{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T23:15:02Z","timestamp":1769728502841,"version":"3.49.0"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"17","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,10,27]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>MRI and PET imaging using radiolabeled amino acids offer a valuable adjunct for defining the extent of tumor growth in gliomas, assessing treatment response, and distinguishing true progression from pseudoprogression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The authors report the case of a 37-year-old patient with intractable epilepsy and suspected recurrence of an oligodendroglioma. MRI revealed progressive gadolinium enhancement in the right frontal lobe, and both fluorethylthyrosine PET and translocator protein imaging demonstrated high tracer uptake in the same region, raising concern for tumor recurrence and progression. The patient underwent extensive resection of the right frontal lobe beyond contrast enhancement. Postoperatively, seizures were well controlled. Interestingly, histopathological analysis revealed predominantly normal brain tissue next to a limited area of tumor recurrence, demonstrating that the observed MRI and PET abnormalities were seizure-induced changes rather than tumor recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>In patients with epileptic seizures, MRI and PET abnormalities may overestimate tumor recurrence and should be interpreted with caution.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25589\">https:\/\/thejns.org\/doi\/10.3171\/CASE25589<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25589","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:05:58Z","timestamp":1762214758000},"source":"Crossref","is-referenced-by-count":0,"title":["PET imaging pitfall in recurrent oligodendroglioma with drug-resistant epilepsy: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Sebastian","family":"Niedermeyer","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, LMU University Hospital, LMU Munich, Munich, Germany"},{"name":"Department of Neurosurgery, Knappschaft Kliniken, University Hospital Bochum, Ruhr-Universit\u00e4t Bochum, Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Schmutzer-Sondergeld","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, LMU University Hospital, LMU Munich, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6864-3369","authenticated-orcid":true,"given":"Sabrina V.","family":"Kirchleitner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, LMU University Hospital, LMU Munich, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2914-3649","authenticated-orcid":true,"given":"Stefanie","family":"Quach","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, LMU University Hospital, LMU Munich, Munich, Germany"},{"name":"Department of Neurosurgery, University Hospital, Bielefeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathalie L.","family":"Albert","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany"},{"name":"German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany"},{"name":"Bavarian Cancer Research Center (BZKF), Partner Site Munich, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niklas","family":"Thon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, LMU University Hospital, LMU Munich, Munich, Germany"},{"name":"Department of Neurosurgery, Knappschaft Kliniken, University Hospital Bochum, Ruhr-Universit\u00e4t Bochum, Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"suppl 2","key":"bib1","series-title":"Epilepsia","first-page":"113","article-title":"Neuroimaging of status epilepticus","volume":"59","author":"Meletti","year":"2018","unstructured":"Meletti SMonti GMirandola LVaudano AEGiovannini G.Neuroimaging of status epilepticus. Epilepsia. 2018;59(suppl 2):113-119."},{"issue":"1","key":"bib2","series-title":"Neurooncol Adv","first-page":"vdz010","article-title":"Current status of PET imaging in neuro-oncology","volume":"1","author":"Galldiks","year":"2019","unstructured":"Galldiks NLohmann PAlbert NLTonn JCLangen KJ.Current status of PET imaging in neuro-oncology. Neurooncol Adv. 2019;1(1):vdz010."},{"issue":"1","key":"bib3","series-title":"Lancet Oncol","first-page":"e29","article-title":"PET-based response assessment criteria for diffuse gliomas (PET RANO 1.0): a report of the RANO group","volume":"25","author":"Albert","year":"2024","unstructured":"Albert NLGalldiks NEllingson BMPET-based response assessment criteria for diffuse gliomas (PET RANO 1.0): a report of the RANO group. Lancet Oncol. 2024;25(1):e29-e41."