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Incidental Detection of Remote Ictal Hypermetabolism on FDG PET/CT Following Brain Metastatectomy : A Rare Diagnostic

Nivedita Kundu1, Dikhra Khan2, Sambit Sagar2

  • 1Department of Nuclear Medicine, All India Institute of Medical Sciences.

Clinical Nuclear Medicine
|August 3, 2026
PubMed

Insights

FDG PET/CT scans can show non-cancerous activity. In a breast cancer patient, this study found seizure-related brain metabolism, not tumor recurrence, on a follow-up scan.

Area of Science:

  • Oncology
  • Neurology
  • Nuclear Medicine

Background:

  • Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) is a key tool in cancer management.
  • Non-neoplastic hypermetabolic processes can mimic malignancy on FDG PET/CT.
  • Seizure-related activity can present as focal hypermetabolism on FDG PET/CT.

Purpose of the Study:

  • To report the incidental finding of probable ictal/peri-ictal hypermetabolism on FDG PET/CT.
  • To highlight a potential pitfall in interpreting FDG PET/CT scans in oncology patients.
  • To emphasize the importance of recognizing non-neoplastic causes of hypermetabolism to prevent misdiagnosis.

Main Methods:

  • Case report of a 39-year-old woman with treated breast carcinoma and prior left temporal metastatectomy.
  • Follow-up FDG PET/CT imaging was performed.
  • Analysis of imaging findings, including CT correlation and assessment for systemic disease.

Main Results:

  • Incidental detection of a focal, intensely FDG-avid cortical area in the left posterior parietal region.
  • The hypermetabolism showed no CT correlate or other evidence of active systemic disease.
  • The imaging pattern was consistent with seizure-related cortical hypermetabolism, not tumor recurrence.

Conclusions:

  • FDG PET/CT can reveal non-neoplastic hypermetabolism, such as seizure activity.
  • This finding in the reported case mimicked tumor recurrence but was likely seizure-related.
  • Awareness of this uncommon pitfall is crucial to avoid false-positive interpretations and unnecessary upstaging in cancer patients.
Keywords:
FDG PET/CTFDG pitfallbrain metastasisictal hypermetabolismincidental findingpost metastatectomy

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