An Unusual Case of Maxillary Sinus Cholesterol Granuloma Showing FDG Uptake on PET/CT
We report an unusual case of paranasal sinus CG with 18F-FDG uptake. A 76-year-old man presented with right refractory epistaxis. PET/CT showed FDG uptake in the maxillary sinus. CT findings are typically uncharacteristic, whereas MRI scans are characterized by a high signal on both T1-weighted and T2-weighted images. Nasal endoscopy from the ostium revealed a granulomatous lesion with hemorrhage at the base of the maxillary sinus. After pathological examination by endoscopic sinus surgery, the patient was diagnosed with CG. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Sarcoidosis Mimicking Primary Pulmonary Artery Sarcoma
A 71-year-old man with coronary artery disease, sarcoid uveitis, and recurrent ventricular tachycardia treated with implantable cardioverter-defibrillator presented with increasing dyspnea for several months. Echocardiography showed a large echogenic mass causing severe narrowing of the proximal main pulmonary artery and a resultant gradient of 65 mm Hg. Ventilation-perfusion scintigraphy showed diffusely decreased perfusion of the left lung and an additional mismatched segmental perfusion defect in the left upper lobe. Cardiac MRI could not be performed because of the implantable cardioverter-defibrillator. (Source: Clini...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Pulmonary Artery Sarcoma With Low 18F-FDG Uptake
A 75-year-old man presented with dyspnea for more than 2 months, with blood test showing low platelet count and cardiac ultrasound showing severe pulmonary hypertension (>54 mm Hg). A CT pulmonary angiogram showed a filling defect in the pulmonary trunk, right and left pulmonary arteries, raising the possibilities of pulmonary embolism or artery sarcoma. FDG PET/CT was performed for further evaluation and showed low uptake in the pulmonary wall, which supported the diagnosis of pulmonary embolism. Patient was treated with anticoagulants with no changes on repeated CT pulmonary angiogram. Patient underwent surgery, and h...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

FDG-Avid Pulmonary Nodules and Tracheobronchial Mural Inflammation in IgG4-Related Disease
We report the case of a 9-year-old girl who presented with acute fevers, cough, and epistaxis with nasal swelling, and found to have a nasal mass. On 18F-FDG PET/CT, she was found to have marked nodal and pulmonary parenchymal disease with diffuse and symmetrical mural FDG uptake within the trachea and bronchial tree. The differential diagnosis was broad, and she was diagnosed with IgG4-RD (IgG4-related disease) and improved on appropriate treatment. To our knowledge, there are only 2 other pediatric cases of IgG4-related pulmonary disease in the literature, and our case serves as a unique constellation of intrapulmonary I...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Advantage of 68Ga-PSMA PET/CT on Postradiotherapy Response Assessment of Juvenile Nasal Angiofibroma
Prostate-specific membrane antigen (PSMA) is universally expressed in the endothelial cells of tumor-associated neovasculature of juvenile nasopharyngeal angiofibroma. Functional 68Ga-PSMA PET/CT also enables easier differentiation of the residual tumor from postoperative changes. An 18-year-old man with the residual intracranial disease received radiotherapy after surgery. In PSMA PET/CT imaging, uptake was noted initially only in the residual disease, and the same was absent after successful response to radiotherapy, unlike contrast MRI, which showed persistent enhancement. Functional 68Ga-PSMA PET/CT may be a very usefu...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Pembrolizumab-Induced Thyroiditis and Colitis—Presentation and Resolution on Serial FDG PET/CT
A 58-year-old man with previous melanoma of the left leg underwent whole-body 18F-FDG PET/CT to stage metastatic disease prior to commencing pembrolizumab. Follow-up FDG PET/CT after 3 months of treatment showed partial metabolic response of soft tissue and nodal metastases and diffuse increased thyroid and colonic uptake, suggestive of thyroiditis and colitis. Pembrolizumab was ceased, and a repeat FDG PET/CT scan showed regression of uptake in the thyroid gland and colon, in keeping with resolution of inflammatory change. Immune-related adverse events induced by Immune checkpoint inhibitors, such as pembrolizumab, should...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Warthin Tumor Incidentally Detected on PET/CT Showing Both 68Ga-DOTANOC and 18F-FDG Uptake
A patient with moderately differentiated pancreatic neuroendocrine tumor with synchronous multifocal liver metastases was referred for further staging with PET/CT. The examinations were performed on 2 consecutive days and showed mild 68Ga-DOTANOC and intense 18F-FDG uptake in an incidental right parotid nodule. Differential diagnoses include primary or metastatic neuroendocrine tumor, malignant or benign primary parotid tumor, and intraparotid lymph node. Histology revealed characteristics of a Warthin tumor. While focal FDG uptake in Warthin tumor is frequently described, the somatostatin expression was rarely reported. T...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Aggressive Bone Metastatic Prostate Cancer With Periosteal Reaction in 18F-Choline PET/CT
We report herein the case of a 65-year-old man treated since 2013 for prostate cancer with early bone metastases. This asymptomatic patient was referred for 18F-choline PET/CT due to a major elevation of prostate-specific antigen to>1500 ng/mL. The results indicated multiple bone lesions, disseminated on the axial skeleton, girdles, and upper extremities of femurs. Interestingly, we described the development of an intensely hypermetabolic spiculated periosteal reaction, evidencing a rapidly progressive disease. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Incidental Detection of Urothelial Carcinoma on 18F-Fluciclovine PET/CT
We present a case report of an 82-year-old man with history of both prostate and bladder cancer who presented for a fluciclovine study due to rising PSA levels. There was incidental detection of focal penile activity, and a subsequent urethral biopsy performed showed urothelial carcinoma, which was also seen on a subsequent MRI study. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Internal Jugular Vein and Cerebral Venous Sinus Infective Thrombophlebitis Detected With 99mTc-HMPAO White Blood Cell Scintigraphy
This study illustrates the value of 99mTc-HMPAO-WBC imaging as a tool for evaluating thrombophlebitis, particularly in patients with renal failure in whom contrast-enhanced CT may not be possible. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Incidental Detection of a Small Cell Lung Cancer by 18F-Choline PET/CT Performed for Recurrent Hyperparathyroidism After Parathyroidectomy
We report the case of a 64-year-old woman with musculoskeletal pain and elevated serum parathyroid hormone who had undergone parathyroidectomy for primary hyperparathyroidism 4 years earlier. An 18F-choline PET/CT scan was performed and incidentally showed an intense uptake in a right upper lobe pulmonary nodule and in the right hilar, mediastinal, and cervical lymph nodes. Histopathological analysis confirmed the diagnosis of a small cell lung cancer. Clinical symptoms and recurrent hyperparathyroidism were therefore consistent with a paraneoplastic syndrome. A complete metabolic response was achieved on 18F-FDG PET/CT sc...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Recurrent Brain Metastasis of Triple Negative Breast Cancer With High Uptake in 68Ga-PSMA-11 PET/CT
We present a 47-year-old woman with TNBC having recurrent brain metastasis with avid PSMA receptor activity versus low FDG uptake. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Sinus Tarsi Syndrome on Bone Scintigraphy With SPECT/CT: Spectrum of Findings
We present 3 cases of sinus tarsi syndrome, review the spectrum of imaging findings associated with sinus tarsi syndrome, and show the key role that SPECT/CT can play in its diagnosis. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Concurrent Liver and Mesentery Primary Extraosseous Multiple Myeloma on 18F-FDG PET/CT
We report a rare case with biopsy-proven concurrent liver and mesentery primary EMM at the time of initial staging after serologic diagnosis of multiple myeloma. 18F-FDG PET/CT is valuable in detection of EMM when the patient has no osseous lesions and a negative bone marrow biopsy. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

18F-Fluciclovine–Avid Mediastinal Lymph Node Metastasis of Cutaneous Malignant Melanoma
A 63-year-old man with recent diagnosis of high-risk prostate adenocarcinoma was referred to our Nuclear Medicine Department for 18F-fluciclovine PET/CT to rule out metastasis in the setting of elevated serum prostate-specific antigen levels. The patient had previous history of nodular melanoma of the right cheek treated 6 years back with surgery and adjuvant radiation. Surveillance 18F-FDG PET/CT for melanoma 1 month back had revealed enlarged FDG-avid mediastinal para-aortic lymph nodes, which on endoscopic biopsy had revealed melanoma metastasis. On current fluciclovine PET/CT, the same enlarged para-aortic lymph nodes ...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

