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FET PET in Primary Central Nervous System Vasculitis
Lothar Burghaus, Christoph Kabbasch1, Martina Deckert2
1Radiology and Neuroradiology.
Abstract:
Primary central nervous system vasculitis is confined to the brain and spinal cord. While serological markers of inflammation are usually normal, conventional angiography may confirm the diagnosis. The diagnostic method of choice is central nervous system biopsy. A 57-year-old man suffered from a first generalized epileptic seizure. MRI revealed a contrast-enhancing lesion, and O-(2-[F]fluoroethyl)-L-tyrosine amino acid PET displayed increased metabolic activity, both findings highly suggestive of a malignant glioma. Surprisingly, histology obtained following stereotactic biopsy revealed small-vessel vasculitis.
Insights
Primary central nervous system vasculitis can mimic brain tumors. A patient presenting with seizures and imaging suggestive of glioma was unexpectedly diagnosed with vasculitis via brain biopsy, highlighting diagnostic challenges.
Area of Science:
- Neurology
- Neuroimaging
- Pathology
Background:
- Primary central nervous system vasculitis (PCNSV) affects the brain and spinal cord.
- Inflammatory markers are often normal in PCNSV, complicating diagnosis.
- Conventional angiography can aid diagnosis, but brain biopsy is definitive.
Observation:
- A 57-year-old man presented with a new-onset generalized epileptic seizure.
- Magnetic resonance imaging (MRI) showed a contrast-enhancing lesion.
- Positron emission tomography (PET) with O-(2-[F]fluoroethyl)-L-tyrosine revealed increased metabolic activity.
Findings:
- These imaging findings were highly suggestive of a malignant glioma.
- Histological examination of a stereotactic biopsy unexpectedly revealed small-vessel vasculitis.
Implications:
- This case highlights the importance of considering PCNSV in the differential diagnosis of enhancing brain lesions.
- Central nervous system biopsy remains the gold standard for diagnosing PCNSV, even when initial imaging suggests malignancy.
- Accurate diagnosis is critical for appropriate treatment and patient management.
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