title: 99mTc-MIBI SPECT in distinguishing neoplastic from nonneoplastic intracerebral hematoma.
abstract: Distinguishing neoplastic from nonneoplastic intracerebral hematoma has great clinical relevance for the appropriate management of patients. Imaging is not always able to clearly identify a tumor-related intraparenchymal cerebral hemorrhage (ICH), especially in the acute phase, the diagnosis being frequently based on evolution patterns. The aim of this study was to test the value of (99m)Tc-methoxyisobutylisonitrile ((99m)Tc-MIBI) SPECT as a noninvasive diagnostic tool in early diagnosis of hemorrhagic brain neoplasm.
  
  
  METHODS
  We prospectively studied 29 patients harboring a nontraumatic acute onset of clinical deterioration caused by ICH with atypical clinical or neuroradiologic features. All patients underwent (99m)Tc-MIBI SPECT within 48 h from the clinical onset. Early and delayed images were obtained. Both visual and semiquantitative analyses were performed. The (99m)Tc-MIBI index was obtained from both early and delayed images and the retention index was calculated.
  
  
  RESULTS
  In 19 patients (65.5%), a nonneoplastic hemorrhage (15 vascular degenerative diseases, 2 cavernous angiomas, 1 thrombosed middle cerebral artery giant aneurysm, and 1 sinus rectus thrombosis) was diagnosed by clinical and neuroradiologic follow-up or open surgery. In 10 patients (34.5%), a neoplastic hemorrhage (6 metastases, 2 glioblastomas multiforme, 1 ependymoma, and 1 intracranial angioblastic meningioma) was diagnosed by direct histologic typing (open surgery or stereotactic biopsy). In all neoplasm-related hemorrhages, a focal increased tracer uptake was observed in the area of the lesion, whereas no focal increased tracer uptake was noted in all nonneoplastic hematomas. A wide cutoff in the early ratio between neoplastic and nonneoplastic hemorrhages was found. Moreover, a statistically significant difference was found in the delayed ratio (P < 0.01) and the retention index (P < 0.05) between the 2 groups.
  
  
  CONCLUSIONS
  Our data suggest that (99m)Tc-MIBI SPECT could play a role in the early noninvasive diagnostic work-up of hemorrhagic brain lesions, allowing a clear differentiation between neoplastic and nonneoplastic ICHs. The high availability and low cost of this nuclear medicine technique can be considered additional advantages.
authors.affiliation: Department of Radiological Sciences, University of Messina, Messina, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Minutoli
authors.forename: Filippo F
authors.initials: FF
authors.lastname: Angileri
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Cosentino
authors.forename: Giorgio Restifo
authors.initials: GR
authors.lastname: Pecorella
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cardali
authors.forename: Oreste
authors.initials: O
authors.lastname: De Divitiis
authors.forename: Antonino
authors.initials: A
authors.lastname: Germanò
authors.forename: Sergio
authors.initials: S
authors.lastname: Baldari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging*; D002543:Cerebral Hemorrhage / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006406:Hematoma / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011859:Radiography; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi