18F-FDG PET/MRI of Rhinosporidiosis of the Upper Airways
A 41-year-old man from South Asia presented with a several months’ history of unilateral nasal obstruction and bleeding. At nasal endoscopy, two strawberry-like, friable, polypoid masses in the upper airways were detected. The patient’s clinical trait was compatible with an infectious disease. 18F-FDG PET/MRI was performed to evaluate the disease extension. Two lesions occupying the nasal cavity and the nasopharynx, slightly hyperintense in T2-weighted sequences, with intense radiopharmaceutical uptake were evidenced. Endoscopic resection was performed with histopathologic diagnosis of rhinosporidiosis, a chron...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Extensive Extramedullary Hematopoiesis in Thalassemia: Soft Tissue Uptake on: 99m: Tc-MDP SPECT/CT
We report the case of a 45-year-old man with thalassemia major referred for a bone scan as a workup for generalized bone pain. 99mTc-MDP SPECT CT showed multiple elongated soft tissue masses along the inner aspects of ribs and along both sides of dorsal spine with calcification and mild tracer uptake. There was also a large lobulated presacral soft tissue mass displacing the bladder and involving the adjacent pelvic bone. Biopsy of mildly avid tracer uptake in pelvic soft tissue mass was extramedullary hematopoiesis confirmed by biopsy. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Blood-Pool SPECT/CT in Chronic Ankle Tendinopathy
We report 2 cases where blood-pool SPECT/CT had a high added value compared with standard 3-phase bone scintigraphy with only delayed SPECT/CT for the etiological diagnosis of painful ankles. Two men, aged 48 and 62 years, were referred for suspicions of medial and lateral malleoli stress fractures, respectively. Although standard planar blood-pool imaging and delayed SPECT/CT were inconclusive, blood-pool SPECT/CT showed markedly increased uptake along posterior tibial tendon and peroneal tendon, respectively, leading to diagnose tendonitises. These cases illustrate that blood-pool SPECT/CT can extend the diagnostic yield...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

99mTc-MDP Bone Scintigraphy in Gaucher Disease
In this case report, we present the bone scintigraphic findings of a 9-year-old boy with Gaucher disease who has a history of fractures to evaluate the extent of his osseous lesions. Gaucher disease is a genetic deficiency of lysosomal enzyme glucocerebrosidase, which results in the accumulation of glucocerebroside in the macrophages in the reticuloendothelial cells of the spleen, liver, and bone marrow. Most patients with type 1 Gaucher disease present a clinical or radiographic evidence of infiltrative bone disease. Lipid-filled macrophages called Gaucher cells infiltrate the bone marrow, leading to medullary expansion, ...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

18F-Fluciclovine Uptake in Acute Appendicitis
An 85-year-old man with biochemical recurrence of prostate cancer after prostatectomy was imaged with 18F-fluciclovine PET/CT. Images incidentally revealed 18F-fluciclovine uptake in a dilated appendix with associated fat stranding, suggestive of acute appendicitis. The patient was then questioned about abdominal symptoms, and he reported severe right lower quadrant pain. He then underwent laparoscopic appendectomy with pathology confirming acute appendicitis. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Scrotal Sac Metastasis in Adenocarcinoma Prostate: Findings on: 68: Ga-PSMA PET/CT
We present a case of a 45-year-old man diagnosed with locally advanced acinar adenocarcinoma prostate, post bilateral orchidectomy and radiotherapy treatment, who showed a rising trend of serum PSA levels with discovery of scrotal sac metastasis on serial 68Ga–prostate-specific membrane antigen PET/CT scans. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Cavernosal Metastasis From Prostate Cancer on 18F-Fluciclovine PET/CT
Uncommon penile metastasis from prostate cancer has been reported on PET/CT imaging with 18F-FDG, 18F-fluorocholine, 11C-choline, and 68Ga-PSMA. The author presents an additional case of 18F-fluciclovine PET/CT depiction of proximal and distal cavernosal metastases from prostate cancer with corresponding contrast-enhanced CT findings. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

