Complementary role of MRI and positron emission tomography in diagnosing cerebral abscess in a patient with metastatic paraganglioma

Abstract

Technological advances have increased the ability of imaging to provide an accurate preoperative diagnosis of an intracranial mass. We present the case of a patient with metastatic paraganglioma, who presented with headache and depressed conscious state. We had chronic tachycardia and low-grade fevers due to increased catecholamine secretion, which limited his clinical assessment. The combination of novel positron emission tomography tracers and advanced magnetic resonance imaging techniques was able to provide a confident preoperative diagnosis of a pyogenic intracranial abscess, which was not suspected clinically. This allowed appropriate therapy to be instituted until the patient's clinical state improved sufficiently for neurosurgery to be performed.

How we read: the combined use of MRI and novel PET tracers for the characterisation and treatment planning of masses in neuro-oncology

“…This information, combined with conventional and advanced MRI sequences, may provide a more confident diagnosis. For example, a non-FET-avid intracranial mass has a limited differential of non-malignant conditions, including abscess [19] and tumefactive demyelination [20]. Most grade III and IV gliomas (> 95%) [21] and grade II oligodendrogliomas demonstrate high tracer uptake [18], but uptake is more variable in grade I and II astrocytomas, with approximately 30% exhibiting low uptake [18].…”