PMC4294188_01
(A) Anterior image of the head in an 131I whole body scan performed at 48 h. Activity in the nose and mouth area (arrow) was initially interpreted as normal. (B) Posterior image of the head from the same study as Fig. 1 (48 h) showing intense activity on the same level as the nose, mouth, and nasopharynx. Visual clues that indicate this activity is posterior include the increase intensity in the posterior image and better definition of the finding in this view. (C) Lateral (oblique) image of the head obtained at 72 h, after re-evaluation of the 48 h images, showed an intense mass of activity in the posterior head. (D) Sagittal section of 131I SPECT/CT (fused image) at 72 h showed a large intense mass in the posterior skull.
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F1
Activity in the head and face was thought to show a normal concentration in salivary glands, nose and mouth (Fig. 1A). Further study of the 131I images suggested that a normal distribution of 131I could not totally explain the findings in the head as the activity was more intense in the posterior than the anterior image (Fig. 1A and B). A lateral scan of the head (Fig. 1C) revealed an 131I avid mass in the back of the head and SPECT/CT images (Fig. 1D) showed that it originated in the occipital skull.
(A) Axial section of CT from SPECT/CT demonstrates that the tumor originated in the occipital skull with displacement and disruption of the inner and outer tables. (B) Sagittal section of an MRI shows the extent of the posterior fossa tumor which compresses the cerebellum.
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F2
Diagnostic CT (Fig. 2A) and MRI imaging (Fig. 2B) showed that the mass appeared extra-dural without invasion of the brain; however, there was compression of the cerebellum and displacement of the superior sagittal sinus to the right.