Focal 18F-DOPA Uptake in Brain Parenchyma Surrounding Developmental Venous Anomalies

Abstract

We report the finding of increased F-DOPA uptake within parenchyma surrounding a developmental venous anomaly, found incidentally in a 64-year-old woman undergoing PET scan to assess for Parkinson's disease. Not identified on previous T1/T2 MRI, susceptibility-weighted imaging MRI performed post-PET scan demonstrated the presence of developmental venous anomaly within the left cerebellar hemisphere. Focal uptake of F-DOPA may suggest the presence of a brain tumor and prompt invasive diagnostic investigations. Nuclear medicine physicians should be aware of this finding when interpreting F-DOPA PET and consider appropriate imaging to identify venous anomalies prior to more invasive investigations for possible brain tumors.

Distant Recurrence of a Cerebral Cavernous Malformation in the Vicinity of a Developmental Venous Anomaly: Case Report of Local Oxy-Inflammatory Events

“…Moreover, signal-intensity abnormalities in the brain parenchyma adjacent to a DVA have been shown to correlate with DVA angioarchitectural factors that cause disturbance of blood flow, including number and tortuosity of medullary veins, and angulation, tortuosity, stenosis, and thrombosis of the draining vein [ 15 , 80 ], as well as to increase with age [ 41 , 83 ]. In addition, distinct functional neuroimaging findings, based on positron emission tomography (PET), have remarkably demonstrated that such signal-intensity abnormalities are frequently related to significant metabolic alterations [ 84 , 85 , 86 ]. Given the established strong association of both disturbed blood flow and altered metabolism with inflammation [ 87 , 88 , 89 , 90 ], it is, therefore, conceivable that the signal-intensity abnormalities that occur in the brain parenchyma adjacent to a DVA may be related to sterile inflammatory conditions caused by the local release of damage-associated inflammatory inducers, such as DAMPs (alarmins) and consequent glial activation [ 75 , 76 , 91 ].…”

“…Overall, on the basis of the compelling evidence described above, it is possible to propose that sterile inflammatory responses induced in the brain parenchyma by changes in angioarchitectural and hemodynamic features of a pre-existing DVA may represent a novel plausible etiological mechanism for the long-term distant recurrence of a DVA-related hemorrhagic sCCM lesion identified in our study. Indeed, in addition to correlating with the age-dependent increase in the prevalence of sCCMs associated with DVAs [ 40 ], such a mechanism might also be associated with the age-dependent increase in the prevalence of structural and metabolic signal-intensity abnormalities detected in the brain parenchyma of DVAs using MRI and PET analyses, respectively [ 41 , 83 , 84 , 85 , 86 ]. Furthermore, the fact that focal chronic oxy-inflammatory conditions generated by distinct pathogenic determinants can affect the stability of sensitive capillary vessels located nearby also raises the possibility that this pathological effect influences the onset and severity of both sCCM and fCCM lesions, thereby suggesting that different causative determinants eventually converge into common molecular mechanisms and outcomes.…”

Cerebrovascular Malformation Mimicking Recurrent Lymphoma on Dual Time-Point 18F-FDOPA PET

“…DVAs can be subtle on many MR sequences and are best seen on postcontrast T1 sequences and SWI. The single previously published case of 18 F-FDOPA uptake of DVA in an adult 10 was a woman who underwent PET scan to assess for Parkinson disease, without any underlying malignancy. Notably, it could not be identified on the patient’s previous T1/T2 MR, requiring further SWI MR post-PET scan.…”