Skull vault hemangioma mimicking neoplastic lesion on [68Ga]Ga-PSMA-11 PET/CT in a patient with glioblastoma: A case report

Abstract

We present the case of a 47-year-old woman treated by radiochimotherapy for a glioblastoma which underwent a [68Ga]Ga-PSMA-11-PET/CT to distinguish postradiation changes from an evolutionary process. This demonstrated a weak homogeneous uptake surrounding the lesion. There was a focal and moderate uptake of a pseudo lytic skull diploe lesion near to the glioblastoma, finally attributed to a calvaria hemangioma. Calvaria hemangiomas are less frequent than vertebral hemangiomas and may demonstrate a modest PSMA uptake that one should keep in mind so as not to misinterpret the examination in patients followed for glioblastomas.

Discriminating Inflammatory Radiation-Related Changes From Early Recurrence in Patients With Glioblastomas

“…In this patient, a lesion of the skull vault demonstrating weak uptake was unexpectedly discovered (SUV max , 3.3). After comparing these findings with the MRI findings and radiological consultation, this image was attributed to a benign skull vault hemangioma 46 . Because the glioblastoma lesion showed a similar weak fixation (SUV max , 3.2), it was attributed to postradiation modifications rather than recurrence.…”

“…After comparing these findings with the MRI findings and radiological consultation, this image was attributed to a benign skull vault hemangioma. 46 Because the glioblastoma lesion showed a similar weak fixation (SUV max , 3.2), it was attributed to postradiation modifications rather than recurrence. The patient underwent bevacizumab treatment at a radionecrotic dosage and was still alive 3 years after examination without receiving any new chemotherapy.…”

Prostate-Specific Membrane Antigen as Target for Neuroimaging of Central Nervous System Tumors

“…They warn that this false positive indicates that 68 Ga-PSMA may not be fully able to differentiate recurrence from radiation necrosis. Moreau et al echoed these concerns in their case report of a GBM patient with modest 68 Ga-PSMA-11 (HBED-CC) uptake (SUV max of 3.2), who was determined to have postradiation changes based on clinical imaging [48]. Without an established threshold for defining recurrence versus postradiation treatment effect, it may be difficult to interpret some of the 68 Ga-PSMA PET images, especially given the wide range of values for SUV max and TBR that have thus far been demonstrated in gliomas.…”

Hemangioma of the Ilium Simulating Bone Metastasis on 18F-PSMA-1007 PET/CT

“…Hemangioma of the ilium is rare 1,2,5,6 . There are a few case reports of 68 Ga-PSMA uptake in vertebral 7–9 and skull 10 hemangiomas, which may be due to PSMA expression in endothelial cells. Low-to-moderate PSMA uptake has been shown in many other benign bone lesions, including osteophyte, 11 Schmorl node, 12 fracture, 13 osteoid osteoma, 14 Paget disease, 15 fibrous dysplasia, 16 and infection 17 .…”