Case Author(s): Jeff A. Chesnut, D.O. and Henry Royal, M.D. , 6/24/99 . Rating: #D2, #Q4
Diagnosis: Meningioma
Brief history:
64 year old female being evaluated for elevated gastrin levels and recurrent peptic ulcers.
Images:
Whole body images from octreotide scintigram are shown.
View main image(ot) in a separate image viewer
View second image(ot).
Isolated view of the head - octreotide scintigram.
View third image(mr).
Coronal MRI image of the brain is shown.
View fourth image(mr).
Coronal MRI of the brain with pointer.
Full history/Diagnosis is available below
Diagnosis: Meningioma
Full history:
64 year old female with Zollinger-Ellison syndrome and a gastrin level
above 500. Being evaluated for gastrinoma.
Radiopharmaceutical:
In-111 pentetreotide
Findings:
The 24 hr. whole-body scintigrams reveal no evidence of gastrinoma. There
is intense increased activity near the left skull base, however.
Discussion:
Octreotide is used for the detection of somatostatin receptor positive
tumors. This study reveled an incidental focus of increased
activity in the head. Among the more common
causes of activity in the head during octreotide scintigraphy are metastases
from somatostatin positive tumors, meningiomas, well-differentiated
astrocytomas (but not in undifferentiated glioblastomas), and in pituitary
adenomas.
Followup:
The patient had a history of a long-standing, stable meningioma adjacent to the
left cavernous sinus. Her previous MRI studies were obtained and the
meningioma was demonstrated to correspond with the increased activity on
the octreoscan image.
Major teaching point(s):
A number of tumors may cause increased octreotide activity in the head.
Differential Diagnosis List
1. Metastasis from a somatastatin receptor positive tumor.
2. Meningioma
3. Well-differentiated astrocytoma
ACR Codes and Keywords:
References and General Discussion of Octreotide Scintigraphy (Anatomic field:Skull and Contents, Category:Neoplasm, Neoplastic-like condition)
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Case number: ot005
Copyright by Wash U MO