FDG-Avid Lung Nodule Formation by the Use of Hemostatic Powder: A Potential Cause of False-Positive FDG PET/CT
We report a case of a 59-year-old man who was considered having a false-positive FDG-PET pulmonary nodular lesion in favor of metastasis, which was formed by the use of hemostatic powder. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

18F-FDG PET/CT in the Diagnosis and Follow-up of Balint Syndrome
Balint syndrome is a rare neurological disorder characterized by simultanagnosia, optic ataxia, and ocular apraxia, and its etiology can be very heterogeneous. Diagnosis is based on neuropsychological evaluation, but brain radiological and nuclear medicine imaging also plays an important role. Because few case reports have been published in literature, in this work, we present 2 patients affected by Balint syndrome in which 18F-FDG PET/CT helped in the diagnosis and follow-up. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

68Ga–Prostate-Specific Membrane Antigen Focal Pulmonary Activity With No Corresponding CT Abnormality
We describe a case of 68Ga–prostate-specific membrane antigen PET/CT scan with focal tracer concentration in the lung without any abnormalities in the CT part. 18F-FDG focal uptake in lungs without corresponding CT lesions is described. Two possible mechanisms proposed to explain this finding in FDG PET/CT scans are iatrogenic pulmonary microembolism and 18F-FDG–avid infection or inflammation that precedes structural findings. Logically, these proposed mechanisms seem to be applicable to 68Ga–prostate-specific membrane antigen as well. In our case, there were no features of any lung infection/inflammation...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Incidental Detection of Elastofibroma Dorsi With 68Ga-FAPI-46 and 18F-FDG PET/CT in a Patient With Esophageal Cancer
A 71-year-old man underwent 18F-FDG and 68Ga-FAPI-46 PET/CT for initial staging prior to surgery of a squamous cell carcinoma of the lower esophagus under the prospective study NCT04147494. Both scans showed increased uptake in the mid and distal esophagus without evidence of metastatic disease. A soft tissue right infrascapular mass with mild 18F-FDG and moderate 68Ga-FAPI-46 uptake was incidentally found. The patient underwent robotic-assisted Ivor-Lewis esophagectomy and excision of the right infrascapular mass. Histopathology of the right chest wall mass confirmed the diagnosis of elastofibroma. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Gallbladder Perforation Into the Peritoneal Cavity
We report a challenging case of type 1 gallbladder perforation due to acute acalculous cholecystitis. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

False-Positive 18F–Prostate-Specific Membrane Antigen–1007 PET/CT Caused by Hepatic Multifocal Inflammatory Foci
A 68-year-old man with history of treated prostate cancer was referred to 68Ga–prostate-specific membrane antigen (PSMA)–11 PET/CT imaging. Moderate bone involvement was observed, with a normal liver tracer uptake. Bone biopsy confirmed metastases of prostate cancer. After therapy adjustment, a follow-up 18F-PSMA-1007 PET/CT revealed good response in bone lesions, although it showed 3 new rounded liver intense uptake foci. Concurrent PSA was 0.6 ng/mL. Liver function tests were normal. PET/CT-guided hepatic biopsy demonstrated no malignant cells, focal inflammation, and steatosis, being possibly the inflammatio...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Widespread Metastatic Gastric Signet-Ring Cell Carcinoma Shown by 68Ga-FAPI PET/CT
The present study compared 68Ga-FAPI and 18F-FDG PET/CT in a patient with GSRCC (gastric signet-ring cell carcinoma). In this case, 68Ga-FAPI PET/CT shows much higher tumor-to-background contrast of primary tumor and reveals more metastatic lesions than 18F-FDG PET/CT. This case demonstrates that 68Ga-FAPI PET/CT outperforms 18F-FDG in identifying both primary and metastatic lesions in GSRCC. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Incidental Findings of a Vestibular Schwannoma on 18F-Choline PET/CT
We report an increased uptake of 18F-choline in the right cerebellopontine angle area in a 73-year-old man with biochemical failure prostate cancer after radical prostatectomy, potentially suggestive of bone metastasis in the base of the skull. A brain MRI was also performed showing an intense gadolinium enhancement focus in the same area, concordant with a right vestibular schwannoma, subsequently histologically proven. This case underlines that schwannoma is a diagnostic pitfall in 18F-choline PET/CT, suggesting this radiolabeled tracer as a promising tool for brain tumors characterization due to its higher signal-to-bac...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

