- Email: [email protected]
TC con 18F-FDG
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ARTICLE IN PRESS Rev Esp Med Nucl Imagen Mol. 2017;xxx(xx):xxx–xxx
Interesting image
Spinal epidural involvement in Erdheim-Chester disease: 18 F-FDG PET/CT findings Afectación epidural espinal en la enfermedad de Erdheim-Chester: hallazgos en 18 F-FDG PET/TC A. Biyi a,∗ , H. Ennouali b , S.N. Oueriagli a , S.E. Moussaoui c , M. Rabhi d , A. Doudouh a a
Department of Nuclear Medicine, Mohammed V Military Teaching Hospital, Mohammed V University of Rabat, Rabat, Morocco Department of Radiology, Mohammed V Military Teaching Hospital, Mohammed V University of Rabat, Rabat, Morocco c Department of Endocrine Diseases, Mohammed V Military Teaching Hospital, Mohammed V University of Rabat, Rabat, Morocco d Department of Internal medicine, Mohammed V Military Teaching Hospital, Mohammed V University of Rabat, Rabat, Morocco b
We report a case of 26 year-old woman with histologically proven diagnosis of Erdheim-Chester disease (ECD) with diabetes insipidus and typical radiologic and scintigraphic bilateral lesions in femur, tibia and maxillary sinus wall. Evolution under
vasopressin and interferon alpha was marked by clinical improvement for four years. Recently, she complained of complex migraine headaches. Neurological examination was normal. Brain MRI image (Fig. 1A and D) demonstrated in addition to the known retro-sellar
Fig. 1. Brain post-contrast axial (A) and sagittal (D) T1 weighted MRI showing a left para and retro-sellar mass and a second one near the torcular characterized as a meningioma. On PET and PET/CT images (axial [B, C] and sagittal [E, F] respectively), the first mass was visible (red arrows) as a focus of high metabolism. No increased 18 F-FDG uptake was noted at the cerebellar tentorium (black and white arrows).
∗ Corresponding author. E-mail address: [email protected] (A. Biyi). http://dx.doi.org/10.1016/j.remn.2017.03.007 ˜ S.L.U. y SEMNIM. All rights reserved. 2253-654X/© 2017 Elsevier Espana,
Please cite this article in press as: Biyi A, et al. Spinal epidural involvement in Erdheim-Chester disease: 18 F-FDG PET/CT findings. Rev Esp Med Nucl Imagen Mol. 2017. http://dx.doi.org/10.1016/j.remn.2017.03.007
G Model REMNIM-905; No. of Pages 2 2
ARTICLE IN PRESS A. Biyi et al. / Rev Esp Med Nucl Imagen Mol. 2017;xxx(xx):xxx–xxx
Fig. 2. 18 F-FDG PET/CT in sagittal [A] and axial [B, C] views showing increased metabolic activity on two epidural masses from T5 to T6 (A and B, arrowheads) and T12 to L2 (A and C, arrowheads), corresponding to those visualized on a sagittal T2-weighted MRI images as a marked hypointensity (D, arrows).
mass a second one near the torcular mimicking a meningioma. On 18 F-FDG PET/CT images (Fig. 1B, C, E and F), the first mass was visible as a focus of high metabolism. No increased 18 F-FDG uptake was noted at the cerebellar tentorium. In addition, whole body image showed increased metabolism on epidural mass at the level of T5 to T6 and T12 to L2 (Fig. 2A and B and A and C, respectively). On T2-weighted MRI image, theses lesions were markedly hypointense (Fig. 2D). Up today, the patient remains asymptomatic. In ECD, pachymeningeal thickening or meningioma-like dural mass lesions have been reported often at the falx cerebri, cerebellar tentorium, or sellar region and more rarely at the spinal level.1 Even if patients are asymptomatic, extra skeletal lesions should be systematically researched. In our patient, and despite we have no histological evidence of the brain involvement, PET/CT was able to make difference between the hypermetabolic parasellar
lesion and meningioma that appeared as an area of decreased uptake suggestive of low tumor aggressiveness. Hypermetabolic dural meningiomas are usually grade 2 or 3.2,3 Furthermore, to the best of our knowledge, this is the first description of spinal epidural involvement in ECD with a focus on the utility of early detection of such involvement on PET/CT scan in an asymptomatic patient. References 1. Takeuchi T, Sato M, Sonomura T, Itakura T. Erdheim-Chester disease associated with intramedullary spinal cord lesion. Br J Radiol. 2012;85:e62–4. 2. Xiangsong Z, Xingchong S, Chang Y, Xiaoyan W, Zhifeng C. 13 N-NH3 versus F18 FDG in detection of intracranial meningioma: initial report. Clin Nucl Med. 2011;36:1003–6. 3. Liu RS, Chang CP, Guo WY, Pan DH, Ho DM, Chang CW, et al. 1-11C-acetate versus 18F-FDG PET in detection of meningioma and monitoring the effect of gammaknife radiosurgery. J Nucl Med. 2010;51:883–91.
