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Year : 2017  |  Volume : 32  |  Issue : 3  |  Page : 243-244  

Extra-striatal uptake of 99mTc-TRODAT-1 in meningioma detected on SPECT/CT: Diagnostic clue or mere coincidence?


Department of Nuclear Medicine, MIOT International Hospital, Chennai, Tamil Nadu, India

Date of Web Publication13-Jun-2017

Correspondence Address:
Piyush Chandra
DNB, Department of Nuclear Medicine, MIOT International Hospital, Manapakkam, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_34_17

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   Abstract 

Incidental observation of extra-striatal uptake of 99mTc-TRODAT-1 has been reported previously in multiple space-occupying lesions of the brain. We present here a SPECT/CT scan of a 60-year old female with parkinsonism, with normal presynaptic dopaminergic transporters expression and with an intense tracer uptake in a large right-sided frontoparietal meningioma.

Keywords: Computed tomography, meningioma, SPECT, SPECT/CT, TRODAT-1


How to cite this article:
Chandra P, Nath S. Extra-striatal uptake of 99mTc-TRODAT-1 in meningioma detected on SPECT/CT: Diagnostic clue or mere coincidence?. Indian J Nucl Med 2017;32:243-4

How to cite this URL:
Chandra P, Nath S. Extra-striatal uptake of 99mTc-TRODAT-1 in meningioma detected on SPECT/CT: Diagnostic clue or mere coincidence?. Indian J Nucl Med [serial online] 2017 [cited 2017 Jun 24];32:243-4. Available from: http://www.ijnm.in/text.asp?2017/32/3/243/207885

A 60-year-old female presented with complaints of gradually progressive asymmetric lower limb weakness (left > right, proximal > distal), rest tremor, rigidity, and postural instability.99m Tc-TRODAT-1 scan was done for evaluation of clinically suspected Parkinson's disease (PD). Serial transaxial single photon emission tomography (SPECT) images ([Figure 1], caudal to cranial) show the normal tracer uptake in bilateral basal ganglia (long thin white arrow) and the incidental focal increased tracer uptake in the right frontoparietal region (dashed white arrow). Transaxial computed tomography (CT) images [Figure 1]b show a large extra-axial, dural-based soft tissue mass in the right frontal-parietal region with calcification, mild peritumoral edema, and minimal midline shift (small bold white arrow)—most likely to be meningioma. The fused serial transaxial SPECT/CT image [Figure 1]b shows an intense tracer uptake in the right frontoparietal mass. The patient was started on levodopa, but did not show any improvement. The patient was later advised excision of frontoparietal mass lesion; however, she refused the surgery.
Figure 1: (a) Serial trans-axial SPECT images showing normal TRODAT uptake in bilateral basal ganglia and extra-striatal uptake in the right fronto-parietal region, better characterized on (b) serial trans-axial CT images and (c) trans-axial SPECT/CT images

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A normal functional neuroimaging of the pre-synaptic dopaminergic system as per the new movement disorder society (MDS) criteria excludes a diagnosis of PD. One of the other exclusion criteria is demonstration of alternative conditions (such as tumors) that are known to cause  Parkinsonism More Details.[1] Meningiomas are the most common intra-cranial tumors associated with parkinsonism. Disruption of the post-synaptic output circuits from basal ganglia to cortex or impairment of tissue perfusion by edema (especially by tumors in frontoparietal region) is the probable mechanism of tumor-induced parkinsonism.[2] These cases usually are unresponsive to levodopa, and only surgical removal of the menigioma has been associated with complete recovery in symptoms.[2],[3],[4],[5] The coincidental extra-striatal uptake of 99m Tc-TRODAT-1 has been reported previously in meningioma, metastasis, subdural hematoma, clival tumors, and oligodendrogliomas.[6],[7],[8],[9],[10] Identification and characterization of these incidental space-occupying lesions on SPECT/CT with normal symmetric striatal uptake not only can avoid misdiagnosis of idiopathic PD, but can also be useful in planning early and appropriate treatment.

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There are no conflicts of interest.

 
   References Top

1.
Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, et al. MDS clinical diagnostic criteria for Parkinson's disease. Mov Disord 2015;30:1591-601.  Back to cited text no. 1
    
2.
Krauss JK, Paduch T, Mundinger F, Seeger W. Parkinsonism and rest tremor secondary to supratentorial tumours sparing the basal ganglia. Acta Neurochir (Wien) 1995;133:22–9.  Back to cited text no. 2
    
3.
Kim J-I, Choi JK, Lee J-W, Hong JY. Intracranial Meningioma-induced Parkinsonism. J Lifestyle Med 2014;4:101–3.  Back to cited text no. 3
    
4.
Benincasa D, Romano A, Mastronardi L, Pellicano C, Bozzao A, Pontieri FE. Hemiparkinsonism due to frontal meningioma. Acta Neurol Belg 2008;108:29–32.  Back to cited text no. 4
    
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Adhiyaman V, Meara J. Meningioma presenting as bilateral parkinsonism. Age Ageing 2003;32:456–8.  Back to cited text no. 5
    
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Yu-Chin W, Te-Chun H, Shung-Shung S, Kuo-Yang Y, Chih-Hsiu W, Yu-Yi L, et al. Clinical Nuclear Medicine 2010;35:107-8.  Back to cited text no. 6
    
7.
Chiu YL, Hu C, Li JY, Weng MJ, Lin WC, Peng NJ. An incidental finding of cerebral meningioma on 99mTc-TRODAT-1 dopamine transporter SPECT/CT. Clin Nucl Med 2012;37:899-900.  Back to cited text no. 7
    
8.
Hsieh TC, Kao CH, Wu YC, Wang CH, Yen KY, Sun SS. Findings of subdural hematoma on Tc-99m-TRODAT-1 SPECT. Clin Nucl Med 2009;34:245-6.  Back to cited text no. 8
    
9.
Chen YR, Hsieh TC, Yen KY, Kao CH. Increased 99mTc TRODAT-1 uptake in anaplastic oligodendroglioma. Clin Nucl Med 2014;39:e104–5.  Back to cited text no. 9
    
10.
Taywade S, Tripathi M, Tandon V, Das CJ, Damle NA, Shamim SA, et al. Tc-99m TRODAT uptake in an osteoid tumor of clivus. Indian J Nucl Med 2016;31:309–10.  Back to cited text no. 10
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