},{"issue":"4","key":"bib4","series-title":"Int J Mol Sci","first-page":"802","article-title":"Molecular targets for PET imaging of activated microglia: the current situation and future expectations","volume":"18","author":"Tronel","year":"2017","unstructured":"Tronel CLargeau BSantiago Ribeiro MJGuilloteau DDupont ACArlicot N.Molecular targets for PET imaging of activated microglia: the current situation and future expectations. Int J Mol Sci. 2017;18(4):802."},{"issue":"13","key":"bib5","series-title":"Eur J Nucl Med Mol Imaging","first-page":"2230","article-title":"TSPO PET for glioma imaging using the novel ligand 18F-GE-180: first results in patients with glioblastoma","volume":"44","author":"Albert","year":"2017","unstructured":"Albert NLUnterrainer MFleischmann DFTSPO PET for glioma imaging using the novel ligand 18F-GE-180: first results in patients with glioblastoma. Eur J Nucl Med Mol Imaging. 2017;44(13):2230-2238."},{"issue":"4","key":"bib6","series-title":"J Clin Neurol","first-page":"243","article-title":"Seizure semiology: its value and limitations in localizing the epileptogenic zone","volume":"8","author":"Tufenkjian","year":"2012","unstructured":"Tufenkjian KL\u00fcders HO.Seizure semiology: its value and limitations in localizing the epileptogenic zone. J Clin Neurol. 2012;8(4):243-250."},{"issue":"6","key":"bib7","series-title":"Epilepsia","first-page":"1069","article-title":"Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies","volume":"51","author":"Kwan","year":"2010","unstructured":"Kwan PArzimanoglou ABerg ATDefinition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):1069-1077."},{"key":"bib8","series-title":"World Neurosurg","first-page":"524","article-title":"Static FET-PET and MR imaging in anaplastic gliomas (WHO III)","volume":"91","author":"Bette","year":"2016","unstructured":"Bette SPeschke PKaesmacher JStatic FET-PET and MR imaging in anaplastic gliomas (WHO III). World Neurosurg. 2016;91:524-531.e1."},{"issue":"1060","key":"bib9","series-title":"Br J Radiol","first-page":"20150857","article-title":"Imaging of oligodendroglioma","volume":"89","author":"Smits","year":"2016","unstructured":"Smits M.Imaging of oligodendroglioma. Br J Radiol. 2016;89(1060):20150857."},{"issue":"11","key":"bib10","series-title":"Eur J Radiol","first-page":"1964","article-title":"Seizure-induced brain lesions: a wide spectrum of variably reversible MRI abnormalities","volume":"82","author":"Cianfoni","year":"2013","unstructured":"Cianfoni ACaulo MCerase ASeizure-induced brain lesions: a wide spectrum of variably reversible MRI abnormalities. Eur J Radiol. 2013;82(11):1964-1972."},{"issue":"3","key":"bib11","series-title":"Surg Neurol","first-page":"246","article-title":"Transient postictal MRI changes in patients with brain tumors may mimic disease progression","volume":"67","author":"Finn","year":"2007","unstructured":"Finn MABlumenthal DTSalzman KLJensen RL.Transient postictal MRI changes in patients with brain tumors may mimic disease progression. Surg Neurol. 2007;67(3):246-250."},{"issue":"1","key":"bib12","series-title":"Epilepsia","first-page":"35","article-title":"Focal cerebral magnetic resonance changes associated with partial status epilepticus","volume":"35","author":"Henry","year":"1994","unstructured":"Henry TRDrury IBrunberg JAPennell PBMcKeever PEBeydoun A.Focal cerebral magnetic resonance changes associated with partial status epilepticus. Epilepsia. 1994;35(1):35-41."},{"issue":"3","key":"bib13","series-title":"Arch Neurol","first-page":"362","article-title":"Nonconvulsive status epilepticus in patients with cancer: imaging abnormalities","volume":"61","author":"Hormigo","year":"2004","unstructured":"Hormigo ALiberato BLis EDeAngelis LM.Nonconvulsive status epilepticus in patients with cancer: imaging abnormalities. Arch Neurol. 2004;61(3):362-365."},{"issue":"10","key":"bib14","series-title":"Neurology","first-page":"1538","article-title":"Seizure-related contrast enhancement of a ganglioglioma","volume":"58","author":"Laigle","year":"2002","unstructured":"Laigle FMartin-Duverneuil NCarpentier AHoang-Xuan KDelattre JY.Seizure-related contrast enhancement of a ganglioglioma. Neurology. 2002;58(10):1538."},{"issue":"1","key":"bib15","series-title":"Neurology","first-page":"211","article-title":"Transient MRI enhancement in a patient with seizures and previously resected glioma: use of MRS","volume":"53","author":"Quan","year":"1999","unstructured":"Quan DHackney DBPruitt AALenkinski RECecil KM.Transient MRI enhancement in a patient with seizures and previously resected glioma: use of MRS. Neurology. 1999;53(1):211-213."