Diagnosis of Recurrent Astrocytoma with
Fludeoxyglucose F18 PET Scanning |
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| The patient was a 32-year-old woman whose left frontotemporal tumor was
diagnosed by biopsy in 1996. After radiation therapy, the volume of the tumor increased
and the tumor was excised stereotactically. Histologic examination of the tumor revealed
it to be a grade II astrocytoma with partially anaplastic grade III areas. In 2000, the patient presented with an epileptic seizure, left-sided hypesthesia of the face, and moderate right hemiparesis. Magnetic resonance imaging showed multiple small areas of hyperdensity in T1-weighted images with contrast medium (gadolinium) in the left frontal subcortical region, in the frontal corpus callosum, in the pons, and in both crura cerebri, which could have been due to the previous radiation therapy. Although a relapse was suspected, a firm diagnosis of a focal recurrence was not established. About 10 days later, PET scanning of the head was performed. The PET scan revealed an intensive hypermetabolic lesion in the left frontal subcortical region, demonstrating relapse of the tumor, and an additional lesion located in the frontotemporal subcortical region, adjacent to the left thalamus (Figure 1). Because of the poor prognosis, no further surgery was performed. The patient died two weeks later.Autopsy revealed infiltration by a grade III anaplastic astrocytoma in the left frontal and temporal lobes, in both the basal ganglia and in the pons; tumor infiltration was thus found in all of the hypermetabolic lesions detected by PET. This case report demonstrates the usefulness of fludeoxyglucose F18 PET for the detection of focal recurrence of high-grade astrocytomas. Mirzaei. N Engl J Med 2001; 344:2030-2031, Jun 28, 2001 |
