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Indian J Nucl Med. 2019 Jul-Sep;34(3):237-240. doi: 10.4103/ijnm.IJNM_31_19.

Tumefactive Demyelination versus Primary Central Nervous System Lymphoma on 18F-Fluorodeoxyglucose Positron Emission Tomography Magnetic Resonance Imaging: A Twist in the Tale.

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Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.


Demyelinating lesions of the central nervous system (CNS) are classically known to be hypometabolic on 18F-Flurodeoxyglucose Positron Emission Tomography (18F-FDG PET). However, demyelinating lesions may show increased tracer uptake on 18F-FDG PET and can radiologically mimic neoplasm. Delayed tracer uptake on FDG PET is one of the diagnostic hallmarks of primary CNS lymphoma (PCNSL). Here, we present two cases in which the brain lesions showed increased FDG uptake on delayed integrated PET Magnetic Resonance Imaging (MRI), which were pathologically proven as CNS demyelination. Such demyelinating lesions may also act as "sentinel lesions" and potential harbinger of PCNSL on follow-up.


18F-fluorodeoxyglucose; delayed uptake; demyelination; positron emission tomography-magnetic resonance imaging; primary central nervous system lymphoma; tumefactive demyelination

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