TSPO PET With 18F-GE-180 to Differentiate Variants of Multiple Sclerosis: Relapsing-Remitting Multiple Sclerosis, Tumefactive Demyelination, and Baló’s Concentric Sclerosis
PET targeting the translocator protein (TSPO) expression is an interesting approach to detect neuroinflammation, as TSPO is upregulated in activated macrophages and microglia. Considering the variable pathophysiology of multiple sclerosis (MS) variants, we compare TSPO PET using 18F-GE-180 in 3 different demyelinating diseases of the central nervous system: relapsing-remitting MS, tumefactive MS, and Baló’s concentric sclerosis. Visualization of neuroinflammation and its PET patterns in addition to MRI may contribute to accurate distinction and monitoring of central nervous system demyelination. (Source: Clini...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Extrastriatal Peri-infarct Accumulation of 99mTc-TRODAT
We describe the extrastriatal accumulation of dopamine transporter imaging agent 99mTc-TRODAT in the peri-infarct area in a 75-year-old man referred for dopamine transporter SPECT imaging with a suspicion of idiopathic Parkinson disease. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Inguinal Canal Deposit—An Uncommon Site of Metastases in Carcinoma Prostate Detected on 68Ga–Prostate-Specific Membrane Antigen PET/CT
We present here a case of prostate cancer with an uncommon inguinal canal deposit that was detected on 68Ga–prostate-specific membrane antigen PET/CT. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Follicular Thyroid Cancer With Nose-Tip Metastasis and 131I Uptake
We present a 56-year-old woman with metastatic follicular thyroid cancer at the nose tip with 131I uptake that is clinically rare, mimicking physiological uptake in the nose, a common finding seen after routine 131I therapeutic imaging. The lesion revealed a metastatic follicular thyroid cancer with 131I uptake and response to 131I therapy. Surgical removal, however, was not performed due to cosmetic and functional considerations. Active surveillance is warranted owing to its relative aggressiveness in nature. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

18F-FDG PET/CT in Labrune Syndrome
A 69-year-old woman presented with cognitive impairment related to attentive, executive, and mnemonic functions; progressive worsening of walking, speaking, writing, and reading ability; and double sphincter incontinence. Leukoencephalopathy, cystic lesions, and calcifications, suspected for Labrune syndrome, were observed at MRI and CT brain images. Generalized wave abnormalities were also visible at electroencephalogram. Functional brain imaging performed with 18F-FDG PET/CT demonstrated a decreased glucose metabolism in impaired brain regions, in accordance with MRI findings. Genetic testing confirmed a mutation of SNOR...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Superior Vena Cava Syndrome Induced Collateral Circulation on 99mTc–Macroaggregated Albumin Lung Perfusion Scintigraphy
Perfusion lung scintigraphy using SPECT/CT is one mainstay in diagnosing pulmonary embolism. Although typically almost all tracer will be accumulated in the lung capillaries, occasionally abnormal uptake can be detected. As superior vena cava syndrome leads to aberrant blood flow, tracer injected to an arm vein might partly circumvent the pulmonary capillary bed and accumulate in well-perfused anatomical structures. In this case, next to the commonly described liver enhancement, more prominent pseudo-uptake of various thoracic vertebrae was observable. However, a time-related FDG PET/CT demonstrated only the hepatic pseudo...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Absent 18F-FDG Uptake in the Brain—Unsuspected Brain Death
Brain death is the complete, irreversible cessation of brain function, including the capacity for brainstem, respiratory, and vegetative activities. It is a clinical diagnosis that can be supplemented with brain perfusion imaging. Absent cerebral blood flow can be visualized with CT angiography or perfusion scintigraphy. 18F-FDG PET/CT, visualizing glucose uptake, is another approach that has been shown to indicate brain death in small case series. We here present a case with unsuspected absent 18F-FDG uptake and thus no metabolic activity, in the brain. The patient was declared brain dead later the same day. (Source: Clin...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