99mTc-PSMA SPECT/CT Versus 68Ga-PSMA PET/CT in the Evaluation of Metastatic Prostate Cancer
Conclusions 99mTc-PSMA SPECT/CT could be a potential substitute for 68Ga-PSMA PET/CT in high-risk patients, except when evaluation of prostate bed is of major concern. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Original Article Source Type: research

68Ga-Fibroblast Activation Protein Inhibitor, a Promising Radiopharmaceutical in PET/CT to Detect the Primary and Metastatic Lesions of Chromophobe Renal Cell Carcinoma
18F-FDG PET/CT was performed to locate the primary lesion in a 71-year-old man with bone metastasis. However, no abnormal 18F-FDG activity likely presenting the primary tumor was observed. 68Ga-fibroblast activation protein inhibitor PET/CT was then performed for further detecting the primary tumor, which showed a higher activity in lesions of bone metastases than 18F-FDG. Additionally, another lesion with intense uptake was observed in the inferior pole of right kidney, likely presenting the primary tumor. A renal biopsy revealed the diagnosis of chromophobe renal cell carcinoma. This case highlighted that 68Ga-fibroblast...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Idiopathic Retroperitoneal Fibrosis With Intense Uptake of 68Ga-Fibroblast Activation Protein Inhibitor and 18F-FDG
A 26-year-old man presented with a retroperitoneal mass with left urinary tract obstruction and hydronephrosis recently. 18F-FDG PET/CT showed the retroperitoneal mass had intense and homogeneous FDG avidity. In 68Ga-FAPI PET/CT, the retroperitoneal mass showed intense radioactivity without other organ involvements. The patient was finally diagnosed with idiopathic retroperitoneal fibrosis. After treatment, the follow-up CT showed significant decrease in size of the retroperitoneal mass. The current case indicated that idiopathic retroperitoneal fibrosis had active uptake of 68Ga-FAPI. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Solitary Femoral Nodal Metastasis Identified With 68Ga–Prostate-Specific Membrane Antigen PET/CT
A 66-year-old man was referred for a 68Ga–prostate-specific membrane antigen (PSMA) PET/CT scan for primary staging of Gleason 8 prostatic adenocarcinoma. The PET/CT images confirmed PSMA activity in the bilateral prostatic apex in keeping with the known malignancy. An intensely PSMA-avid focus was also noted in a nonenlarged right femoral lymph node with no evidence of PSMA-avid metastatic disease elsewhere. Subsequent core biopsy and histopathology confirmed a solitary metastatic focus of prostatic adenocarcinoma in a right femoral lymph node. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Venous Air Embolism Identified by 18F-Fluorocholine Dual-Phase PET/CT
A 60-year-old woman with primary hyperparathyroidism with previous nonconclusive imaging studies was referred for 18F-fluorocholine (18F-FCH) PET/CT as part of the preoperative diagnostic imaging workup to localize the adenoma before minimally invasive surgery. 18F-FCH PET/CT with dual time point was performed, acquiring immediately and 60 minutes after 18F-FCH administration. The early images demonstrated possible hyperfunctioning parathyroid tissue in the mediastinum, located in the right upper paratracheal space (region 2R), with an incidental iatrogenic subclavian venous air bubble embolism presenting as high uptake in...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Elevated 123I-MIBG Activity in Intramuscular Hemangioma
A 3-year-old boy with high-risk neuroblastoma underwent 123I-MIBG scan to evaluate the disease status after surgery and chemotherapy. 123I-MIBG SPECT/CT demonstrated liver metastasis. In addition, mildly increased uptake in the inferior left erector spinae was noted. Contrast-enhanced CT suggested intramuscular hemangioma. The 123I-MIBG accumulation in the intramuscular hemangioma persisted during the follow-up scan, whereas the abnormal activity in the liver was resolved. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

