Is FCH PET able to identify foci of infection superiorly to FDG PET?

• Published in: BMJ case reports Vol. 2017; p. bcr-2017-219944
• Main Authors: Hardy, Liesel Elisabeth, Hessamodini, Hannah, Wallace, Michael, Francis, Roslyn
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 14.07.2017; BMJ Publishing Group
• Series: Case Report
• Subjects: Ablation; Abscesses; Alcohol; Anti-Bacterial Agents - therapeutic use; Antibiotics; Australasia; Brain Abscess - diagnosis; Brain Abscess - diagnostic imaging; Brain Abscess - drug therapy; Brain cancer; Brain research; Carcinoma, Hepatocellular; Case reports; Diagnosis, Differential; Fluorine; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Infections; Liver cancer; Liver Cirrhosis; Liver diseases; Liver Neoplasms; Lung cancer; Male; Medical imaging; Metabolism; Metastasis; Middle Aged; Neuroimaging; Pneumonia; Positron-Emission Tomography; Prostate cancer; Radiopharmaceuticals; Streptococcal Infections - diagnosis; Streptococcal Infections - diagnostic imaging; Streptococcal Infections - drug therapy; Streptococcus milleri Group - isolation & purification; Tomography; Tumors; Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions; White; liver disease; infection (neurology); neuroimaging
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2017-219944

We report a case of a brain abscess identified on fluorine-18 choline (FCH) positron emission tomography (PET) scan, which was not identified on fluorodeoxyglucose (FDG) PET scan. To our knowledge, there are no previous case reports of incidental brain abscess identified by FCH PET imaging. A 51-year-old man, with liver cirrhosis complicated by hepatocellular carcinoma (HCC) was enrolled in a research trial comparing HCC detection in FCH PET versus FDG PET. During the course of the trial, he underwent radiofrequency ablation (RFA) for HCC. A repeat FCH PET scan post-RFA incidentally revealed a 2.5 cm lesion with avid uptake in the left occipital area of the brain. The patient was asymptomatic. MRI suggested this was an abscess. A craniotomy and drainage was performed, with culture of Streptococcus intermedius (S. milleri group) from the thick-walled collection, a causative organism for previous episode of pneumonia. He successfully completed a 6 week course of antibiotics.