A case of dural arteriovenous fistula showing high uptake on methionine positron emission tomography and mimicking diffuse intrinsic pontine glioma

Background

Intracranial dural arteriovenous fistula (dAVF) and gliomas sometimes present with similar imaging findings. Methionine positron emission tomography (MET-PET) is used to diagnose gliomas; however, the findings for dAVF are unknown.

Case report

We report the case of a 59-year-old man who presented with headaches and diplopia. Magnetic resonance imaging showed edema and dilated blood vessels in the pons. The same area had a gadolinium contrast enhancement effect, and MET-PET showed high uptake. Imaging findings suggested diffuse intrinsic pontine glioma with a developmental venous anomaly. However, cerebral angiography revealed a dAVF on the posterior surface of the left petrous bone that had flowed back into the transpontine vein. A shunt ligation was performed. Postoperatively, the symptoms disappeared, and the transpontine vein was thrombosed.

Conclusion

dAVF can cause high MET-PET uptake; therefore, treatment for patients with suspected diffuse intrinsic pontine gliomas should also consider the vasculature surrounding the lesion. In our case, the characteristic imaging finding of a dilated transpontine vein was observed; however, the prognosis was good without requiring postoperative anticoagulants.