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Semi-quantitative Assessment Using [18F]FDG Tracer in Patients with Severe Brain Injury
Published on: November 9, 2018
Organizing intracerebral hematoma mimicking a recurrent brain tumor on FDG-PET
Satoshi Nakajima1, Tomohisa Okada, Yoshiki Arakawa
1From the Departments of *Diagnostic Imaging and Nuclear Medicine, †Neurosurgery, and ‡Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Abstract:
A man underwent resection of low-grade astrocytoma, followed by radiation therapy at the age of 14 years old. He had been followed up for 33 years with no finding of recurrent disease on brain images until the most recent CT and MRI scans showed a mass at the postoperative site in the left parieto-occipital lobe. 18F-FDG PET/CT showed increased uptake in the mass. Resection was conducted, and microscopic examination of the whole mass demonstrated an organizing hematoma. A provisional diagnosis of organizing hematoma should be considered, along with other benign and malignant causes of increased FDG uptake.
Insights
A long-term follow-up revealed a late-presenting mass in a patient previously treated for astrocytoma. Microscopic examination identified an organizing hematoma, highlighting its potential mimicry of recurrent tumors.
Area of Science:
- Neurology
- Oncology
- Radiology
Background:
- A 14-year-old male underwent resection and radiation for low-grade astrocytoma.
- The patient was monitored for 33 years with no signs of disease recurrence.
Observation:
- Recent CT and MRI scans detected a mass at the left parieto-occipital postoperative site.
- 18F-FDG PET/CT imaging demonstrated increased metabolic activity within the mass.
Findings:
- Surgical resection of the mass was performed.
- Microscopic analysis revealed the mass to be an organizing hematoma.
Implications:
- Organizing hematoma should be considered in the differential diagnosis of new masses with increased FDG uptake in previously treated patients.
- This case underscores the importance of comprehensive histopathological evaluation for late-onset intracranial lesions.
- Distinguishing benign post-treatment complications from tumor recurrence requires careful radiological and pathological correlation.
