OBJECTIVETo evaluate the value of (18)F-FDG and (11)C-MET PET-CT scan in differentiation of brain ringlike-enhanced lesions on MRI imaging.

METHODSForty-one brain ringlike-enhanced lesions on MRI imaging including 30 brain tumors and 11 non-neoplastic lesions confirmed pathologically or clinically underwent (18)F-FDG and (11)C-MET PET-CT brain scan. Among them, 15 patients who were suspected to have brain metastasis received body scan by (18)F-FDG PET-CT. Both images were analyzed visually and semi-quantitatively.

RESULTSVisual analysis: for brain tumors the diagnostic sensitivity, specificity and accuracy of (18)F-FDG PET-CT was 53.3%, 72.7%, 58.5%, versus 96.7%, 90.9%, 95.1% of (11)C-MET PET-CT, respectively. All the primary foci in 9 patients with brain metastases were detected by body (18)F-FDG PET-CT scan. Semiquantitative analysis: There was a significant difference in the uptake between highly differentiated malignant and poorly differentiated tumors as well as non-neoplastic lesions for both tracers (P < 0.01), while between low-grade malignant tumors and non-neoplasm lesions, there was a difference in uptake only by (11)C-MET (P < 0.01). No significant difference between the uptakes in brain metastasis and glioblastomas was found by both tracers (P > 0.05).

CONCLUSIONBoth (18)F-FDG and (11)C-MET PET-CT are useful in differentiation of brain ringlike-enhanced lesions on MRI imaging. (11)C-MET PET-CT is more helpful than (18)F-FDG PET-CT in differential diagnosis of low-grade neoplastic from non-neoplastic lesions. Combination of (18)F-FDG and (11)C-MET PET-CT scans can improve the accuracy of differential diagnosis for brain ringlike-enhanced lesions on MRI imaging.

Acetates ; Adolescent ; Adult ; Aged ; Brain Abscess ; diagnosis ; Brain Neoplasms ; diagnosis ; pathology ; secondary ; Carbon ; Carbon Radioisotopes ; Child ; Craniopharyngioma ; diagnosis ; pathology ; secondary ; Diagnosis, Differential ; Female ; Fluorodeoxyglucose F18 ; Glioblastoma ; diagnosis ; pathology ; secondary ; Humans ; Lung Neoplasms ; diagnosis ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pituitary Neoplasms ; diagnosis ; pathology ; secondary ; Positron-Emission Tomography ; methods ; Radiopharmaceuticals ; Sensitivity and Specificity ; Young Adult

Pituitary abscesses are rare but potentially life-threatening disorders. Headaches, pituitary insufficiency and visual disturbances are the most common clinical manifestations mimicking pituitary adenoma.
Pituitary Abscess ; Thyromegaly

Advanced techniques of nasal endoscopy made it possible to approach the optic nerve, pituitary gland, and anterior skull base transnasally. Epidural or brain abscess caused by ascending infection through the defect of the fovea ethmoidalis can be drained with reduced morbidity by endoscopic sinus surgery. Recently we have experienced a brain abscess that was managed by endoscopic transnasal drainage successfully.
Brain Abscess* ; Brain* ; Drainage* ; Endoscopy ; Optic Nerve ; Pituitary Gland ; Skull Base

A 35-year-old woman presented with amenorrhea, polydipsia, polyuria, general weakness and intolerance of cold; the duration of these symptoms had been five years. On brain MRI with Gadolinium enhancement, an intrasellar mass protruding above the sella turcica was demonstrated, and the patient was thought to be a pituitary adenoma. The transsphenoid approach(TSA) was employed, and during at surgery, pus was drained. In a culture of this, no microorganism was identified, and on histologic examination, which suggested lymphocytic infiltration with fibrosis and occasional neutrophils were seen, findings which suggested the possibility of capsule of chronic abscess. Transient postoperative polyuria was noted, but this disappreared soon after broad spectrum antibiotics were administered; hormonal therapy was required for anterior and posterior pituitary hypofunction. Clinical features of this condition and its treatment are also discussed, and the literature pertaining to reported cases is reviewed. An enlarged or erosive sella coexisting with bacterial meningitis, sphenoid sinusitis, cavernous sinus thrombophlebitis or bacterial meningitis coincident with a known or suspected pituitary tumor suggests the presence of a pituitary abscess.
Abscess* ; Adult ; Amenorrhea ; Anti-Bacterial Agents ; Brain ; Cavernous Sinus Thrombosis ; Female ; Fibrosis ; Gadolinium ; Humans ; Magnetic Resonance Imaging ; Meningitis, Bacterial ; Neutrophils ; Pituitary Neoplasms ; Polydipsia ; Polyuria ; Sella Turcica ; Sphenoid Sinus ; Sphenoid Sinusitis ; Suppuration

Pituitary abscess is a rare condition of the pituitary gland. We report MR imaging findings in two cases of surgically-confirmed pituitary abscess occurring in women aged 39 and 28. In both a peripheral rim enhancing lesion, similar to abscesses in other areas of brain, was seen in the pituitary fossa.
Abscess* ; Brain ; Female ; Humans ; Magnetic Resonance Imaging* ; Pituitary Gland