68Ga-FAPI PET/CT in Assessment of Liver Nodules in a Cirrhotic Patient
68Ga-FAPI PET/CT was performed in a 56-year-old cirrhotic patient with multiple liver nodules, which were suspected of hepatocellular carcinoma by contrast-enhanced magnetic resonance but were not visualized by 18F-FDG PET/CT. Increased 68Ga-FAPI liver uptake was observed in this cirrhotic patient. However, the nodules had no pathological 68Ga-FAPI uptake and were clearly visualized due to the low activity compared with surrounding liver parenchyma. The 68Ga-FAPI PET/CT features, suggestive of benign nodules, have been later confirmed by histopathological examination. This case suggested that 68Ga-FAPI PET/CT may be useful...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Decreased Vision and Headache as the Initial Symptoms of Hepatocellular Carcinoma
Sphenoid sinus metastasis is extremely rare. Herein, we report a case of occult hepatocellular carcinoma with initial symptoms of decreased vision and headache, which were caused by sphenoid sinus metastasis. A 44-year-old man recently complained of bilateral decreased vision and headache. Head MRI showed a soft tissue mass in the sphenoid sinus. Pathological examination of the resected sphenoid sinus mass indicated metastatic carcinoma. Subsequently, 18F-FDG PET/CT and immunohistochemical analysis of the sphenoid sinus mass confirmed the hepatic origin of the primary lesion. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

18F-Florbetapir PET in Primary Cerebral Amyloidoma
We present the case of a 54-year-old woman where MRI revealed a T2-hyperintense mass periventricular in the white matter with moderate contrast enhancement. Pathological investigation revealed AL (lambda) amyloidoma. 18F-florbetapir PET/CT was used to support the diagnosis and in follow-up. This case highlights that 18F-florbetapir PET/CT might play a role in the diagnostic workup of patients suggestive of cerebral amyloidoma, especially in cases where biopsy is not feasible. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Abdominal Metastases of Intracranial Germ Cell Tumor Via Ventriculoperitoneal Shunt Detected by 18F-FDG PET/CT
Extraneural metastases of primary brain tumors are rare. Here, we provided a case of a 19-year-old man presenting with 2 intra-abdominal masses, who had a history of intracranial germ cell tumors and a ventriculoperitoneal shunt implanted in order to alleviate obstructive hydrocephalus. The intra-abdominal lesions showed intense FDG uptake and were confirmed to be germ cell tumors by postoperative histopathology. 18F-FDG PET scan could be useful in monitoring metastases of intracranial germ cell tumors via ventriculoperitoneal shunt. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Primary Atrial Undifferentiated Sarcoma Found on FDG PET/CT Mimicking Cardiac Myxoma
A 52-year-old man had shortness of breath and chest discomfort for 2 months. Chest CT and MRI showed a mass in the left atrium attached to the mitral annulus without obvious enhancement. Initial diagnosis was suspected of myxoma. Preoperative FDG PET/CT demonstrated the corresponding lesion with abnormal FDG uptake, indicating a malignancy. Finally, histopathologic examination revealed primary undifferentiated sarcoma. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Primary Pancreatic Lymphoma on FDG PET/CT
A 69-year-old man underwent FDG PET/CT to evaluate a right upper abdominal mass. The images showed peripherally increased activity with central photopenic region in the head of the pancreas, which was consistent with pancreatic malignancy. Histopathologic findings showed characteristic findings of diffuse large B-cell lymphoma. The activity was diminished on follow-up PET/CT after 8 courses of chemotherapy. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Multiple Cutaneous Leiomyomas Showing Increased FDG Uptake
We present a case of multiple cutaneous leiomyomas showing increased FDG uptake with SUVmax of 19.9. This case indicates cutaneous leiomyoma should be considered as a rare differential diagnosis in patients with hypermetabolic cutaneous lesions. Careful correlation with clinical history is needed to avoid misdiagnosis. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Diffuse Increased 68Ga-DOTATATE But Unimpressive 18F-FDG Osseous Activity in a Patient With Rapid-Progressing Synchronous Multifocal Osteosarcoma
Osteosarcoma is usually 18F-FDG–avid. Here we report a case of an 18-year-old young man with widespread osteoblastic and slight osteolytic changes, which had diffusely increased 68Ga-DOTATATE uptake in the osseous lesions, whereas the 18F-FDG PET/CT was unrevealing. The final diagnosis is synchronous multifocal osteosarcoma based on the pathological, clinical, and imaging features. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