Please cite this article in press as: Biyi A, et al. Spinal epidural involvement in Erdheim-Chester disease: 18 F-FDG PET/CT findings. Rev Esp Med Nucl Imagen Mol. 2017. http://dx.doi.org/10.1016/j.remn.2017.03.007
ARTICLE IN PRESS Rev Esp Med Nucl Imagen Mol. 2017;xxx(xx):xxx–xxx
Interesting image
Spinal epidural involvement in Erdheim-Chester disease: 18 F-FDG PET/CT findings Afectación epidural espinal en la enfermedad de Erdheim-Chester: hallazgos en 18 F-FDG PET/TC A. Biyi a,∗ , H. Ennouali b , S.N. Oueriagli a , S.E. Moussaoui c , M. Rabhi d , A. Doudouh a a
Department of Nuclear Medicine, Mohammed V Military Teaching Hospital, Mohammed V University of Rabat, Rabat, Morocco Department of Radiology, Mohammed V Military Teaching Hospital, Mohammed V University of Rabat, Rabat, Morocco c Department of Endocrine Diseases, Mohammed V Military Teaching Hospital, Mohammed V University of Rabat, Rabat, Morocco d Department of Internal medicine, Mohammed V Military Teaching Hospital, Mohammed V University of Rabat, Rabat, Morocco b
We report a case of 26 year-old woman with histologically proven diagnosis of Erdheim-Chester disease (ECD) with diabetes insipidus and typical radiologic and scintigraphic bilateral lesions in femur, tibia and maxillary sinus wall. Evolution under
vasopressin and interferon alpha was marked by clinical improvement for four years. Recently, she complained of complex migraine headaches. Neurological examination was normal. Brain MRI image (Fig. 1A and D) demonstrated in addition to the known retro-sellar
Fig. 1. Brain post-contrast axial (A) and sagittal (D) T1 weighted MRI showing a left para and retro-sellar mass and a second one near the torcular characterized as a meningioma. On PET and PET/CT images (axial [B, C] and sagittal [E, F] respectively), the first mass was visible (red arrows) as a focus of high metabolism. No increased 18 F-FDG uptake was noted at the cerebellar tentorium (black and white arrows).
∗ Corresponding author. E-mail address: [email protected] (A. Biyi). http://dx.doi.org/10.1016/j.remn.2017.03.007 ˜ S.L.U. y SEMNIM. All rights reserved. 2253-654X/© 2017 Elsevier Espana,
Please cite this article in press as: Biyi A, et al. Spinal epidural involvement in Erdheim-Chester disease: 18 F-FDG PET/CT findings. Rev Esp Med Nucl Imagen Mol. 2017. http://dx.doi.org/10.1016/j.remn.2017.03.007
G Model REMNIM-905; No. of Pages 2 2
ARTICLE IN PRESS A. Biyi et al. / Rev Esp Med Nucl Imagen Mol. 2017;xxx(xx):xxx–xxx
Fig. 2. 18 F-FDG PET/CT in sagittal [A] and axial [B, C] views showing increased metabolic activity on two epidural masses from T5 to T6 (A and B, arrowheads) and T12 to L2 (A and C, arrowheads), corresponding to those visualized on a sagittal T2-weighted MRI images as a marked hypointensity (D, arrows).
mass a second one near the torcular mimicking a meningioma. On 18 F-FDG PET/CT images (Fig. 1B, C, E and F), the first mass was visible as a focus of high metabolism. No increased 18 F-FDG uptake was noted at the cerebellar tentorium. In addition, whole body image showed increased metabolism on epidural mass at the level of T5 to T6 and T12 to L2 (Fig. 2A and B and A and C, respectively). On T2-weighted MRI image, theses lesions were markedly hypointense (Fig. 2D). Up today, the patient remains asymptomatic. In ECD, pachymeningeal thickening or meningioma-like dural mass lesions have been reported often at the falx cerebri, cerebellar tentorium, or sellar region and more rarely at the spinal level.1 Even if patients are asymptomatic, extra skeletal lesions should be systematically researched. In our patient, and despite we have no histological evidence of the brain involvement, PET/CT was able to make difference between the hypermetabolic parasellar
lesion and meningioma that appeared as an area of decreased uptake suggestive of low tumor aggressiveness. Hypermetabolic dural meningiomas are usually grade 2 or 3.2,3 Furthermore, to the best of our knowledge, this is the first description of spinal epidural involvement in ECD with a focus on the utility of early detection of such involvement on PET/CT scan in an asymptomatic patient. References 1. Takeuchi T, Sato M, Sonomura T, Itakura T. Erdheim-Chester disease associated with intramedullary spinal cord lesion. Br J Radiol. 2012;85:e62–4. 2. Xiangsong Z, Xingchong S, Chang Y, Xiaoyan W, Zhifeng C. 13 N-NH3 versus F18 FDG in detection of intracranial meningioma: initial report. Clin Nucl Med. 2011;36:1003–6. 3. Liu RS, Chang CP, Guo WY, Pan DH, Ho DM, Chang CW, et al. 1-11C-acetate versus 18F-FDG PET in detection of meningioma and monitoring the effect of gammaknife radiosurgery. J Nucl Med. 2010;51:883–91.
Please cite this article in press as: Biyi A, et al. Spinal epidural involvement in Erdheim-Chester disease: 18 F-FDG PET/CT findings. Rev Esp Med Nucl Imagen Mol. 2017. http://dx.doi.org/10.1016/j.remn.2017.03.007