Pituitary abscess may be caused by direct extension of contiguous infections from purulent sphenoid sinusitis, meningitis or cavernous sinus thrombophlebitis. It also develop after craniotomy or transsphenoidal hypophysectomy. In some cases, it was associated with primary pituitary tumor or cyst which were vulnerable to infection because of impaired circulation, areas of necrosis or local immunological impairment. Primary pituitary abscess may also occur without any preceding infection. Since the clinical features, computed tomographic findings, and laboratory data of primary pituitary abscess were similar to pituitary tumor, preoperative diagnosis of pituitary abscess is difficult. Inhomogenous enhancement with central low density and focal bulge at the level of diaphragm was reported to be compatible with computed tomographic findings of pituitary abscess.
Abscess* ; Cavernous Sinus Thrombosis ; Craniotomy ; Diagnosis ; Diaphragm ; Hypophysectomy ; Meningitis ; Necrosis ; Pituitary Neoplasms ; Sphenoid Sinus ; Sphenoid Sinusitis

Tumorous lesion of intra- and suprasellar area showed unique clinical pictures and also was very hazardous and difficult to remove surgically because of the surrounding important anatomical structures. Here, authors analyzed 28 confirmed tumor of this area during last two and half years retrospectively. Histopathologically, 28 cases were classified in 14 pituitary adenoma cases(6 cases of nonfunctioning adenoma, 1 GH-secreting adenoma and 7 cases of prolactinoma), 7 craniopharyngioma cases, 3 meninigioma cases and each one case of germinoma, Rathke's cleft cyst, pituitary abscess and hamartoma. Sexual incidence was 6:22 in male vs female ratio. Twenty two cases were measured its diameter over 2cm and they extended to suprasellar area in all cases. Five cases of microadenoma were analyzed and they were all enclosed in sella turcica. Visual impairment was the most frequent and prominent clinical symptom, of which incidence was 78.57%(22 cases). The next frequent symptoms were headache and generalized lethargy. Diabetes insipidus was a presenting symptom in 4 cases and hydrocephalus was noted in 4 cases preoperatively. Surgical intervention was carried out in 23 cases, by the way, the performed type of surgery in 21 cases was a conventional transcranial frontotemporal(pterional) microsurgical method. Post-operatively, diabetes insipidus was complicated in 78.26% and pituitary hypofunction was noted 34.78%. Two cases of intracranial hemorrhage was developed after surgery and one was died. Through 6 to 28 months follow up, 82.1% of cases were improved in its clinical status including 7 cured cases.
Abscess ; Adenoma ; Craniopharyngioma ; Diabetes Insipidus ; Female ; Follow-Up Studies ; Germinoma ; Hamartoma ; Headache ; Humans ; Hydrocephalus ; Incidence ; Intracranial Hemorrhages ; Lethargy ; Male ; Meningioma ; Pituitary Neoplasms ; Retrospective Studies ; Sella Turcica ; Vision Disorders

The authors described a case of tuberculous brain abscess, located on the sellar area with as episode of tuberculous meningitis on the past history. Tuberculous brain abscess, encapsulated collection of pus, is quite rare. Especially, occurrence around the sellar area is extremely rare. On brain CT scan, tuberculous brain abscess on sellar region was differented from pituitary adenoma, craniopharyngioma, germinoma, pyogenic brain abscess, etc. The history of previous tuberculous meningitis was meaningful for the diagnosis of our case. So, we have reported this case with review of the articles.
Brain Abscess* ; Brain* ; Craniopharyngioma ; Diagnosis ; Germinoma ; Pituitary Neoplasms ; Suppuration ; Tomography, X-Ray Computed ; Tuberculosis, Meningeal

Abscess formation within the sellar turcica is a rather entity. The development of such as abscess may be due to a direct extension of adjacent infections, such as sphenoid sinusitis, osteomyelitis of the floor of the sella or infections of other sinuses, or may be transmitted through the blood stream. Several intrinsic lesions of the pituitary gland may favor the development of infections. A case of pituitary abscess is reported in which the clinical history, manifestation and laboratory data of 32 year-old Korean female showed a strong resemblance to those in pituitary adenomas. At operation a soft cystic mass was exposed and identified in the pituitary fossa of which content was yellow pus and drained. Studies of the cyst wall and content demonstrated non-specific inflammation of the pituitary gland. A brief review of abscess in the pituitary fossa is presented.
Abscess* ; Adult ; Female ; Humans ; Inflammation ; Osteomyelitis ; Pituitary Gland ; Pituitary Neoplasms ; Rivers ; Sphenoid Sinus ; Sphenoid Sinusitis ; Suppuration

Abscess formation in the pituitary gland is very rare. The development of such a lesion is through to be due to direct extension of adjacent infection or metastasis remote lesion. It has been suggested by some authors that intrinsic lesions of the pituitary gland may favor the development of infections. Tumors and postpartum necrosis of the pituitary gland are the lesions which easily undergo secondary infection. Recently we experienced a case of pituitary abscess. A 27 years old housewife was admitted to our hospital because of intermittent headache, constricted visual field and amenorrhea of about 3 years' duration. Clinical manifestations and diagnostic studies strongly suggested pituitary tumor. Upon surgery, abscess was found in the pituitary fossa. Direct smear of the aspirated material showed many polymorphous leukocytes. No microorganisms were detected on direct smear and in culture. Biopsy of the capsule demonstrated nonspecific of the pituitary gland. There developed transient polydipsia and polyuria postoperatively but soon disappeared under medication of Esidrex. Our case of pituitary abscess is interesting in that it's main symptoms developed after delivery, which suggests Sheehan's syndrome followed by abscess formation.
Abscess* ; Adult ; Amenorrhea ; Biopsy ; Coinfection ; Female ; Headache ; Humans ; Hydrochlorothiazide ; Hypopituitarism ; Leukocytes ; Necrosis ; Neoplasm Metastasis ; Pituitary Gland ; Pituitary Neoplasms ; Polydipsia ; Polyuria ; Postpartum Period ; Visual Fields