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^99mTc-MIBI SPECT in Distinguishing Neoplastic from Nonneoplastic Intracerebral Hematoma

¹ Department of Radiological Sciences, University of Messina, Messina, Italy
² Department of Neurosurgery, University of Messina, Messina, Italy

View larger version (31K): [in a new window]   FIGURE 1. Flow chart describing diagnostic work-up for patients harboring nontraumatic intracerebral hemorrhage at our institution. DSA = digital subtraction angiography.

View larger version (76K): [in a new window]   FIGURE 2. Patient 21: 76-y-old woman with sudden onset of cephalea and aphasia. Medical history did not reveal any significant findings. (A) Emergency CT scan shows atypically located 25-mm large round-shaped cortical hematoma in left parietal region. Lesion is surrounded by moderate edema. (B) Early 99mTc-MIBI SPECT image shows no focal 99mTc-MIBI uptake areas (ER = 1.04). (C) T2-weighted spin-echo MR image obtained 13 d after clinical onset shows lesion as homogeneous hyperintense core with peripheral thin hypointense rim surrounded by moderate edema. Mass effect is minimal. These features suggested vascular degenerative disease. One-year follow-up supports this diagnosis.

View larger version (58K): [in a new window]   FIGURE 3. Patient 27: 52-y-old woman with sudden onset of stupor and mild left hemiparesis. Medical history did not reveal any significant findings. (A) Emergency CT scan reveals 4.5-cm large insular nonhomogeneously hyperdense mass surrounded by discrete edema with significant mass effect. (B) Early 99mTc-MIBI SPECT image shows no focal areas of high 99mTc-MIBI accumulation in area of lesion (ER = 1.3). (C) T1-weighted MR images after intravenous gadolinium administration show nonhomogeneous hemorrhagic lesion with small enhancing area (arrowheads). Digital subtraction angiography (not shown) failed to reveal relevant data. Patient underwent surgery and right thrombosed giant middle cerebral artery aneurysm was found.

View larger version (58K): [in a new window]   FIGURE 4. Patient 2: 72-y-old woman with sudden onset of aphasia and right-sided severe hemiparesis. Medical history revealed arterial hypertension. (A) Emergency CT scan reveals 4-cm large left frontal lobe oval-shaped hyperdense mass with surrounding edema and discrete mass effect. (B) Early 99mTc-MIBI SPECT image shows focal high 99mTc-MIBI uptake in area of lesion (ER = 2.13) (arrowheads). (C) After contrast medium administration, CT shows 15-mm round-shaped nodule with homogeneous contrast enhancement (arrowheads). After stereotactic biopsy, metastasis from cutaneous melanoma was demonstrated.

View larger version (65K): [in a new window]   FIGURE 5. Patient 10: 63-y-old woman with sudden onset of aphasia and mild right hemiparesis. Medical history revealed arterial hypertension. (A) Emergency CT scan shows atypically located complex mass in left parietal region. Lesion is mainly hyperdense with round-shaped component presenting fluid–fluid level. (B) Early 99mTc-MIBI SPECT image shows focal area of high uptake (ER = 2.13) in area of lesion (arrowheads). Contralateral high-activity area is related to physiologic choroids plexus uptake (asterisk). (C) T1-weighted MR image after intravenous gadolinium administration shows strongly enhancing extracerebral lesion (asterisk) with meningeal tail sign. Diagnosis of meningioma was confirmed after surgical excision.

View larger version (13K): [in a new window]   FIGURE 6. Graph shows ER values in 29 patients with intracerebral hemorrhagic brain lesions. Wide cutoff ranging between 1.3 and 2 is appreciable.

View larger version (13K): [in a new window]   FIGURE 7. Graph shows overall semiquantitative analysis results in our series. Statistically significant difference was found in ER (P < 0.01), DR (P < 0.01), and RI (P < 0.05) between neoplastic and nonneoplastic intracerebral hemorrhages.