Objective: Glioblastoma multiforme (GBM) represents the most common and malignant
glioma, accounting for 45%-50% of all gliomas. The median survival time for patients with glioblastoma
is only 12-15 months after surgical, chemioterapic and radiotherapic treatment; a correct diagnosis
is naturally fundamental to establish a rapid and correct therapy. Non-invasive imaging plays a pivotal
role in each phase of the diagnostic workup of patients with suspected for diagnosis. The aim of
this case report was to describe the potential clinical impact of 18F-fluorocholine (FCH) PET/CT in the
assessment of a cystic GBM mimicking a spontaneous hemorrhage.
Methods: a 57 years-old male with intraparenchymal hemorrhage at CT imaging initially in reduction
ad serial imaging and suspected right fronto-temporo-parietal lesion at MRI underwent dynamic and
static (60' after tracer injection) FCH PET/CT of the brain.
Results: FCH PET/CT showed rapid tracer uptake after few second from injection at dynamic acquisition
and consequent incremental mild uptake at static imaging after 60 minutes at the level of oval
formation in the right cerebral hemisphere characterized by annular and peripheral high metabolic activity.
The central region of the lesion was characterized by the absence 18F-FCH uptake most likely
due to blood component. The patient underwent surgery for tumor removal; the histopathological examination
confirmed the suspect of GBM. Chemo-radiotherapic adjuvant protocol according to Stupp
protocol was therefore administrated; to date the patient is alive without any progression disease at 5
months from treatment.
Conclusion: In this case report FCH PET/CT represented the final diagnostic technique to confirm the
suspicious of a cystic GBM. Our case demonstrated the potential role of 18F-FCH PET/CT for discrimination
of higher proliferation area over intraparenchymal hemorrhage, supporting the potential
use of this imaging biomarker in surgical or radiosurgical approach. Obviously, further prospective
studies are needed to confirm this role and to exactly define possible routinely applications.