68Ga-DOTANOC PET/CT With Lung Involvement in the Era of COVID-19 Pandemic
Patient was a 55-year-old man with history of pancreas neuroendocrine tumor grade 2, Ki-67 index 10%. He was treated with surgical resection. 68Ga-DOTANOC PET/CT was performed as part of follow-up of known disease. The images showed opacities in both lungs’ parenchyma with moderate uptake of radiotracer and mediastinal lymph nodes with high uptake suggestive of infection. Two weeks before a high-resolution CT was performed, these findings in the lungs were not present. The patient was asymptomatic and was referred to the emergency department for reverse transcriptase–polymerase chain reaction COVID-19 test, and...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Altered Biodistribution of 68Ga-DOTATOC
68Ga-DOTATOC PET/CT of a patient with metastatic neuroendocrine tumor reveals an abnormal biodistribution of the tracer with a vascular binding and a very low fixation on the known lesions despite the temporary discontinuation of “cold” somatostatin analogs. A possible interaction with a high intake of turmeric may be suspected by inhibition of hepatic uptake process. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Demonstration of Double Bladder Diverticula on Bone Scan
A 75-year-old man with suspected prostate cancer underwent a 99mTc-MDP bone scan to exclude the possibility of bone metastasis. Scans revealed areas of increased tracer uptake in a symmetric distribution on both sides of the pelvis. Further SPECT/CT imaging showed focal 99mTc-MDP accumulation within 2 cystic lesions on both sides of the bladder. Subsequent x-ray cystography showed contrast agent filling within both cystic lesions, which suggested double bladder diverticula. Eventually, these 2 cystic lesions were confirmed by surgery and pathology as double congenital bladder diverticula. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

111In-Labeled White Blood Cell Uptake in the Urinary Bladder in Occult Urinary Tract Infection
A 55-year-old woman with multiple medical problems, including anuric, dialysis-dependent, end-stage renal disease, presented with persistent fever of unknown origin. Despite extensive workup with cross-sectional imaging and panculture, the etiology was not found. Eventually, an 111In-labeled WBC scan was performed to evaluate for occult infection, which revealed intense heterogeneous uptake in the urinary bladder. Subsequent bladder catheterization showed pus and blood, which grew Klebsiella pneumoniae. The fevers resolved with adjustment of the therapy. Although urinary analysis and culture are standard practice in the wo...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

18F-FDG PET/CT for Monitoring of Disease Progression in Metastatic Perivascular Epithelioid Cell Tumor
A 38-year-old woman presented for 18F-FDG PET/CT after multiple intra-abdominal surgical resections of a rare recurrent perivascular epithelioid cell tumor of the gastrointestinal tract. A solitary pelvic metastasis was detected, but surprisingly exhibited neither increased glucose consumption nor contrast enhancement on CT. Follow-up 18F-FDG PET/CT staging in the further disease course revealed multiple abdominal metastases, now, however, with markedly increased 18F-FDG uptake and intraoperatively correlating widespread peritoneal sarcomatosis. This case gives preliminary insight into monitoring of disease progression in ...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Primary Inferior Vena Cava Leiomyosarcoma With Hepatic Metastases on FDG PET/CT
We report FDG PET/CT findings of pathology-proven hepatic metastases from leiomyosarcoma originating from the inferior vena cava in a young woman whose initial presentation was worsening abdominal and chest pain. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Parathyroid Carcinoma With Marked Uptake of 99mTcO4−
A 51-year-old man with a palpable neck mass and elevated parathyroid hormone was referred to our department for parathyroid scintigraphy. After injection of 740 MBq 99mTc-MIBI, a dual-phase scan was obtained, which revealed a persistent and intense focal hyperactivity in the left side of the neck (compatible with the neck mass). Thyroid scan with 99mTcO4− also showed increased uptake of the mass, similar to a hot thyroid nodule. After surgery, parathyroid carcinoma was confirmed pathologically. This case demonstrates a rare presentation of parathyroid carcinoma as a hot nodule in thyroid scan, which has been attribut...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Epithelioid Hemangioma of Vertebra Mimicking Metastasis on FDG PET/CT in a Patient With Renal Cell Cancer
This report indicates importance of quantitative assessment of FDG uptake, as well as combined use of MRI. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Hypermetabolic Cerebral Metastases of Cardiac Myxoma on FDG PET/CT
A 66-year-old woman with a history of surgical resection of left atrial myxoma 6 months ago presented with multiple brain lesions with MRI. An FDG PET/CT was performed for further evaluation. The images showed that cerebral tumors had variable and increased FDG uptake in general, and no other abnormal FDG-avid lesions were noted. The tumor of right occipital lobe was resected and confirmed as metastatic cardiac myxoma on histology. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Effective Management of 177Lu-DOTA0-Tyr3-Octreotate Extravasation
We report here a case of 177Lu-DOTA0-Tyr3-octreotate extravasation. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Resolution of Pulmonary Cement Embolism After Treatment of Rivaroxaban on Ventilation/Perfusion SPECT Image
A 73-year-old woman took a chest radiography for medical check-up, and pulmonary cement embolism was diagnosed. She had undergone percutaneous vertebroplasty. Ventilation-perfusion imaging revealed V/Q mismatched perfusion defect on the lung. Then, she has taken rivaroxaban (orally active direct factor Xa inhibitor) for 6 months and took follow-up V/Q scan. It revealed the disappearance of previous 2 of 3 moderate V/Q mismatches. There are controversies in the role of anticoagulation in treatment of pulmonary cement embolism, and this case shows functional recovery through the perfusion scan after anticoagulation treatment...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Bilateral Silicone Granulomas Mimicking Breast Cancer Recurrence on 18F-FDG PET/CT
We report the case of a 45-year-old woman with a history of right breast reconstruction with silicone implant for breast cancer. An 18F-FDG PET/CT performed several years later revealed the presence of 18F-FDG–avid nodules at the periphery of the silicone implant, in the right internal mammary chain, and in the contralateral breast. Needle core biopsies were positive for bilateral silicone granulomas, without any sign of malignancy. This case displays intense 18F-FDG uptake in silicone granulomas affecting the contralateral breast after implant reconstruction. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

FDG PET/CT in Recurrent Glioblastoma Multiforme With Leptomeningeal and Diffuse Spinal Cord Metastasis
We present a rare case of symptomatic diffuse spinal metastases of glioblastoma multiforme in a 25-year-old woman, who has been previously treated surgically with gross tumor resection followed by adjuvant radiotherapy and chemotherapy with temozolomide. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Widespread Glial Activation in Primary Progressive Multiple Sclerosis Revealed by 18F-PBR06 PET: A Clinically Feasible, Individualized Approach
A 64-year-old man with primary progressive multiple sclerosis (Expanded Disability Status Scale 3.5) underwent PET using 18F-PBR06, a second-generation 18-kDa translocator protein ligand targeting activated brain microglia and astrocytes. Voxel-by-voxel statistical comparison of patient’s PET images (acquired 60–90 minutes postinjection) with a healthy control data set was performed to generate a 3-dimensional z-score map of increased radiotracer uptake, which showed widespread increased glial activation in normal-appearing cerebral white matter, white matter lesional and perilesional areas, brainstem and cereb...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Quality and Safety in Healthcare, Part LXVI: Contributing Causes of Poor Well-being in Medical Students
Problems in the learning environment are the main contributing factors to medical student burnout. These issues include stresses from mistreatment, poor support, cynical supervisors, pressure to get good grades and learn a huge amount of information quickly, fatigue, lack of control, and so on. Personal risk factors include having been seriously ill recently, having a low grit score, being in debt, and having a job. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: From the American College of Nuclear Medicine Source Type: research

