Radiolabeled Leucocyte Imaging in Diffuse Granulomatous Involvement of the Meninges in Wegener's Granulomatosis: Scintigraphic Findings and Their Role in Monitoring Treatment Response to Specific Immunotherapy (Humanized Monoclonal Antilymphocyte Antibodies)

Joseph M. Murphy; Kottekkattu K. Balan; Andoni Toms; Beatriz Gomez-Anson; Martin Lockwood

American Journal of Neuroradiology

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fig 1.
A, Posterior view at 24 hours from a ¹¹¹In-labeled leucocyte examination shows a linear midline area of increased uptake (arrow).
B, Coronal contrast-enhanced T1-weighted (500/9/2) SE MR image shows dural thickening and enhancement in the falx (short wide arrow), tentorium cerebelli (curved arrows), and overlying the brain convexity (long thin arrow). Note how the leucocyte examination underestimates the extent of dural involvement.
C, Posterior view at 24 hours from a ¹¹¹In-labeled leucocyte examination shows normal intracranial appearance after treatment with anti-CD52.
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fig 2.
A, Posterior view at 24 hours from a ^99mTc-HMPAO-labeled leucocyte examination shows abnormal uptake in the midline (open arrow), overlying the brain convexity on the left side (solid arrow), and in the tentorium cerebelli bilaterally (arrowheads).
B, Coronal contrast-enhanced T1-weighted (500/9/2) SE MR image shows dural thickening and enhancement in the falx (short wide arrow), overlying the brain convexity on the left side (long thin arrow), and in the tentorium cerebelli (curved arrows).
C, Normal intracranial appearance after treatment with anti-CD52.
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fig 3.
A, Posterior view at 24 hours from a ¹¹¹In-labeled leucocyte examination shows increased uptake in the right tentorium cerebelli (arrow). A focus of increased uptake is also visible in the left lung (arrowhead), which correlated with a cavitating nodule on a high-resolution CT scan.
B and C, Coronal (B) and sagittal (C) images from a ^99mTc-HMPAO-labeled leucocyte SPECT examination show increased uptake in the right tentorium cerebelli (arrows).
D, Coronal contrast-enhanced T1-weighted (500/9/2) SE MR image shows thickening and enhancement of the right tentorium cerebelli (arrows).
E, Normal intracranial appearance after treatment with anti-CD52. Note focus of increased uptake in the right lung (arrow).