99mTc-Leukocyte Scintigraphy Revealed Viral Pulmonary Infection in a COVID-19 Patient
99mTc-leukocyte scintigraphy was performed on a 40-year-old woman with spiking fevers. A focus of intense uptake in the right upper thorax was identified, concerning for infection along the central line in the superior vena cava. Additionally, heterogeneously increased uptake in both lungs was noted, which suggested pulmonary infection. CT images of the chest showed patchy ground-glass changes in both lungs and a large consolidation in the right lower lobe, which were consistent with changes for COVID-19 (coronavirus disease 2019). Severe acute respiratory syndrome coronavirus 2 RNA test was positive. This case demonstrate...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Acute Aortic Dissection Initially Suspected on 18F-FDG PET/CT
A 64-year-old man with anal cancer underwent follow-up 18F-FDG PET/CT to evaluate chemoradiation therapy response 5 months after an initial PET/CT. The follow-up 18F-FDG PET/CT demonstrated new FDG-avid curvilinear soft tissue adjacent to the abdominal aorta, interpreted as an aortic dissection. Despite lack of clinical symptoms, the patient was directed to an emergency room the same day, where a contrast-enhanced CT confirmed an aortic aneurysm with dissection. The patient underwent endovascular surgical repair the following day. This case demonstrates that newly FDG-avid aortic soft tissue should be recognized and may ne...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Incidental Metastatic Melanoma Identified on 18F-FDOPA PET/CT With Confirmation by Histology
A 47-year-old woman with a history of surgically treated abdominal paraganglioma and left thigh melanoma underwent an 18F-FDOPA PET/CT for suspected locoregional recurrence of paraganglioma. 18F-FDOPA PET/CT disconfirmed this recurrence but revealed 2 FDOPA-avid left inguinal lymph nodes, confirmed on a subsequent 18F-FDG PET/CT. Excision and pathology characterized these lymph nodes as melanoma metastases. 18F-FDOPA PET/CT is a widely used and valuable tool in the assessment of paraganglioma, both for staging and recurrence detection. Uptake of FDOPA has only rarely been documented in metastatic melanoma that could be a p...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Three Cases of Diffuse, Intense Stomach Uptake on DOTATATE PET
We describe 3 patients with suspected or known neuroendocrine tumor who were found to have diffuse and intense stomach uptake on DOTATATE PET. All patients underwent esophagogastroduodenoscopy and/or endoscopic ultrasound; the cause of the stomach uptake was attributed to proton-pump inhibitor use, chronic gastritis, and gastrinoma, respectively. These 3 cases highlight that diffuse and intense stomach DOTATATE uptake can be a benign finding probably attributed to proton-pump inhibitor use, chronic gastritis, or gastrinoma. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Solitary Hard Palate Langerhans Cell Histiocytosis Demonstrated on PET/CT Scan in an Adult
Langerhans cell histiocytosis (LCH) is rare in adults. Oral and maxillofacial LCH commonly affects the bones of the skull and jaws. Here we report a case of a 57-year-old man with a painless oral mass evaluated by 18F-FDG PET/CT. PET/CT showed a solitary 18F-FDG-avid tumor in his left hard palate. LCH was confirmed after surgery. This case reminds us that LCH should be considered in an adult with hypermetabolic hard palate lesion on 18F-FDG PET/CT. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Hepatic Schwannoma on 18F-FDG PET/CT
Schwannoma is a slow-growing benign tumor, which originates from Schwann cells and is usually asymptomatic. The most common sites of schwannomas are the head, neck, and extremities. However, a schwannoma located in the liver is extremely rare. Here, we report a 53-year-old woman with a hepatic lesion accidentally found by ultrasound. It was highly suggestive of hepatic cholangiocarcinoma by MRI. 18F-FDG PET/CT could not exclude hepatic malignant tumor due to its high metabolism. Finally, it was confirmed as hepatic schwannoma by postoperative pathology. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Whole-Body 177Lu–Prostate-Specific Membrane Antigen Scan Pattern With Excess Free 177Lu-Chloride in a Metastatic Castration-Resistant Prostate Cancer Patient
A 56-year-old man with metastatic castration-resistant prostate cancer was referred for radioligand therapy with 177Lu–prostate-specific membrane antigen. In the third cycle, a posttherapy whole-body scan showed unexpected skeletal and joint uptake apart from his known metastatic lesions. This observation raised suspicion for possible impurity (mainly free lutetium) in the applied radiopharmaceutical product. After contacting the radiopharmaceutical company, we were informed that the radiochemical purity of the used batch of 177Lu–prostate-specific membrane antigen had been 95%. This is the first report of exce...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