18F-FDG PET and 18F-FDG PET/CT in Vulvar Cancer: A Systematic Review and Meta-analysis
Conclusions Despite limited literature data, this systematic review and meta-analysis revealed that a negative preoperative PET/CT scan may exclude groin metastases in at least early-stage vulvar cancer patients currently unfit for sentinel node biopsy and select those eligible for a less invasive surgical treatment. A positive PET/CT result should otherwise be interpreted with caution. Larger prospective studies are needed to confirm these results and to evaluate the diagnostic value of standardized semiquantitative analysis compared with the qualitative one. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Original Articles Source Type: research

[18F]PR04.MZ PET/CT Imaging for Evaluation of Nigrostriatal Neuron Integrity in Patients With Parkinson Disease
Conclusions [18F]PR04.MZ PET/CT is a highly sensitive imaging modality for the detection of dopaminergic deficit in nigrostriatal pathways in PD. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Original Articles Source Type: research

Clinical Assessment of 177Lu-DOTATATE Quantification by Comparison of SUV-Based Parameters Measured on Both Post-PRRT SPECT/CT and 68Ga-DOTATOC PET/CT in Patients With Neuroendocrine Tumors: A Feasibility Study
Introduction Patients and Methods Patients with WD-GEP-NET who benefited from a pretherapeutic 68Ga-DOTATOC PET/CT and a 177Lu-DOTATATE SPECT/CT after the cycle 1 of peptide receptor radionuclide therapy were prospectively included. SPECT/CT acquisitions were performed on a system calibrated with a conversion factor of 9.48 counts/MBq per second and were reconstructed with an iterative algorithm allowing quantification using the SPECTRA Quant software (MIM Software, Cleveland, OH). For each patient, different SUV parameters were recorded on both PET/CT (Ga parameters) and SPECT/CT (Lu parameters) for comparison: ph...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Original Articles Source Type: research

Quantitative Features From CHO PET Distinguish the WHO Grades of Primary Diffuse Glioma
Conclusions Quantitative features from CHO PET are reliable in determining the WHO grade of primary diffuse gliomas. Our findings suggest that GBM has a larger volume, a more spherical shape, higher choline activity in most interval segments, and a more symmetrical distribution than LGG. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Original Articles Source Type: research

Comparative Performance of 99mTc-TRODAT-1 SPECT/CT and 18F-FDOPA PET/CT Imaging in Patients With Parkinson’s Disease, Parkinson-Plus Syndrome, and Essential Tremor
Purpose The aim of this study was to assess the utility of presynaptic dopaminergic imaging using 99mTc-TRODAT-1 SPECT/CT and 18F-FDOPA PET/CT and compare their performance in Parkinson’s disease (PD), Parkinson-plus syndrome (PPS), and essential tremor (ET). Patients and Methods A total of 103 patients (PD = 48, PPS = 19, and ET = 36) were enrolled prospectively. Hoehn and Yahr (H&Y) staging and MDS-UPDRS (Movement Disorder Society–Sponsored Revision of Unified Parkinson’s Disease Rating Scale) were done for PD and PPS cases. All the patients underwent 99mTc-TRODAT-1 SPECT/CT and 18F-FDOPA...
Source: Clinical Nuclear Medicine - January 9, 2021 Category: Nuclear Medicine Tags: Original Articles Source Type: research

18F-PSMA-1007 PET/CT for Initial Staging of Renal Cell Carcinoma in an End-Stage Renal Disease Patient
A 46-year-old man with end-stage renal disease and renal cell carcinoma underwent 18F-FDG PET/CT for initial staging followed by 18F-PSMA-1007 PET/CT. Unlike 18F-FDG, which undergoes renal clearance, 18F-PSMA-1007 undergoes hepatobiliary clearance and thus generates superior quality images. 18F-PSMA-1007 PET/CT showed intense tracer-avid left renal mass lesion (FDG nonavid); lytic bone lesions (FDG avid) and single liver lesion (FDG nonavid). This case highlights the superiority of 18F-PSMA-1007 over 18F-FDG PET/CT in identifying primary lesion as well as metastatic sites in case of renal cell carcinoma even in the presenc...
Source: Clinical Nuclear Medicine - December 9, 2020 Category: Nuclear Medicine Tags: Interesting Images Source Type: research