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Variable Aβ tracer uptake in hyperostosis frontalis interna: implications for brain Aβ PET/CT interpretation.

Joseph M Ryan^1,2, Hina J Shah^1,2, Michael P McCormick³

¹Department of Nuclear Medicine Mass General Brigham Boston Massachusetts USA.

Alzheimer'S & Dementia (Amsterdam, Netherlands)

|July 1, 2026

Summary

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Hyperostosis frontalis interna (HFI) can affect amyloid-beta (Aβ) PET scans. Careful review is needed to avoid misinterpreting tracer uptake in HFI patients, especially older women.

Area of Science:

Neurology
Radiology
Nuclear Medicine

Background:

Hyperostosis frontalis interna (HFI) is a common incidental finding on head CT scans.
HFI involves thickening of the inner table of the frontal bone.
Its impact on amyloid-beta (Aβ) positron emission tomography (PET) imaging is not well understood.

Purpose of the Study:

To report two cases of HFI identified during amyloid-beta PET/CT imaging.
To describe distinct patterns of tracer uptake in the calvarium affected by HFI.
To highlight potential misinterpretations in quantitative PET analyses due to HFI.

Main Methods:

Two patients with HFI underwent 18F-florbetaben PET/CT imaging.
Scans were assessed for amyloid-beta plaque burden using Centiloid values.

Keywords:

Centiloid amyloid beta calvarial hyperostosis donanemab hyperostosis frontalis interna lecanemab positron emission tomography

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Tracer uptake within the HFI region of the calvarium was specifically examined.

Main Results:

Patient 1 showed marked 18F-florbetaben uptake within the HFI region, with a Centiloid of 59.
Patient 2 exhibited HFI but no 18F-florbetaben uptake in the affected calvarium, with a Centiloid of 82.
Distinct patterns of tracer retention were observed in the HFI areas.

Conclusions:

Off-target tracer retention in HFI can lead to visual and quantitative misinterpretations in Aβ PET scans.
This is particularly relevant for older women with HFI.
Careful visual inspection and adjusted quantification masks are crucial for accurate PET measurements in HFI patients.