Positron Emission Tomography in a Case of Intracranial Hemangiopericytoma

Kracht, Lutz W.; Bauer, Andreas; Herholz, Karl; Terstegge, K.; Friese, Michael; Schröder, R.; Heiss, Wolf‐Dieter

doi:10.1097/00004728-199905000-00008

Cited by 20 publications

(6 citation statements)

References 15 publications

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“…Since haemangiopericytoma is even rarer than meningioma, the current literature on its PET findings is scarce. A previous case report found that haemangiopericytoma showed increased uptake of 11 Cmethionine and O-H 2 O but low uptake on 18 F-FDG [12]. In our case, most of the recurrent haemangiopericytomas showed avid enhancement on CT but low FDG uptake on PET, indicative of low glucose utilisation.…”

Section: Discussionsupporting

confidence: 57%

¹⁸F-FDG-PET-CT imaging findings of recurrent intracranial haemangiopericytoma with distant metastases

Chan

Zhang²,

Khong³

2010

BJR

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ABSTRACT.A 42-year-old woman presented with local recurrence and distant lung and liver metastases 7 years after resection of a primary intracranial haemangiopericytoma. Whole-body 18 F-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET)-CT scan showed no increased uptake in local recurrence or distant metastases except for a focus of increased FDG uptake within a hepatic metastasis. The hypermetabolic area correlated with an intratumoral hypoenhancing area on the CT scan. PET-CT scan may be useful to allow further understanding of the tumour. Haemangiopericytoma is an uncommon tumour and accounts for less than 1% of all intracranial tumours. It caused much confusion because of its imaging similarities to meningioma and its uncertain cellular origin. Its rarity, non-specific imaging findings and lack of specific tumour markers pose diagnostic difficulties.We report a case of intracranial haemangiopericytoma treated with surgical resection. Local recurrence and distant metastases in the lung and liver occurred seven years after complete resection of the primary intracranial tumour.18 F-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography-computed tomography (PET-CT) was performed for assessment of the extent of disease. Case reportA 42-year-old woman presented with headache and unsteady gait for one month in September 2001. CT and MRI scans of the brain showed an 8 cm extra-axial homogeneous enhancing mass in the left posterior cranial fossa causing hydrocephalus. The initial diagnosis was left cerebellar tentorial meningioma. Angiogram showed hypervascular tumour and the tumour was supplied mainly by the tentorial branch of the left internal carotid artery and branches from the left vertebral artery and external carotid artery. Pre-operative embolisation with 150-250 mm polyvinyl alcohol particles and n-butyl cyanoacrylate was performed to reduce intraoperative bleeding.Histology from an intra-operative frozen section and the whole surgical specimen diagnosed haemangiopericytoma. Randomly orientated plump cells and a rich network of reticulum fibres investing individual cells were found in the tumour. Characteristic staghorn vessels were identified. Immunohistochemistry staining of the tumour cells were focally positive for CD34, and the findings were compatible with meningeal haemangiopericytoma [1,2]. After total resection of the tumour, the patient received post-operative cranial irradiation.The patient underwent regular clinical follow-up. There was no sign of tumour recurrence until seven years after the operation, when she complained of a palpable epigastric mass with dull pain. Tumour markers including carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP) were normal. Hepatitis B surface antigen was negative. Whole-body 18 F-FDG-PET-CT was obtained for further evaluation. The CT part of the examination was performed with administration of intravenous contrast, including both arterial and portal venous phases of the liver.CT showed seven well-defined arterial-phase enhancing lesio...

