Diffuse vertebral body metastasis from a glioblastoma multiforme: a technetium-99m Sestamibi single-photon emission computerized tomography study

Abstract

The authors report on a case of right temporal glioblastoma multiforme (GBM) that metastasized to multiple bone regions (dorsolumbar vertebrae and iliac bone) 8 months after initial diagnosis, despite combined radio- and chemotherapy. Results of a whole-bone single-photon emission computerized tomography (SPECT) study using the imaging agent Sestamibi (MIBI) revealed extracranial metastases from the GBM. A magnetic resonance imaging study of the dorsolumbar spinal region completed the radiological investigation. Cells immunoreactive to glial fibrillary acidic protein were observed in a specimen obtained from the right iliac bone. Postmortem examination confirmed metastasis to extracranial bone and revealed two other metastatic localizations in the lung and heart. This is the first reported case of extracranial bone metastasis from a GBM demonstrated on a whole-bone MIBI SPECT scan. In patients with malignant glioma and lower-back pain (especially prolonged pain), bone metastasis, although uncommon, does occasionally occur and its possibility should be investigated; a MIBI SPECT study may prove useful in this regard.

Spinal and extracranial metastatic dissemination of malignant glioma

“…Metastatic disease typically occurs within the neuraxis, but extracranial spread has also been described. [3][4][5][6][7][8][9][10] If advances in microsurgery, radiation therapy, chemotherapy and other adjuvant treatment of malignant glioma lead to an increase in survival for malignant glioma, it is likely that the incidence of metastatic disease will also rise.…”

Multiple extraneural metastasis of glioblastoma multiforme

“…A review of the literature from 1928 to 2006 demonstrates fewer than 130 reported cases of extraneural GBM Multiple explanations exist for this phenomenon, including increased interest among specialists in authoring case reports on this topic, and improved access to neurosurgical care, improved neuro-imaging, and advances in the multimodal treatment of gliomas. In particular, improvements in neuro-imaging techniques and therapeutic advances allow earlier diagnosis and longer patient survival, increasing the timeframe in which GBM cells may spread and form extracranial metastases 4,9 . Extraneural metastases are considered to be a sign of advanced disease and frequently occur between 8 to 24 months following the initial diagnosis 10 .…”

Imaging Malignant Gliomas with 99mTc-MIBI Brain Single-Photon Emission Computed Tomography

“…99m Tc-MIBI is a cationic complex of technetium, and is concentrated in mitochondria as a result of active diffusion due to increased negative transmembrane potentials [14][15][16]. Uptake is non-specific, but is driven by metabolic demand [14][15][16]. In this article, we review the roles of 99m Tc-MIBI SPECT in the management and follow up of malignant glioma patients.…”

“…In primary brain tumors 99m Tc-MIBI brain SPECT demonstrated a better specificity than TI-201 TI [10][11][12][13]. 99m Tc-MIBI is a cationic complex of technetium, and is concentrated in mitochondria as a result of active diffusion due to increased negative transmembrane potentials [14][15][16]. Uptake is non-specific, but is driven by metabolic demand [14][15][16].…”