18F-Fluciclovine PET/MRI in a Patient With Squamous Cell Carcinoma of the Uterine Cervix Correlated With 18F-FDG PET/CT
A 32-year-old woman with a FIGO (International Federation of Gynecology and Obstetrics) stage IIA invasive squamous cell carcinoma of the uterine cervix underwent a clinical FDG PET/CT scan, which revealed intense uptake in the primary. On research 18F-fluciclovine PET/MRI, the primary showed elevated fluciclovine uptake at 5 and 40 minutes after radiotracer injection, with no evidence of regional or distant metastasis. Fluciclovine PET may have diagnostic value for cervical cancer imaging with a potential advantage over FDG of minimal urinary activity from renal excretion; however, in this patient, the metabolic activity ...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Multimodality Imaging Features of a Misleading Sacral Giant Cell Tumor in 18F-FDG PET/CT, Bone Scan, and MRI
We report the case of an asymptomatic 66-year-old woman referred for initial staging of an invasive ductal breast carcinoma. Initial workup incidentally revealed a bone tumor of right sacral wing corresponding to a giant cell tumor (GCT). We present the imaging characteristics of GCT on 99mTc-HDP bone scan (doughnut sign), 18F-FDG PET/CT (intense and heterogeneous uptake of a prominent geographic lytic lesion with partial rupture of cortical), and MRI (hyposignal with gadolinium enhancement on T1-weighted images and heterogeneous hypersignal on T2-weighted images). GCT is a benign but locally aggressive primary bone tumor,...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

FDG PET/CT Findings in Biliary Papillomatosis
Biliary papillomatosis is a rare disease with high malignant potential. A 64-year-old woman underwent FDG PET/CT, which showed an intense FDG uptake in the location of an aggregated biliary papillomatosis with high-grade intraepithelial neoplasia/carcinoma in situ but did not show FDG uptake in the sporadic, small biliary papilloma. FDG PET/CT may be an effective method to identify the components of the malignant transformation of biliary papillomatosis. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

A Case of Localized Malignant Peritoneal Mesothelioma With Lung Cancer Detected by 18F-FDG PET/CT
A 62-year-old woman was referred for cough and lower abdominal pain. 18F-FDG PET/CT showed strong uptake not only in the left lung mass and hilar and mediastinal lymph nodes, but also a huge lower abdominal mass. All lesions were initially thought to be multiple metastases because bronchial biopsy of the lung mass showed poorly differentiated adenocarcinoma. However, the abdominal mass was found to be malignant peritoneal mesothelioma after surgical resection. It was difficult to diagnose this case correctly before resection because localized malignant peritoneal mesothelioma is rare. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Detection of Residual Tumor With 68Ga-Pentixafor PET/CT in a Patient With Waldenström Macroglobulinemia and Concurrent John Cunningham Virus–Related Progressive Multifocal Leukoencephalopathy
A 75-year-old man diagnosed with Waldenström macroglobulinemia (WM) complained of neurological symptoms. Baseline 18F-FDG PET/CT showed diffusely increased radioactivity in the bone marrow and decreased FDG uptake in the right cerebellum. After rituximab-containing immunochemotherapy, the patient had clinically partial response of WM, but the cerebellar lesion was enlarged. Repeated 18F-FDG PET/CT was similar to the baseline. 68Ga-pentixafor PET/CT detected residual tumor of WM in occipital bone and cervical lymph nodes, but there was no uptake in the cerebellar lesion. Finally, John Cunningham virus–related pro...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Radioligand Therapy With 177Lu–Prostate-Specific Membrane Antigen in a Patient With Non–Prostate-Specific Antigen–Secreting Metastatic Prostate Cancer
We present a 65-year-old man with non–PSA-secreting prostate cancer and widespread metastases with rather fair response to 177Lu-prostate-specific membrane antigen radioligand therapy. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Radioiodine Retention Within Dilated Common Biliary Duct Mimicking Metastatic Thyroid Cancer Diagnosed by the Combination of SPECT/CT and MRI
A 55-year-old woman with papillary thyroid carcinoma under total thyroidectomy and cervical lymph node dissection was referred for 131I radioiodine therapy. Posttherapeutic whole-body scintigraphy revealed increased focal uptake in the right upper abdomen, which localized to the region of the head of the pancreas on SPECT/CT fusion images. Further evaluation with MRI affirmed the radioiodine retention corresponded to bile duct dilation. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

