technetium-tc-99m-exametazime and Hemangioma

Topics: Diagnosis, Differential; Female; Hemangioma; Humans; Leukocytes; Lumbar Vertebrae; Middle Aged; Osteomyelitis; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

We report a case of successful radiosurgical treatment of lesional epilepsy of mesial temporal origin. A patient presented with a 2-year history of medically intractable complex partial seizures associated with a mesial temporal angioma. Interictal scalp EEG and MEG showed focal epileptiform activity around the lesion. 99mTc-HMPAO-SPECT and 18F-FDG-PET demonstrated depressed blood flow and glucose metabolism in the corresponding temporal lobe. The patient underwent gamma knife radiosurgery for the causative lesion with a low marginal dose of 18 Gy. After treatment, the partial attack ceased without shrinkage of the lesion or peri-lesional parenchymal radiation injury.

Topics: Adult; Brain Neoplasms; Electroencephalography; Epilepsy, Temporal Lobe; Female; Fluorodeoxyglucose F18; Hemangioma; Humans; Magnetic Resonance Imaging; Magnetoencephalography; Radiopharmaceuticals; Radiosurgery; Technetium Tc 99m Exametazime; Temporal Lobe; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

Technetium-d, HMPAO SPECT was performed in 70 patients suffering from intracerebral tumors of various histologic types (glioma n = 30, meningioma n = 19, metastases n = 10, angioma n = 3, neuroma n = 2, lymphoma n = 2, neurocytoma n = 1, epidermoid n = 1, gliosis n = 1, cholesteatoma n = 1). Tumor classification was histologically verified in all subjects except in two cases with inoperable angiomas. SPECT was performed under resting state conditions with a dual-head rotating camera (SIEMENS ZLC 37) following intravenous injection of 18-25 mCi 99mTc-d, 1-HMPAO. Regional tracer deposit was expressed in terms of a cerebellar index (CBI). Significantly higher regional HMPAO uptake was found in meningiomas when compared with gliomas of different malignancy (ANOVA p less than 0.05). Within gliomas, regional uptake increased with malignancy (n.s.). In 23 patients, a total of 32 tumor specimens were obtained for histochemical analysis of glutathione (GSH) content using high-pressure liquid chromatography. A significant correlation (least square method, p less than 0.001) between CBIs and GSH values was found, supporting the hypothesis that GSH is the predominant factor for the conversion of the lipophilic complex to hydrophilic derivates.

Topics: Adult; Aged; Aged, 80 and over; Brain Neoplasms; Cerebrovascular Circulation; Female; Glioma; Glutathione; Hemangioma; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon