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

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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.

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