SPECT in distinguishing neoplastic from nonneoplastic intracerebral hematoma
Minutoli F, Angileri FF, Cosentino S, Pecorella GR, Cardali S, De
Divitiis O, Germano A, Baldari S
Radiological Sciences, University of Messina, Messina, Italy.
Distinguishing neoplastic from nonneoplastic intracerebral hematoma has great
clinical relevance for the appropriate management of patients.
Imaging is not always able to clearly identify a tumor-related intraparenchymal
cerebral hemorrhage (ICH), especially in the acute phase, the diagnosis being
frequently based on evolution patterns.
The aim of this study was to test the value of (99m)Tc-methoxyisobutylisonitrile
((99m)Tc-MIBI) SPECT as a noninvasive diagnostic tool in early diagnosis of
hemorrhagic brain neoplasm.
We prospectively studied 29 patients harboring a nontraumatic acute onset of
clinical deterioration caused by ICH with atypical clinical or neuroradiologic
All patients underwent (99m)Tc-MIBI SPECT within 48 h from the clinical
Early and delayed images were obtained.
Both visual and semiquantitative analyses were performed.
The (99m)Tc-MIBI index was obtained from both early and delayed images and the
retention index was calculated.
In 19 patients (65.5%), a nonneoplastic hemorrhage (15 vascular degenerative
diseases, 2 cavernous angiomas, 1 thrombosed middle cerebral artery giant
aneurysm, and 1 sinus rectus thrombosis) was diagnosed by clinical and
neuroradiologic follow-up or open surgery.
In 10 patients (34.5%), a neoplastic hemorrhage (6 metastases, 2 glioblastomas
multiforme, 1 ependymoma, and 1 intracranial angioblastic meningioma) was
diagnosed by direct histologic typing (open surgery or stereotactic
In all neoplasm-related hemorrhages, a focal increased tracer uptake was
observed in the area of the lesion, whereas no focal increased tracer uptake was
noted in all nonneoplastic hematomas.
A wide cutoff in the early ratio between neoplastic and nonneoplastic
hemorrhages was found.
Moreover, a statistically significant difference was found in the delayed ratio
(P < 0.01) and the retention index (P < 0.05) between the 2 groups.
Our data suggest that (99m)Tc-MIBI SPECT could play a role in the early
noninvasive diagnostic work-up of hemorrhagic brain lesions, allowing a clear
differentiation between neoplastic and nonneoplastic ICHs.
The high availability and low cost of this nuclear medicine technique can be
considered additional advantages.
PMID: 14530468 [PubMed - indexed for MEDLINE]