A 60-year-old Chinese man was admitted to Hospital with the history of intermittent convulsion of left upper limb with numbness of left lower limb for more than half a month, without headache, dizziness, nausea, vomiting and other symptoms. Brain magnetic resonance imaging (MRI) revealed an occupying lesion in right frontal lobe (Figure 1 A-C), then brain metastasis and gliomas were considered. A chest X-ray was taken, and no abnormality was detected. Tumor markers were slightly higher and results were summarized. Subsequently, he was referred for an FDG PET/CT imaging to evaluate the whole-body, the images revealed a low-density lesion in right frontal lobe with distinct borderline, and FDG uptake was deficient completely, less than that of white matter ( Figure 2). Meanwhile, a solitary pulmonary nodule was detected in upper lobe of the right lung with higher FDG uptake (standardized uptake values (SUVmax: 2.1) (Figure 3), without any other abnormality in other organs.
DiscussionLung cancers form a leading cause of death worldwide, of which more than 80% show non-small cell histology [1]. Unfortunately, most lung cancers present at a clinically advanced stage [2,3]. PET/CT is now an important cancer imaging tool, both for diagnosis and staging, as well as offering prognostic information based on response.Because of the high FDG uptake in gray matter, the contrast of the uptake from the tumor versus normal brain tissue decreases, leading to low sensitivity. It is accepted that the correlation of grades with 18 F-FDG showed high-grade brain tumor demonstrated hypermetabolism with high FDG uptake, while low-grade brain tumors revealed low levels of glucose metabolism with less than, equal to, or slightly higher than that of white matter. Cerebral metastases mainly occur in the supratentorial
AbstractLung cancers form a leading cause of death worldwide. The prognosis in lung cancer is greatly worsened by the presence of metastases, the brain is an extremely common metastatic site. Non small-cell lung cancer (NSCLC) was more frequently associated with hypermetabolic metastatic brain lesions than small-cell lung cancer (SCLC).18 F-FDG PET/CT is increasingly used in detecting and staging of lung cancer as single "one stop shop" method. However FDG uptake deficiency from NSCLC has not well addressed. Here we presented a particular case of 18 F-FDG PET/CT for cerebral metastasis with 18 F-FDG uptake deficiency from NSCLC.