68Ga-FAPI PET/CT in Assessment of Leptomeningeal Metastases in a Patient With Lung Adenocarcinoma
We presented a case of 64-year-old woman with pathologically diagnosed lung adenocarcinoma. Brain metastases were highly suspected due to the appearance of neurological symptoms. However, no abnormal finding in the brain was observed on 18F-FDG PET/CT. Contrast-enhanced MRI showed the presence of leptomeningeal metastases but with a negative cerebrospinal fluid analysis. For this reason, the patient underwent 68Ga-FAPI PET/CT, later fused with MRI scans that showed intense uptake of 68Ga-FAPI in leptomeningeal regions correspondent to the sites of gadolinium enhancement. This case highlights that 68Ga-FAPI would be promisi...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Abnormal FDG Uptake on PET/CT Due to Periosteal Reaction Caused by Hypervitaminosis D in a Pediatric Patient
A 7-year-old boy presented with diffuse bone pain. FDG PET/CT was performed to find the possible underlying malignant cause of hypercalcemia. The images demonstrated multiple foci of abnormal FDG activity at the sites of periosteal reaction. In addition, calcium deposit was noted in the basal ganglia, stomach, and the colon. History taking revealed that the patient had routinely taken an over-the-counter “supplement” that contains a high dose of vitamin D. One week after calcitonin therapy and stopping the supplement, the patient became symptom free. This case suggests that hypervitaminosis D might cause hyperm...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Quality and Safety in Healthcare, Part LXII: Efforts by National Organizations to Promote Resident Wellness
Multiple national organizations promote resident wellness. The Accreditation Council for Graduate Medical Education limits work hours and sleep deprivation for residents. The Accreditation Council for Graduate Medical Education requires that residency programs take into consideration the intensity of the work, how residents are scheduled, and that residents be given reasonable time off to go to medical and dental care appointments. The Action Collaborative on Clinician Well-Being and Resilience, the National Wellness Institute, the American Medical Association, and the American College of Radiology are some of the other na...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: From the American College of Nuclear Medicine Source Type: research

Sentinel Node Imaging and Radioguided Surgery in the Era of SPECT/CT and PET/CT: Toward New Interventional Nuclear Medicine Strategies
We review recent technological advances and new clinical indications for sentinel node (SN) and radioguided surgery in order to delineate future tendencies of interventional nuclear medicine in this field. A literature research was performed in PubMed to select relevant articles to be used as key references for analysis of the current approaches and tendencies in SN and radioguided surgery, as well as the evolving contribution of nuclear medicine intervention techniques to the various clinical applications. For classic indications such as melanoma and breast cancer, the incorporation of the SN approach based on the combine...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Opinion Paper/Commentary Source Type: research

Dual-Phase 99mTc-MIBI SPECT/CT in the Characterization of Enhancing Solid Renal Tumors: A Single-Institution Study of 147 Cases
Purpose The aim of this study was to investigate the value of dual-phase 99mTc-MIBI SPECT/CT in the differential diagnosis between benign and malignant enhancing solid renal tumors. Patients and Methods Totally, 180 patients were imaged with dual-phase 99mTc-MIBI SPECT/CT, which was performed 30 minutes and 90 minutes after 99mTc-MIBI administration. Among them, 147 patients with 148 histologically proved solid renal tumors met the selection criteria and were included for the final analysis. Relative quantification was performed by measuring the radioactive uptake ratio of tumor to the normal renal parenchymal backgro...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Original Articles Source Type: research

Clinical Impact of PET Imaging in Patients With Metastatic Prostate Cancer
Prostate cancer (Pca) is the most common cancer and the second leading cause of death among men. Although conventional bone scans and abdominal CT are preferred in most of the guidelines and clinical trials, PET/CT has already started to become the inevitable part of Pca management because of its higher sensitivity and specificity. Radiotracers used for PET imaging show different molecular aspects of the disease process. Although 68Ga–prostate-specific membrane antigen offers the highest sensitivity and specificity, other PET radiotracers such as 18F-FDG and 68Ga-DOTATATE still have a role in patients with prostate-s...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Original Articles Source Type: research

