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The Journal of Nuclear Medicine Vol. 41 No. 11 1861-1867
© 2000 by Society of Nuclear Medicine
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PET in Differentiation of Recurrent Brain Tumor from Radiation Injury*

Daniel D. Langleben and George M. Segall

Nuclear Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, and Division of Nuclear Medicine, Stanford University School of Medicine, Stanford, California


Figure 1
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FIGURE 1. Sixty-y-old woman with stage IV ovarian cancer (diagnosed Sept. 1993) treated with surgery and chemotherapy until April 1994. (A) GdDTPA T1-weighted (Tr = 766, TE = 13) MRI scan (performed April 4, 1997) showing ring-enhancing lesions with central low signal in the right parietal cortex, the white matter of the right frontal lobe, and the right caudate head and anterior portion of the internal capsule. (B) PET scan (performed April 2, 1997) shows 2 right parietal cortical hypermetabolic lesions, hypometabolism in right frontoparietal area, and 2 areas of annular hypermetabolism with central hypometabolism: in the right frontal white matter and adjacent to the right caudate. In 1995, patient developed ataxia and right-sided hearing problems. MRI showed 2 right parietal metastases. Patient was treated with whole-brain radiation (30 Gy in 10 fractions) and dexamethasone and then with stereotactic radiosurgery (18 Gy to right parietal lesions). She developed seizures 8 mo later; MRI showed enlargement of 2 right parietal lesions. On April 4, 1997, she had stereotactic removal of the superficial lesions that were hypermetabolic on PET. Deeper lesions could not be removed because of location. Patient was lost to follow up after this procedure.

 

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FIGURE 2. MR and PET scans of 50-y-old man, with a history of grade 2 right frontal oligodendroglioma, who presented with headaches and memory loss. (A) GdDTPA T1-weighted (Tr = 700, TE = 16) MR scan of 50-y-old man, showing an area of low signal in the right parietal lobe with predominantly peripheral contrast enhancement, edema, and focal areas of hemorrhage, which indicated the possibility of tumor or DLRI. (B) PET scan of patient's brain, showing hypometabolic right frontoparietal area consistent with changes after surgery and radiation. No hypermetabolic foci to suggest recurrent tumor. Tumor was resected on September 8, 1993, and treated with radiation therapy to the frontal and parietal lobes (total dose between September 29 and November 9, 1993 = 56 Gy). Patient continued to have mild cognitive deficits and psychosis. In 1995, patient developed new neurologic deficits and dementia worsened. MR showed progression of edema and enhancement in the right parietal lobe, next to the resection site. PET scan in November 1995 was negative for abnormal hypermetabolic foci; a second craniotomy was performed December 1995, and right frontoparietal cystic lesion without evidence of malignancy on a frozen section was removed. Histologic examination showed mixed astrocytoma and oligodendroglioma without mitotic activity, and with areas of focal necrosis. Patient died in February 1996.

 





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