},{"issue":"1","key":"bib16","series-title":"J Nucl Med","first-page":"129","article-title":"Epileptic activity increases cerebral amino acid transport assessed by 18F-fluoroethyl-l-tyrosine amino acid pet: a potential brain tumor mimic","volume":"58","author":"Hutterer","year":"2017","unstructured":"Hutterer MEbner YRiemenschneider MJEpileptic activity increases cerebral amino acid transport assessed by 18F-fluoroethyl-l-tyrosine amino acid pet: a potential brain tumor mimic. J Nucl Med. 2017;58(1):129-137."},{"issue":"4","key":"bib17","series-title":"Rev Esp Med Nucl Imagen Mol","first-page":"234","article-title":"(11)C-Methionine uptake in secondary brain epilepsy","volume":"33","author":"Lopci","year":"2014","unstructured":"Lopci EBello LChiti A.(11)C-Methionine uptake in secondary brain epilepsy. Rev Esp Med Nucl Imagen Mol. 2014;33(4):234-236."},{"issue":"9","key":"bib18","series-title":"Epilepsia","first-page":"e191","article-title":"Transient and chronic seizure-induced inflammation in human focal epilepsy","volume":"57","author":"Butler","year":"2016","unstructured":"Butler TLi YTsui WTransient and chronic seizure-induced inflammation in human focal epilepsy. Epilepsia. 2016;57(9):e191-e194."},{"key":"bib19","series-title":"Seizure","first-page":"42","article-title":"Microglial positron emission tomography (PET) imaging in epilepsy: applications, opportunities and pitfalls","volume":"44","author":"Scott","year":"2017","unstructured":"Scott GMahmud MOwen DRJohnson MR.Microglial positron emission tomography (PET) imaging in epilepsy: applications, opportunities and pitfalls. Seizure. 2017;44:42-47."},{"issue":"suppl 8","key":"bib20","series-title":"Epilepsia","first-page":"69","article-title":"Surgical treatment of the extratemporal epilepsies","volume":"50","author":"Roper","year":"2009","unstructured":"Roper SN.Surgical treatment of the extratemporal epilepsies. Epilepsia. 2009;50(suppl 8):69-74."},{"issue":"suppl 2","key":"bib1","series-title":"Epilepsia","first-page":"113","article-title":"Neuroimaging of status epilepticus","volume":"59","author":"Meletti","year":"2018","unstructured":"Meletti SMonti GMirandola LVaudano AEGiovannini G.Neuroimaging of status epilepticus. Epilepsia. 2018;59(suppl 2):113-119."},{"issue":"1","key":"bib2","series-title":"Neurooncol Adv","first-page":"vdz010","article-title":"Current status of PET imaging in neuro-oncology","volume":"1","author":"Galldiks","year":"2019","unstructured":"Galldiks NLohmann PAlbert NLTonn JCLangen KJ.Current status of PET imaging in neuro-oncology. Neurooncol Adv. 2019;1(1):vdz010."},{"issue":"1","key":"bib3","series-title":"Lancet Oncol","first-page":"e29","article-title":"PET-based response assessment criteria for diffuse gliomas (PET RANO 1.0): a report of the RANO group","volume":"25","author":"Albert","year":"2024","unstructured":"Albert NLGalldiks NEllingson BMPET-based response assessment criteria for diffuse gliomas (PET RANO 1.0): a report of the RANO group. Lancet Oncol. 2024;25(1):e29-e41."},{"issue":"4","key":"bib4","series-title":"Int J Mol Sci","first-page":"802","article-title":"Molecular targets for PET imaging of activated microglia: the current situation and future expectations","volume":"18","author":"Tronel","year":"2017","unstructured":"Tronel CLargeau BSantiago Ribeiro MJGuilloteau DDupont ACArlicot N.Molecular targets for PET imaging of activated microglia: the current situation and future expectations. Int J Mol Sci. 2017;18(4):802."},{"issue":"13","key":"bib5","series-title":"Eur J Nucl Med Mol Imaging","first-page":"2230","article-title":"TSPO PET for glioma imaging using the novel ligand 18F-GE-180: first results in patients with glioblastoma","volume":"44","author":"Albert","year":"2017","unstructured":"Albert NLUnterrainer MFleischmann DFTSPO PET for glioma imaging using the novel ligand 18F-GE-180: first results in patients with glioblastoma. Eur J Nucl Med Mol Imaging. 2017;44(13):2230-2238."},{"issue":"4","key":"bib6","series-title":"J Clin Neurol","first-page":"243","article-title":"Seizure semiology: its value and limitations in localizing the epileptogenic zone","volume":"8","author":"Tufenkjian","year":"2012","unstructured":"Tufenkjian KL\u00fcders HO.Seizure semiology: its value and limitations in localizing the epileptogenic zone. J Clin Neurol. 2012;8(4):243-250."},{"issue":"6","key":"bib7","series-title":"Epilepsia","first-page":"1069","article-title":"Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies","volume":"51","author":"Kwan","year":"2010","unstructured":"Kwan PArzimanoglou ABerg ATDefinition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):1069-1077."},{"key":"bib8","series-title":"World Neurosurg","first-page":"524","article-title":"Static FET-PET and MR imaging in anaplastic gliomas (WHO III)","volume":"91","author":"Bette","year":"2016","unstructured":"Bette SPeschke PKaesmacher JStatic FET-PET and MR imaging in anaplastic gliomas (WHO III). World Neurosurg. 