Correspondence

Diagnosis of Recurrent Astrocytoma with Fludeoxyglucose F18 PET Scanning

N Engl J Med 2001; 344:2030-2031June 28, 2001

Article

To the Editor:

The recent report of an astrocytoma following the pyramidal tract (Dec. 7 issue)1 was quite interesting. We report on the use of fludeoxyglucose F18 positron-emission tomography (PET) in the evaluation of a patient with an astrocytoma.

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. Thirty minutes after intravenous injection of 190 MBq of fludeoxyglucose F18, PET images of the brain were acquired (ECAT-ART scanner, Siemens CTI, Knoxville, Tenn.). Two Cs-137 point sources were applied for attenuation correction, and the ordered-subsets–expectation-maximization algorithm was used for iterative reconstruction. 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 1Figure 1Transaxial Slices of the Brain with Abnormal Uptake of Fludeoxyglucose F18 in the Left Hemisphere.). 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.

Siroos Mirzaei, M.D.
Peter Knoll, Ph.D.
Horst Kohn, M.D.
Wilhelminenspital, A-1171 Vienna, Austria

1 References

1. 1

   Spuler A, Atkinson JLD. Astrocytoma following the pyramidal tract. N Engl J Med 2000;343:1702-1702
   Full Text | Web of Science | Medline

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