March 2010, Vol 67, No. 3 >

< Previous Article

Full Content is available to subscribers

Subscribe/Learn More

Next Article >

Images in Neurology | March 2010

FDG-PET a Pivotal Imaging Modality for Diagnosis of Stroke-Onset Intravascular Lymphoma

Shigeki Yamada, MD, PhD; Ryuichi Nishii, MD, PhD; Satoshi Oka, MD, PhD; Tatsuya Higashi, MD, PhD; Miyuki Yagi, MD; Takeshi Satow, MD, PhD; Takayo Suzuki, MD, PhD; Masaaki Saiki, MD, PhD

Arch Neurol. 2010;67(3):366-367. doi:10.1001/archneurol.2010.6.

Text Size: A A A

Published online

Article

Figures

References

Comments

Extract

Intravascular lymphoma (IVL) is a rare, fatal disease, often presenting with neurological deficits. Here we describe 2 patients initially diagnosed with recurrent atherosclerotic cerebral infarction followed by accurate diagnosis of IVL by positron emission tomography with ¹⁸fluorodeoxyglucose (FDG-PET).

Case 1 is a 65-year-old man with dysarthria and mild right hemiparesis. Two days later, he was diagnosed with left cerebral infarction and severe stenosis of intracranial left internal carotid artery on magnetic resonance imaging. His clinical course and radiological findings are summarized in Figure 1. While N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography (IMP-SPECT) studies revealed increased IMP uptake in the left frontal lobe, oxygen 15 gas PET did not reveal any abnormalities. We could not find any appropriate reasons for this discrepancy. Almost 100 days after onset, FDG-PET revealed high FDG uptake in the left frontal lobe. Brain biopsy was performed and revealed large B-cell IVL. The patient received whole-brain irradiation and steroid treatment, which transiently improved his symptoms, but he died 7 months after onset.

Figures in this Article

Sign In to Access Full Content

Username

Password

Forgot Your Password?

Don't have Access?

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large

Figures

Place holder to copy figure label and caption

Figure 1.

Summary of imaging for patient 1. Diffusion imaging on day 2 showed acute left cerebral infarction. Magnetic resonance angiography (MRA) showed severe stenosis at the cavernous segment of the left internal carotid artery. Positron emission tomography with ¹⁸fluorodeoxyglucose (FDG-PET) revealed high FDG uptake in the left middle frontal gyrus, corresponding to the area of increased N-isopropyl-p-[123I]iodoamphetamine (IMP) uptake on IMP–single-photon emission computed tomography (IMP-SPECT). Arrowheads indicate the most important findings. CBF indicates cerebral blood flow; CMRO₂, cerebral metabolic rate for oxygen; FLAIR, fluid-attenuated inversion recovery; MRI, magnetic resonance imaging; and O¹⁵, oxygen 15. (To convert 30 Gy to rad, multiply by 100.)

Grahic Jump Location

View Large | Save Figure | Download Slide (.ppt) | View in Article Context

Place holder to copy figure label and caption

Figure 2.

Summary of imaging for patient 2. Three-dimensional (3-D) magnetic resonance angiography (MRA) on day 9 revealed irregular stenotic changes in the main trunk and branches of right middle cerebral artery. Positron emission tomography with ¹⁸fluorodeoxyglucose (FDG-PET) 10 days after the onset showed high FDG uptake in the territory of right middle cerebral artery and right basal ganglia, which corresponded to the area of gadolinium enhancement by magnetic resonance imaging (MRI). In addition, multiple high-accumulation spots were scattered throughout brain. On day 17, FDG-PET 1 week after the first course of CHOP (cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate and prednisolone) chemotherapy and whole-brain radiation (total, 11 Gy [to convert to rad, multiply by 100]), revealed that the lesions of increased FDG uptake in bilateral cerebral hemispheres were fairly decreased, although 1 new lesion in the right temporal lobe showed an increase in FDG accumulation. Arrowheads indicate the most important findings. FLAIR indicates fluid-attenuated inversion recovery; R, rituximab.

Grahic Jump Location

View Large | Save Figure | Download Slide (.ppt) | View in Article Context

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

Correspondence

Submit a Letter

CME

Accreditation Information

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit^TM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 Credit^TM.

Note: You must get at least of the answers correct to pass this quiz.

Clear Answers | Save For Later

You have not filled in all the answers to complete this quiz

The following questions were not answered:

Sorry, you have unsuccessfully completed this CME quiz with a score of

The following questions were not answered correctly:

Commitment to Change (optional):

Indicate what change(s) you will implement in your practice, if any, based on this CME course.

Your quiz results:

The filled radio buttons indicate your responses. The preferred responses are highlighted

For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes

Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).

Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.

All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.

Instructions

Thank you for submitting a comment on this article. It will be reviewed by JAMA Neurology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.

Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.

* = Required Field

Comment Author(s)* (if multiple authors, separate names by comma)

Example: John Doe

Affiliation & Institution*

Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.

Please disclose any conflicts of interest or check the box below.

No potential conflicts or relevant financial interests

Comment Title*

Comment*

Get Audio Code

Submit Cancel

Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Print
PDF
Email

AMA

You must be logged in and have an account to share content.

Return to: FDG-PET a Pivotal Imaging Modality for Diagnosis of Stroke-Onset Intravascular Lymphoma

This feature is provided as a courtesy. By using it you agree that that you are requesting the material solely for personal, non-commercial use, and that it is subject to the AMA's Terms of Use. The information provided in order to email this article will not be shared, sold, traded, exchanged, or rented. Please refer to The JAMA Network's Privacy Policy for additional information.

© 2013 American Medical Association. All Rights Reserved.
Share
Get Citation

Yamada S, Nishii R, Oka S, et al. FDG-PET a Pivotal Imaging Modality for Diagnosis of Stroke-Onset Intravascular Lymphoma. Arch Neurol. 2010;67(3):366-367. doi:10.1001/archneurol.2010.6.

Download citation file:

RIS (Zotero)

EndNote

BibTex

Medlars

ProCite

RefWorks

Reference Manager

© American Medical Association
Get Permissions
Get Alerts

Processing your request... Please Wait.
Submit a Letter
Submit a Comment

Sign In to Access Full Content

Username

Password

Forgot Your Password?

Full Content is available to subscribers

FDG-PET a Pivotal Imaging Modality for Diagnosis of Stroke-Onset Intravascular Lymphoma

Extract

Figures in this Article

Topics

Sign In to Access Full Content

Don't have Access?

First Page Preview

Figures

Tables

Interactive Graphics

Video

References

Correspondence

Sign In

Don't have Access?

Sign In to Access Full Content

Related Content

JAMA Neurology

Content

Services

The JAMA Network

Sites

AMA Publishing Group Journals

Information For

Services

Content Resources

Other Resources

Sign In

Register for a FREE personal account

Want to Subscribe?

Don't have Access?

Forgot Your Password?