Multimodality PET/CT and MRI Evaluation of a Parasagittal Parietal Brain Lesion: Broad Differential Diagnostic Considerations

Background Parasagittal parietal lesions present a diagnostic challenge due to overlapping radiological features among dural-based and cortical pathologies. Integration of anatomical and functional imaging can aid in refining the differential diagnosis. Case Presentation: We report the case of a 19 year old patient presenting with persistent headache. Contrast-enhanced magnetic resonance imaging (CE-MRI) revealed a heterogeneously enhancing parasagittal parietal lesion with associated mass effect. FDG PET/CT demonstrated marked metabolic uptake, while Gallium-68 PET/CT revealed concordant uptake, suggesting somatostatin receptor expression. The differential diagnosis included hemangiopericytoma, meningioma, parafalcine oligodendroglioma, cortical glioma, and dural metastases. Conclusion This case emphasizes the importance of a multimodality approach, combining MRI with both FDG and Ga-68 PET/CT, in characterizing complex intracranial lesions and narrowing the differential diagnosis prior to histopathological confirmation.