Serial positron emission tomography (PET) in gliomatosis cerebri treated with radiotherapy: a case report

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Abstract

Results of serial positron emission tomography (PET) in a biopsy-proven case of gliomatosis cerebri (GC) are reported. Computed tomography (CT) with and without contrast failed to detect focal abnormalities, but magnetic resonance (MR) revealed iso-intensity or low-intensity lesions in T1-weighted images and high-intensity lesions in T2-weighted images. Lesions were seen in the left thalamus, right temporal lobe and claustrum, and pons. Radiotherapy remarkably improved clinical and imaging findings. Both before and shortly after radiotherapy, 11C-methionine PET images showed hypermetabolism while 15O-water PET images showed a marked increase in cerebral blood flow in GC lesions. However, 6 months later PET images had remarkably improved, appearing nearly normal.

Introduction

Gliomatosis cerebri (GC) is an uncommon neoplastic condition loosely defined as a diffusely infiltrating glioma involving extensive areas of the brain. Diagnosis is difficult because symptoms and signs are variable and nonspecific, and neuroimaging usually does not show a localized mass [1], [2], [3], [4], [5]. Positron emission tomography (PET) in GC has been reported only rarely [6], [7]. We describe the findings of serial PET studies in a patient with biopsy-proven GC.

Section snippets

Case report

A 19-year-old male was admitted to our hospital with a history of abulia and hypersomnia. He had been in low spirits for 2 months and had slept nearly around the clock. Past history and family history were unremarkable. Physical examination on admission showed no abnormalities. Blood pressure was 115/75 mm Hg and heart rate was 70/min with a regular rhythm. He was somnolent, as he reportedly had for the 8 days preceding admission. The pupils were equal, measured 3 mm in diameter, and reacted

Discussion

Gliomatosis cerebri (GC) has a bimodal distribution of occurrence, showing a peak for age at death in the second decade and another peak in the fifth. Mental and behavioral changes (19 of 48 cases in one review), seizures (14 of 48), and headache (14 of 48) are the most commonly reported initial symptoms [1]. The symptoms in our patient, a 19-year-old male in his second decade, also were mental and behavioral: abulia and hypersomnia. The altered mental status and sleep disorder may have

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