Diagnosis of Cavernous Sinus Hemangioma by [99mTc]Tc- RBC Scintigraphy

Guzmán Ortiz S and Javier de Haro del Moral F*

Nuclear Medicine Service, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain

^*Correspondance to: Javier de Haro del Moral F 

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Abstract:

Preoperative diagnosis of cavernous Hemangiomas (HC) is generally difficult because they are rare lesions that are misdiagnosed as meningiomas on Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), being essential their differential diagnosis prior to biopsy or surgery, because extracerebral cavernous sinus HC is often complicated by incomplete excision and/or hemorrhage with a high morbidity and mortality rate. We present the case of a 51-year-old male with a history of tinnitus and vertigo. He underwent an MRI which showed a 0.8 cm right cavernous lesion compatible with meningioma. In view of the findings of right parasellar meningioma, it was decided to follow up the lesion with MRI, which remained stable for ten years. However, in the last control study there was evidence of minimal growth of the lesion, currently measuring 1 cm, with a hypointense signal in T1 and hyperintense in T2 with intense enhancement after gadolinium administration. Neither the dural tail seen in the baseline study nor the mass effect was clearly seen, so the differential diagnosis of hemangioma vs. meningioma was considered. A brain scintigraphy with autologous red blood cells labeled with Tc-99m ([99mTc]Tc-RBC) was performed, which showed a right parasellar focal deposit in the early phase that progressively increased in the late phase of the study, showing a characteristic pattern of hemangioma. Given the significant morbidity and mortality encountered in the surgery of patients with cavernous sinus hemangiomas, the patient is treated conservatively. In conclusion, the prospective diagnosis by combined use of MRI and brain scintigraphy with [99mTc]Tc-RBC is potentially beneficial for the differential diagnosis between hemangioma and cavernous sinus meningioma.

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Cite the Article:

Guzmán Ortiz S, Javier de Haro del Moral F. Diagnosis of Cavernous Sinus Hemangioma by [99mTc]Tc-RBC Scintigraphy. Ann Clin Case Rep. 2022; 7: 2303..