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Neurosarcoidosis Mimics High-Grade Glioma in Dynamic 18F-FET PET Due to LAT Expression

Unterrainer, Marcus, MD, MSc*†‡; Diekmann, Caroline*; Dorostkar, Mario, MD§; Vettermann, Franziska Jill, MD*; Kümpfel, Tania, MD; Tonn, Jörg-Christian, MD†‡¶; Bartenstein, Peter, MD*†‡; Albert, Nathalie Lisa, MD*†‡

doi: 10.1097/RLU.0000000000002266
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We present a 45-year-old man with newly generalized tonic-clonic seizures due to a contrast-enhancing frontal lesion with perifocal edema suggestive for high-grade glioma (HGG). For further evaluation, a dynamic 18F-FET PET scan was performed, which showed high 18F-FET-uptake with early peak and constantly decreasing time-activity curves, a characteristic feature of HGG. Stereotactic biopsy and histological evaluation excluded a neoplastic lesion but confirmed a manifestation of neurosarcoidosis with strong expression of the L-amino-acid-transporter considered responsible for 18F-FET-uptake. Therefore, unknown manifestations of neurosarcoidosis represent a clinical pitfall in 18F-FET PET and can mimic HGG.

From the *Department of Nuclear Medicine, University Hospital, LMU Munich;

German Cancer Consortium (DKTK), partner site Munich, Munich;

German Cancer Research Center (DKFZ), Heidelberg; and

§Department of Neuropathology,

Institute of Clinical Neuroimmunology, and

Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany.

Received for publication June 18, 2018; revision accepted July 20, 2018.

Conflicts of interest and sources of funding: none declared.

Correspondence to: Marcus Unterrainer, MD, MSc, Department of Nuclear Medicine University Hostpital, LMU Munich Marchioninistr. 15, 81377 Munich, Germany. E-mail: marcus.unterrainer@med.uni-muenchen.de.

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