Pachymeningitis Demonstrated on Gallium SPECT/CT Scan

Abstract

A 34-year-old woman presented with a 3-month history of right-sided headaches associated with photophobia and pulsatile tinnitus. Investigations including lumbar puncture revealed elevated opening CSF pressure, increased protein, and presence of monocytosis consistent with an inflammatory/infective process. Brain MRI showed an area of thickened enhancing dura around the venous sinus posteriorly. 67Ga scintigraphy demonstrated focal intracranial uptake in the posterior occipital region, and biopsy confirmed a chronic inflammatory infiltrate with no granulomas.

Hypertrophic Pachymeningitis Presenting as “Eyebrows” Sign on 18F FDG PET/CT

“…Recently, Wong et al reported the image findings of pachymeningitis involving the dura surrounding the venous sinus on Ga-67 single-photon emission computed tomography/computed tomography. 9 Ga-67 scintigraphy can be more sensitive than FDG PET/CT in identifying meningeal inflammation due to lack of physiological uptake in the brain parenchyma; however, limited availability and high radiation exposure remain matter of concern. 10 Furthermore, FDG PET co-registered with MRI can be used for optimally targeting the site of dural biopsy in patients with negative serology, culture, and CSF examination.…”