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Section: Discussionsupporting

confidence: 57%

¹⁸F-FDG-PET-CT imaging findings of recurrent intracranial haemangiopericytoma with distant metastases

Chan

Zhang²,

Khong³

2010

BJR

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“…Among gliomas, Chan et al [21] found the highest microvessel counts in anaplastic oligodendrogliomas, which of all the gliomas demonstrated the highest [ 11 C]MET uptake in a sample of 86 newly diagnosed gliomas [1]. In addition, in one patient harbouring an intracranial haemangiopericytoma we found a very high [ 11 C]MET uptake [22]. Taken together, these findings indicate that tumour vascularisation and [ 11 C]MET uptake may be related.…”

Section: Introductionsupporting

confidence: 60%

Methyl-[11C]-l-methionine uptake as measured by positron emission tomography correlates to microvessel density in patients with glioma

Kracht

Friese

Herholz

et al. 2003

Eur J Nucl Med Mol Imaging

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181

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Positron emission tomography (PET) using methyl-[(11)C]- l-methionine ([(11)C]MET) is a useful tool in the diagnosis of brain tumours. The main mechanism of [(11)C]MET uptake is probably increased transport via the L-transporter system located in the endothelial cell membrane. We used [(11)C]MET-PET and microvessel count in glioma specimens to investigate whether the increased amino acid uptake is related to angiogenesis. Twenty-one patients with newly diagnosed and histologically confirmed glioma were investigated with [(11)C]MET-PET before open surgery. [(11)C]MET uptake was determined within an 8-mm region of interest in the area of the tumour showing the highest uptake, and the ratio to uptake in the corresponding contralateral region was calculated. To measure angiogenesis, immunostaining with factor VIII antibody was applied to sections from tumour tissue, and highlighted microvessels were counted in the area of highest vascularisation. In the entire patient group, a positive correlation was found between microvessel count and [(11)C]MET uptake (Spearman: r=0.89, P<0.001). This correlation was also significant in subgroups of patients [patients with grade II and III astrocytomas (Spearman: r=0.77, P<0.01) and patients with glioblastoma (Spearman: r=0.64, P<0.05)]. Angiogenesis, as assessed by microvessel count, and increased amino acid uptake, as assessed by [(11)C]MET-PET, are closely related events in gliomas. [(11)C]MET-PET offers a direct measure of amino acid transport and an indirect measure of microvessel density. [(11)C]MET-PET might be a useful tool to select potential responders to anti-angiogenic therapy and to monitor patients during such therapy.

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“…[10][11] Likewise, positron emission tomography (PET) has been used in one case of hemangiopericytoma and demonstrated features (low glucose utilization) distinct from meningioma. 12 The role of somatostatin receptors for diagnosis and treatment of hemangiopericytoma is unproven but may have been helpful in our case five. 17 The treatment of choice is complete surgical excision.…”

Section: Discussionmentioning

confidence: 83%

Neuro-ophthalmic manifestations of hemangiopericytoma

Lee

Eggenberger

Galetta

et al. 2004

Seminars in Ophthalmology

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Positron Emission Tomography in a Case of Intracranial Hemangiopericytoma

Cited by 20 publications

References 15 publications

¹⁸F-FDG-PET-CT imaging findings of recurrent intracranial haemangiopericytoma with distant metastases

¹⁸F-FDG-PET-CT imaging findings of recurrent intracranial haemangiopericytoma with distant metastases

Methyl-[11C]-l-methionine uptake as measured by positron emission tomography correlates to microvessel density in patients with glioma

Neuro-ophthalmic manifestations of hemangiopericytoma

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Positron Emission Tomography in a Case of Intracranial Hemangiopericytoma

Cited by 20 publications

References 15 publications

18F-FDG-PET-CT imaging findings of recurrent intracranial haemangiopericytoma with distant metastases

18F-FDG-PET-CT imaging findings of recurrent intracranial haemangiopericytoma with distant metastases

Methyl-[11C]-l-methionine uptake as measured by positron emission tomography correlates to microvessel density in patients with glioma

Neuro-ophthalmic manifestations of hemangiopericytoma

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¹⁸F-FDG-PET-CT imaging findings of recurrent intracranial haemangiopericytoma with distant metastases

¹⁸F-FDG-PET-CT imaging findings of recurrent intracranial haemangiopericytoma with distant metastases