2016;91:524-531.e1."},{"issue":"1060","key":"bib9","series-title":"Br J Radiol","first-page":"20150857","article-title":"Imaging of oligodendroglioma","volume":"89","author":"Smits","year":"2016","unstructured":"Smits M.Imaging of oligodendroglioma. Br J Radiol. 2016;89(1060):20150857."},{"issue":"11","key":"bib10","series-title":"Eur J Radiol","first-page":"1964","article-title":"Seizure-induced brain lesions: a wide spectrum of variably reversible MRI abnormalities","volume":"82","author":"Cianfoni","year":"2013","unstructured":"Cianfoni ACaulo MCerase ASeizure-induced brain lesions: a wide spectrum of variably reversible MRI abnormalities. Eur J Radiol. 2013;82(11):1964-1972."},{"issue":"3","key":"bib11","series-title":"Surg Neurol","first-page":"246","article-title":"Transient postictal MRI changes in patients with brain tumors may mimic disease progression","volume":"67","author":"Finn","year":"2007","unstructured":"Finn MABlumenthal DTSalzman KLJensen RL.Transient postictal MRI changes in patients with brain tumors may mimic disease progression. Surg Neurol. 2007;67(3):246-250."},{"issue":"1","key":"bib12","series-title":"Epilepsia","first-page":"35","article-title":"Focal cerebral magnetic resonance changes associated with partial status epilepticus","volume":"35","author":"Henry","year":"1994","unstructured":"Henry TRDrury IBrunberg JAPennell PBMcKeever PEBeydoun A.Focal cerebral magnetic resonance changes associated with partial status epilepticus. Epilepsia. 1994;35(1):35-41."},{"issue":"3","key":"bib13","series-title":"Arch Neurol","first-page":"362","article-title":"Nonconvulsive status epilepticus in patients with cancer: imaging abnormalities","volume":"61","author":"Hormigo","year":"2004","unstructured":"Hormigo ALiberato BLis EDeAngelis LM.Nonconvulsive status epilepticus in patients with cancer: imaging abnormalities. Arch Neurol. 2004;61(3):362-365."},{"issue":"10","key":"bib14","series-title":"Neurology","first-page":"1538","article-title":"Seizure-related contrast enhancement of a ganglioglioma","volume":"58","author":"Laigle","year":"2002","unstructured":"Laigle FMartin-Duverneuil NCarpentier AHoang-Xuan KDelattre JY.Seizure-related contrast enhancement of a ganglioglioma. Neurology. 2002;58(10):1538."},{"issue":"1","key":"bib15","series-title":"Neurology","first-page":"211","article-title":"Transient MRI enhancement in a patient with seizures and previously resected glioma: use of MRS","volume":"53","author":"Quan","year":"1999","unstructured":"Quan DHackney DBPruitt AALenkinski RECecil KM.Transient MRI enhancement in a patient with seizures and previously resected glioma: use of MRS. Neurology. 1999;53(1):211-213."},{"issue":"1","key":"bib16","series-title":"J Nucl Med","first-page":"129","article-title":"Epileptic activity increases cerebral amino acid transport assessed by 18F-fluoroethyl-l-tyrosine amino acid pet: a potential brain tumor mimic","volume":"58","author":"Hutterer","year":"2017","unstructured":"Hutterer MEbner YRiemenschneider MJEpileptic activity increases cerebral amino acid transport assessed by 18F-fluoroethyl-l-tyrosine amino acid pet: a potential brain tumor mimic. J Nucl Med. 2017;58(1):129-137."},{"issue":"4","key":"bib17","series-title":"Rev Esp Med Nucl Imagen Mol","first-page":"234","article-title":"(11)C-Methionine uptake in secondary brain epilepsy","volume":"33","author":"Lopci","year":"2014","unstructured":"Lopci EBello LChiti A.(11)C-Methionine uptake in secondary brain epilepsy. Rev Esp Med Nucl Imagen Mol. 2014;33(4):234-236."},{"issue":"9","key":"bib18","series-title":"Epilepsia","first-page":"e191","article-title":"Transient and chronic seizure-induced inflammation in human focal epilepsy","volume":"57","author":"Butler","year":"2016","unstructured":"Butler TLi YTsui WTransient and chronic seizure-induced inflammation in human focal epilepsy. Epilepsia. 2016;57(9):e191-e194."},{"key":"bib19","series-title":"Seizure","first-page":"42","article-title":"Microglial positron emission tomography (PET) imaging in epilepsy: applications, opportunities and pitfalls","volume":"44","author":"Scott","year":"2017","unstructured":"Scott GMahmud MOwen DRJohnson MR.Microglial positron emission tomography (PET) imaging in epilepsy: applications, opportunities and pitfalls. Seizure. 2017;44:42-47."},{"issue":"suppl 8","key":"bib20","series-title":"Epilepsia","first-page":"69","article-title":"Surgical treatment of the extratemporal epilepsies","volume":"50","author":"Roper","year":"2009","unstructured":"Roper SN.Surgical treatment of the extratemporal epilepsies. 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