FDG PET in Lhermitte-Duclos Disease

Lhermitte-Duclos Disease Related With Cowden Syndrome Mimicking Metastatic Lung Cancer on FDG PET/CT

ABSTRACT

Cowden syndrome is characterized by multiple hamartomatous and neoplastic lesions including Lhermitte-Duclos disease, which is the main criterion for the diagnosis. Herein, we presented a patient with suspected metastatic disease referred to PET/CT, which showed mildly hypermetabolic multinodular thyroid goiter, multiple hamartomatous pulmonary, and breast nodules. Also, intense hypermetabolism was noted on the cerebellar tumor lesion. Lhermitte-Duclos disease was diagnosed based on the characteristic MRI findings, and she was followed up with a diagnosis of Cowden syndrome. Our case indicates that Cowden syndrome should be included as a differential diagnosis of abnormal FDG uptake in the multiple systemic hamartomatous tumors.

Biological characteristics of a cerebellar mass regrowing after removal in a patient with lhermitte-duclos disease: emission tomography studies

Lhermitte-Duclos disease is a rare disorder characterized by a slowly enlarging mass in the cerebellum. The exact nature of this lesion remains unclear, but it has been variously characterized as hypertrophy, hamartoma or benign neoplasm. Single-photon emission computed tomography (SPECT) with ¹²³I-iomazenil and ^99mTc-ethyl cysteinate dimer (ECD) display central benzodiazepine receptors that are widely distributed in the normal brain cortex, a combination of brain perfusion, enzymatic activity and blood-brain barrier function, respectively. This report describes the case of a 30-year-old man who developed Lhermitte-Duclos disease. The mass regrew after a subtotal removal 13 years earlier. The cerebellar lesion exhibited hyperperfusion and hypermetabolism on blood flow and a metabolic rate of oxygen imaging on ¹⁵O-gas positron emission tomography (PET), as well as a hyperactivity and a defect in the uptake on ^99mTc-ECD and ¹²³I-iomazenil SPECT imaging, respectively. The present Lhermitte-Duclos lesion might have the biological characteristics of both hypertrophy and neoplasm, from the perspective of results from ¹⁵O-gas PET, ^99mTc-ECD and ¹²³I-iomazenil SPECT.

A surgically treated case of Lhermitte-Duclos disease with a precise natural history and high uptake of FDG on PET

We describe herein a surgically treated case of Lhermitte-Duclos disease in a 33-year-old man. The clinical presentation seemed typical in terms of symptoms, neurological signs, and neuroimaging. High and heterogenous fluorodeoxyglucose uptake in positron emission tomography study is presented and discussed. Furthermore, we performed volumetric analysis of the tumor with sequential magnetic resonance imaging over the course of 7 years before surgery, making this report the first with a long-term natural history, revealing that this rare disease entity may have a neoplastic nature.

Intense F-18 FDG accumulation in idiopathic tumoral calcinosis

An elderly Japanese woman presented to our hospital with a 5-month history of a growing mass on her right cheek. She did not complain of local pain, headache, hearing difficulty, or tinnitus. CT and MRI showed a dense calcified mass and F-18 fluorodeoxyglucose (FDG) PET demonstrated intense accumulation in the mass. Resection of the mass was performed and it was histologically diagnosed as idiopathic tumoral calcinosis.

Functional imaging of inflammatory diseases using nuclear medicine techniques

Molecular imaging with positron emission tomography (PET) and single-photon emission computed tomography (SPECT) is increasingly used to diagnose, characterize, and monitor disease activity in the setting of inflammatory disorders of known and unknown etiology. These disorders include sarcoidosis, atherosclerosis, vasculitis, inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and degenerative joint disease. Gallium-67 ((67)Ga) citrate, labeled leukocytes with technetium-99m ((99m)Tc) or indium-111 ((111)In), and (18)F-fluorodeoxyglucose (FDG) represent the most widely used radiopharmaceutical agents. However, other preparations, such as labeled murine monoclonal antigranulocyte antibodies and labeled human polyclonal nonspecific immunoglobulin G, chemotactic peptides, interleukins, chemokines, and liposomes, have been used to image inflammation. Also, (99m)Tc nanocolloid scintigraphy has been found to be suitable for bone and joint diseases, especially RA. Among the single photon emitting imaging agents, the recommended radiotracer for abdominal inflammation has been (99m)Tc-hexamethylpropylene amine oxime (HMPAO)-labeled leukocytes. During the last several years, FDG-PET imaging has been shown to have great value for the detection of inflammation and has become the centerpiece of such initiatives. This very powerful technique will play an increasingly important role in the management of patients with inflammatory conditions. FDG-PET can provide valuable information in patients with pulmonary and extrapulmonary sarcoidosis, and is a useful tool for testing the efficacy of various treatments. FDG-PET combined with computed tomography holds great promise for assessing atherosclerosis of the large arteries. This modality is very sensitive in detecting large-vessel vasculitis and can be used to monitor the disease course. FDG-PET is also being used to study the inflamed synovial joints both in the experimental and clinical settings, especially for the investigation and management of RA and degenerative joint disease. This technique also has the potential to become the imaging modality of choice in assessing IBD, replacing radiolabeled autologous leukocyte imaging in this setting. Detection of inflammation in the lungs and airways may improve our knowledge about a multitude of disorders that affect these structures. Therefore, functional imaging, led by FDG-PET imaging, is likely to play an increasingly critical role in assessing inflammatory disorders of known and unknown etiologies, and will improve their management immensely in the future.