Multifocal Meningiomas Mimicking Dural-Based Intracranial Metastases at 18F-Fluciclovine PET/CT

Abstract

A 78-year-old man with biochemically recurrent prostate adenocarcinoma (prostate-specific antigen, 2.3 ng/mL) but without detectable disease in the chest, abdomen, or pelvis at conventional CT imaging or in the bones at 99mTc-MDP scintigraphy underwent 18F-fluciclovine (anti–1-amino-3-18F-fluorocyclobutane-1-carboxylic acid) PET/CT to evaluate for occult recurrent or metastatic disease. Imaging identified intense radiotracer uptake within 3 dural-based lesions along the left cerebral convexity. Subsequent MRI and biopsy confirmed multifocal World Health Organization grade 2 atypical meningiomas. Focal intracranial radiotracer uptake at 18F-fluciclovine PET/CT may create a diagnostic dilemma as incidental meningiomas can mimic intracranial metastases.

Coexistence of Dural and Intraventricular Meningioma-A Rare Entity

“…Multiple meningioma may rarely present as bipolar disorder like psychiatric illness making imaging mandatory to rule out organic lesion prior to targeted medical management of bipolar psychotic illness [19]. Multiple dural-based meningioma also forms a differential diagnosis of multiple dural-based metastases [20]. Classical benign meningioma appears as a homogeneous, round to ovoid, dural-based, extra-axial lesion with sharp margins, internal calcification and near-homogeneous postcontrast enhancement with or without bone reaction.…”

Incidental Spinal Meningioma on an 18F-Fluciclovine PET/CT

“…[5][6][7] There are reported cases of 18 F-fluciclovine uptake within intracranial meningiomas, which can mimic dural metastases, a differential diagnosis that should also be considered. 8,9…”

“…Meningiomas also show avidity to other PET radiotracers such as 11 C-methionine, 68 Ga-DOTATATE, 68 Ga-PSMA, and so on [5][6][7]. There are reported cases of 18 F-fluciclovine uptake within intracranial meningiomas, which can mimic dural metastases, a differential diagnosis that should also be considered 8,9.…”

Multifocal Meningiomas Mimicking Metastasis on 18F-Fluciclovine PET/CT

“…Focal intracranial 18F-fluciclovine radiotracer uptake especially at the skull base may present with a diagnostic challenge, and it may be difficult to differentiate between bone metastasis and meningiomas. Keywords 18F-fluciclovine • 18 F-FACBC • Meningioma • PET/CT • Prostate cancer 18 F-FACBC PET/CT is a novel technique that has gained increasing popularity for evaluating recurrent prostatic adenocarcinoma in patients with an elevated prostate-specific antigen (PSA) who have received prior cancer therapy [1,2]. 18 F-FACBC used in this imaging modality is a synthetic radiolabeled amino acid that takes advantage of the prostatic cancer cell upregulation of transmembrane amino acid transport due to increased amino acid metabolism for energy production and protein synthesis [3,4].…”