The Imaging Features and Clinical Associations of a Novel Tau PET Tracer—18F-APN1607 in Alzheimer Disease
Purpose of the Report In vivo tau PET imaging could help clarify the spatial distribution of tau deposition in Alzheimer disease (AD) and aid in the differential diagnosis of tauopathies. To date, there have been no in vivo 18F-APN1607 tau PET studies in patients with AD. Methods We applied tau tracer in 12 normal controls (NCs) and 10 patients in the mild to moderate stage of probable AD. Detailed clinical information, cognitive measurements, and disease severity were documented. Regional SUV ratios (SUVRs) from 18F-AV-45 (florbetapir), 18F-APN1607 PET images, and regional gray matter (GM) atrophic ratios were calcul...
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Original Articles Source Type: research

One-by-One Comparison of Lymph Nodes Between 18F-FDG Uptake and Pathological Diagnosis in Esophageal Cancer
Conclusions The FDG uptake by each LN is a potentially useful marker for navigation surgery in esophageal cancer and has higher accuracy than LN weight or diameter. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - September 9, 2020 Category: Nuclear Medicine Tags: Original Articles Source Type: research

68Ga–Prostate-Specific Membrane Antigen PET–Positive Paget Bone Disease With Metastatic Prostatic Carcinoma
We report the case of a patient newly diagnosed with prostate cancer who was found to have multiple osseous metastases, with coexisting Paget disease in the left hemipelvis diagnosed because of typical scintigraphic and SPECT/CT appearance. 68Ga–prostate-specific membrane antigen PET/CT was also performed for initial staging. Pagetoid bones showed increased prostate-specific membrane antigen uptake like skeletal metastases. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - August 13, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Expression of CXCR4 Receptors in Refractory Atypical Mediastinal Carcinoid
We present the case of a 52-year-old man with mediastinal atypical carcinoid (grade II) neuroendocrine tumor showing mild somatostatin receptor expression and intense FDG avidity with progressive disease on chemotherapy. Chemokine receptor targeted PET/CT with CXCR4 (68Ga-CXCR4) showed tracer avidity in tumor sites higher than the physiological sites, which may pave the way for CXCR4-targeted radionuclide therapy in this subgroup of patients. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - August 13, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

The Use of FDG PET Parametric Imaging in the Diagnosis of Olivopontocerebellar Atrophy
We present a case involving a 66-year-old man with adult-onset progressing cerebellar signs reflective of a cerebellar syndrome with no significant family history and unremarkable genetic testing for spinocerebellar ataxia. This case was found to be most consistent with sporadic olivopontocerebellar atrophy, which falls under the multiple system atrophy category. This diagnosis can be made using 18F-FDG PET/CT scanning and with MRI in some cases. However, in this case, relatively new PET/CT quantification and parametric imaging software was used for analysis, CortexID Suite. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - August 13, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

68Ga-DOTATOC PET for Treatment Efficacy Evaluation of Cardiac Sarcoidosis
Cardiac sarcoidosis (CS) has a poor prognosis related to life-threating arrhythmias and heart failure. Treatment includes anti-inflammatory therapies and implantable pacemaker and/or cardioverter defibrillator. The presence of cardiac devices and physiologic myocardial glucose uptake are major limitations of both cardiac magnetic resonance and 18F-FDG PET/CT, reducing their diagnostic value. Somatostatin-based PET/CT has been proposed to detect active CS. Contrarily to 18F-FDG uptake, which reflects nonspecific leukocyte infiltration, 68Ga-DOTATOC may identify active granulomatosis. Herein, we underline the specificity of ...
Source: Clinical Nuclear Medicine - August 13, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Gallbladder Carcinoma Presenting With Elbow Swelling
We report a case of primary gallbladder carcinoma, which presented with elbow swelling in the absence of locoregional nodal spread detected on whole-body 18F-FDG PET/contrast-enhanced CT at initial evaluation. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - August 13, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

99mTc-RBC SPECT/CT for Duodenal Bleeding Point Detection
This is a case of a 63-year-old man who presented with acute melena and low hemoglobin. Upper and lower gastrointestinal evaluations failed to localize the bleeding focus. 99mTc-RBC planar scintigraphy identified 2 sites of suspected bleeding in the lower abdomen area. Subsequent SPECT/CT was performed and identified the precise main focus of active bleeding, the second and third parts of the duodenum, and also described the blood accumulation in the jejunum. Esophagogastroduodenoscopy was immediately performed, and results confirmed spurting blood from the small vessel with multiple ulcers in the second part of the duoden...
Source: Clinical Nuclear Medicine - August 13, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research