Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2022; 10(23): 8400-8405
Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8400
Incidental accumulation of Technetium-99m pertechnetate in subacute cerebral infarction: A case report
Yeon-Hee Han, Hwan-Jeong Jeong, Hyun Goo Kang, Seok Tae Lim
Yeon-Hee Han, Hwan-Jeong Jeong, Seok Tae Lim, Department of Nuclear Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jounbuk National University Medical School and Hospital, Jeonju 54907, Jeonbuk, South Korea
Hyun Goo Kang, Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Jeonbuk, South Korea
Author contributions: Han YH and Lim ST were nuclear physicians, performed the conceptualization, investigation, and contributed to manuscipt drafting; Jeong HJ reviewed the literature and contributed to manuscript editing; Kang HG was a neurophysician and performed the disease consultation and manuscript drafting; Han YH and Lim ST were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Seok Tae Lim, PhD, Professor, Department of Nuclear Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jounbuk National University Medical School and Hospital, 20 Geonjiro Deokjin-gu, Jeonju 54907, Jeonbuk, South Korea. stlim@jbnu.ac.kr
Received: April 5, 2022
Peer-review started: April 5, 2022
First decision: June 16, 2022
Revised: June 17, 2022
Accepted: July 5, 2022
Article in press: July 5, 2022
Published online: August 16, 2022
Abstract
BACKGROUND

When interpreting nuclear medicine images, unexpected findings are sometimes encountered. Recognizing these findings and determining the mechanism of their occurrence could have a significant impact on early diagnosis of critical diseases and the appropriate management of patients.

CASE SUMMARY

A 59-year-old man was admitted to the emergency room due to left hemiparesis, left hemifacial palsy, and mild dysarthria. After 2 wk of hospitalization, the patient complained of dry eyes and mouth. Thus, salivary scintigraphy was performed to evaluate the functional status of his salivary glands. Incidental accumulation in the right frontoparietal area was found on salivary scintigraphy. Fluid-attenuated inversion recovery phase magnetic resonance (FLAIR phase MR) image showed diffuse high signal intensity in the same area. Anterior and posterior horns of the right lateral ventricle were obliterated and the midline was slightly shifted to the left side due to right frontoparietal swelling. On salivary scintigraphy, Tc-99m pertechnetate was incidentally accumulated in a subacute cerebral infarction lesion. Two years after the diagnosis of acute infarction, the second series of salivary scintigraphy showed no abnormal activity in the brain. FLAIR phase MR image also demonstrated markedly decreased high signal intensity in the previous infarction lesion without evidence of swelling indicating chronic cerebral infarction.

CONCLUSION

This case highlights that Tc-99m pertechnetate could accumulate in a subacute cerebral infarction lesion. The mechanism of an unexpected uptake of Tc-99m pertechnetate in unusual sites should be evaluated and kept in mind for better interpretation.

Keywords: Cerebral infarction, Tc-99m pertechnetate, Salivary scintigraphy, Case report

Core Tip: Tc-99m pertechnetate is a truly carrier-free radiotracer transported by sodium iodide symporter. Salivary scintigraphy using Tc-99m pertechnetate is frequently performed for diagnosing salivary gland diseases such Sjogren's syndrome. Here, we present a rare case of Tc-99m pertechnetate accumulation in the subacute cerebral infarction lesion. The reason for Tc-99m pertechnetate accumulation is thought to be due to ingrowth and proliferation of new capillaries with enhanced permeability in the subacute cerebral infarction lesion. The present case highlights that Tc-99m pertechnetate could accumulate in a subacute cerebral infarction lesion. The mechanisms of an unexpected uptake of Tc-99m pertechnetate in unusual sites should be evaluated and kept in mind for better interpretation.