TY - JOUR T1 - <sup>99m</sup>Tc-MIBI SPECT in Distinguishing Neoplastic from Nonneoplastic Intracerebral Hematoma JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 1566 LP - 1573 VL - 44 IS - 10 AU - Fabio Minutoli AU - Filippo F. Angileri AU - Sebastiano Cosentino AU - Giorgio Restifo Pecorella AU - Salvatore Cardali AU - Oreste De Divitiis AU - Antonino Germanò AU - Sergio Baldari Y1 - 2003/10/01 UR - http://jnm.snmjournals.org/content/44/10/1566.abstract N2 - Distinguishing neoplastic from nonneoplastic intracerebral hematoma has great clinical relevance for the appropriate management of patients. Imaging is not always able to clearly identify a tumor-related intraparenchymal cerebral hemorrhage (ICH), especially in the acute phase, the diagnosis being frequently based on evolution patterns. The aim of this study was to test the value of 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) SPECT as a noninvasive diagnostic tool in early diagnosis of hemorrhagic brain neoplasm. Methods: We prospectively studied 29 patients harboring a nontraumatic acute onset of clinical deterioration caused by ICH with atypical clinical or neuroradiologic features. All patients underwent 99mTc-MIBI SPECT within 48 h from the clinical onset. Early and delayed images were obtained. Both visual and semiquantitative analyses were performed. The 99mTc-MIBI index was obtained from both early and delayed images and the retention index was calculated. Results: In 19 patients (65.5%), a nonneoplastic hemorrhage (15 vascular degenerative diseases, 2 cavernous angiomas, 1 thrombosed middle cerebral artery giant aneurysm, and 1 sinus rectus thrombosis) was diagnosed by clinical and neuroradiologic follow-up or open surgery. In 10 patients (34.5%), a neoplastic hemorrhage (6 metastases, 2 glioblastomas multiforme, 1 ependymoma, and 1 intracranial angioblastic meningioma) was diagnosed by direct histologic typing (open surgery or stereotactic biopsy). In all neoplasm-related hemorrhages, a focal increased tracer uptake was observed in the area of the lesion, whereas no focal increased tracer uptake was noted in all nonneoplastic hematomas. A wide cutoff in the early ratio between neoplastic and nonneoplastic hemorrhages was found. Moreover, a statistically significant difference was found in the delayed ratio (P &lt; 0.01) and the retention index (P &lt; 0.05) between the 2 groups. Conclusion: Our data suggest that 99mTc-MIBI SPECT could play a role in the early noninvasive diagnostic work-up of hemorrhagic brain lesions, allowing a clear differentiation between neoplastic and nonneoplastic ICHs. The high availability and low cost of this nuclear medicine technique can be considered additional advantages. ER -