gms | German Medical Science

Objective: This is the first case report to describe the use of PET-Computed tomography in a comatose patient.

Methods: A 61 year old patient was operated for an acute subdural hematoma. After emergency surgery, the patient remained in coma, the initial anisochoria declined. Follow-up computed tomography (CT) revealed additional intracerebral lesions and remnants of the extra cerebral hemorrhage.

Results: As the initial polytrauma-CT scan already raised the strong suspicion of a neoplastic metastatic illness, unknown so far to the patient and his family, further craniotomy or craniectomy were critically discussed. After consultations with nuclear medicine and oncology, a full-body PET / CT with 226 MBq 18F-FDG with 8 bed positions was performed (as low-dose CT without contrast medium). The investigation of the ventilated patients took 4 hours due to isolation times and technical retrofits. It confirmed a renal cell carcinoma with pulmonary and various nodal metastasis. Cerebral metastasis was not excluded because the perifocal hypermetabolism of the contusion possibly masked a tumor. Therapy was limited; there was no further operation, the patient died due to increased intracranial hypertension.

Conclusion: The average sensitivity of the PET / CT in case of a renal cell carcinoma is 86.2% (compared to 75.7% in CT), with average specificity of 85.9% (46.8% for the CT). In addition, the frequency of detection of metastases is significantly higher. These statistics justify the use of PET / CT in the decision process towards therapy limitation. Disadvantages of the method are the long absence of the patient from the ICU and the high personnel expenses. The problem of informed consent has to be discussed individually.