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Timing of Examination Affects Reliability of ^99mTc-Methoxyisobutylisonitrile SPECT in Distinguishing Neoplastic from Nonneoplastic Brain Hematomas

¹ Department of Radiological Sciences, University of Messina, Messina, Italy
² Department of Neurosciences, Psychiatry, and Anesthesiology, University of Messina, Messina, Italy

View larger version (94K): [in a new window]   FIGURE 1. Patient 19, a 71-y-old man with sudden onset of left-sided hemiparesis and drowsiness. (A) Emergency CT scan shows atypically located 5-cm large, inhomogeneous hematoma in right frontal region. Lesion is surrounded by moderate edema and determines compression of lateral ventricles and subfalcine herniation. (B) 99mTc-MIBI SPECT image obtained at 10 d shows ringlike 99mTc-MIBI uptake at periphery of lesion (arrowheads) (99mTc-MIBI index = 1.9).

View larger version (74K): [in a new window]   FIGURE 2. Patient 17, a 55-y-old man with sudden onset of cephalalgia. (A) Emergency CT scan shows atypically located 25-mm large, round hematoma in right paratrigonal region. Lesion is surrounded by moderate edema. (B) 99mTc-MIBI SPECT image obtained at 10 d shows homogeneous focal area of 99mTc-MIBI uptake (arrowheads) (99mTc-MIBI index = 1.33).

View larger version (15K): [in a new window]   FIGURE 3. Bar graph showing 99mTc-MIBI uptake in 4 groups of patients who underwent 99mTc-MIBI SPECT 2, 5, 10, and 30 d after onset of clinical deterioration. Statistically significant difference was found between groups 1 and 3 (*P = 0.02), groups 1 and 4 (**P = 0.001), and groups 2 and 4 (#P = 0.03).

View larger version (49K): [in a new window]   FIGURE 4. Patient 5, a 76-y-old woman with sudden onset of aphasia, right-sided hemiparesis, and drowsiness. (A) Emergency CT scan shows atypically located hematoma in left frontal region with subarachnoid spreading (arrowheads). Lesion is surrounded by moderate edema. (B) 99mTc-MIBI SPECT image obtained 2 d after onset of clinical deterioration shows no 99mTc-MIBI uptake (99mTc-MIBI index = 1). (C) 99mTc-MIBI SPECT image obtained 30 d after onset of clinical deterioration shows ringlike 99mTc-MIBI uptake (arrowheads) (99mTc-MIBI index = 2).