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan

Correspondence: For correspondence or reprints contact: Masayuki Sasaki, MD, PhD, Department of Radiology, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-82, Japan.

ABSTRACT

We report a case of high uptake of ¹¹C-methionine (MET), ¹⁸F-FDG (FDG)and ²⁰¹Tl-CI (TI) in brain radiation necrosis. Twenty-one years previously, the patient had undergone surgery and radiation therapy consisting of 6O-Gy for ependymoma in the anterior horn of the right lateral ventricle. The clinical features consisting of frequent seizures of the left face and arm suddenly appeared 2 wk before admission. MRI depicted a T1 and T2-prolonged lesion in the right frontal lobe. Abnormally high uptake in this area demonstrated by MET-PET, FDG-PET, TI-SPECT or HMPAO-SPECT suggested the presence of a recurrent tumor. A craniotomy was then performed and an intraoperative electrocorticogram showed continuous epileptic spikes in the lesion. The epileptic foci were resected and the histological features of the lesion were consistent with radiation necrosis. After surgery, the seizures disappeared and the postoperative examinations with MET-PET, FDG-PET, TI-SPECT and HMPAO-SPECT no longer showed abnormally high uptake. Hypermetabolism and hyperperfusion related to epileptic fits are therefore thought to result in high uptake of MET, FDG and TI in radiation necrosis.

Key Words: radiation necrosis • thallium-201-chloride • carbon-11-methionine • fluorine-l8-FDG • SPECT • PET

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