Focal 123I-MIBG Uptake in the Medial Segment of the Normal Liver
An 84-year-old man with parkinsonism was referred for 123I-MIBG scintigraphy. Abnormal uptake in the right upper abdomen was incidentally seen in planar image, and SPECT revealed focal uptake in the medial segment (S4) of the liver. Subsequent triple-phase contrast-enhanced CT showed no evidence of hepatic tumors, although in the arterial phase, there were an enhanced region corresponding to the uptake area and the enhanced vein of Sappey that flowed into S4. In this case, the focal 123I-MIBG uptake would be attributable to hemodynamic change in the liver. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Anaplastic Oligodendroglioma Found as an Incidental Photopenic Lesion on 18F-FP-CIT PET/CT Image
18F-FP-CIT PET is a useful modality for imaging dopamine transporters. It has excellent resolution compared with 123I-beta-CIT SPECT and is widely used clinically for the evaluation of Parkinson disease. In general, the main focus of 18F-FP-CIT PET imaging is the basal ganglia, and it is important to observe whether 18F-FP-CIT uptake is normal in the putamen and caudate nuclei. However, abnormal findings may be seen in other brain regions besides the basal ganglia. Here, we present a case of anaplastic oligodendroglioma, a high-grade tumor, which was found as an incidental photopenic lesion on 18F-FP-CIT PET/CT. (Source: C...
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Myocardial Infarction With Nonobstructive Coronary Arteries Assessed by 11C-Acetate Cardiac PET
We present a 63-year-old man with myocardial infarction with nonobstructive coronary arteries due to vasospasm, who underwent 11C-acetate PET after antispastic medication. By quantifying myocardial blood flow and kmono, 11C-acetate PET could detect the initial ischemic insult by vasospasm and sufficient amount of remaining viable myocardium, while excluding significant inducible ischemia. We suggest that 11C-acetate PET can be a clinically valuable tool for assessing the pathophysiology of myocardial infarction with nonobstructive coronary arteries. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Asymptomatic Isolated Vulvar Metastasis in Old Treated Case of Carcinoma Rectum—Diagnosis and Treatment Response Evaluation by 18F-FDG PET/CT Scan
We report a clinically asymptomatic, old treated case of carcinoma rectum, presenting with raised serum carcinoembryonic antigen level, referred for 18F-FDG PET/CT scan for restaging. Whole-body PET/CT scan revealed an isolated FDG-avid lesion in the left labia majora region, which on histopathology was found to be metastasis from carcinoma rectum. Subsequent 18F-FDG PET/CT done after 4 cycles of chemotherapy revealed favorable response to therapy. 18F-FDG PET/CT facilitates the detection of unusual site of metastasis and its subsequent response evaluation in the index case. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

18F-FDG-Labeled Autologous Leukocyte PET-CT in a Patient With Aortic Valve-Tube Graft Infection After Bentall Procedure
Infection of aortic valve-tube graft, although rare, is associated with high morbidity and mortality. Early identification of site and extent of infection is not only challenging but also crucial for adequate patient management and prognostication of disease. Combined clinical, laboratory investigation and imaging modalities assist in the identification of aortic valve graft infection. Molecular imaging techniques like PET/CT using 18F-FDG and 18F-FDG-labeled autologous leukocytes (LALs) have improved the sensitivity for detection of infection, resulting in better outcome for these patients. 18F-FDG-labeled autologous leuk...
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

A Case of Mediastinal Leiomyosarcoma Demonstrated on FDG PET/CT Imaging
A 56-year-old man presented with persisting chest tightness over 1 month. A mediastinal mass was found by chest radiography. To further evaluate the mass, chest CT was performed and the malignancy was suspected. Staging FDG PET/CT demonstrated a hypermetabolic lesion located in the left middle mediastinum without extra-lesion involvement. The lesion pathologically confirmed mediastinal leiomyosarcoma after surgical resection. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Case of Solitary Peritoneal Metastasis From Atypical Bronchopulmonary Carcinoid on 18F-FDG PET/CT
We present a case of a 36-year-old woman with cough, hemoptysis, dyspnea with detection of lung mass, and incidental detection of pelvic mass. Fine needle aspiration cytology failed to reveal the true nature of both the lesions. FDG PET/CT showed intensely avid mediastinal nodes, left lung, and rectouterine masses. Core biopsy from lung mass revealed atypical carcinoid without appreciable uptake on 68Ga-DOTANOC scan. Subsequent postchemotherapy CT scan shows significant regression in lung and peritoneal masses. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Multiple Intravascular Papillary Endothelial Hyperplasia of Bone Mimicking Malignancy on 99mTc-MDP Bone Scan and 18F-FDG PET/CT
In this study, we present the case of a 53-year-old woman having occasional chest pains located in the middle of the sternum and the left chest wall. Multiple intravascular papillary endothelial hyperplasia lesions with high metabolism distributed in the sternum, left ribs, 12th thoracic vertebra, and left ilium on bone scintigraphy as well as PET/CT, which were easily misdiagnosed as bone malignant tumors. Increased awareness of this benign lesion and its high metabolic findings will improve preoperative diagnosis and avoid misinterpretation that may lead to an unnecessary invasive treatment. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

PET/CT and MR Features of Infiltrating Spinal Angiolipoma
Spinal angiolipomas are benign tumors predominantly found in the epidural space. Infiltrating spinal angiolipoma is an extremely rare type, which tends to invade the surrounding tissue and may mimic an aggressive tumor. Herein, we reported the case of a 64-year-old woman with a thoracic angiolipoma involving the T9 vertebral body and its appendix. The lesion showed long T1 and T2 signal intensity on MRI and slightly increased FDG uptake on PET/CT. After surgery, the pathologic examination demonstrated features consistent with angiolipoma, and the patient was free of symptoms. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Diffuse Skeletal Hemangiomatosis Mimicking Metastastic Disease on 18F-FDG PET/CT
We present a case of a 53-year-old man suffering back and proximal right femur pain underwent 18F-FDG PET/CT scan. Multiple hypermetabolic lesions of bone were concerning for metastatic carcinoma. Since no primary malignancy was found, open biopsy was performed and histologic examination led to a diagnosis of diffuse skeletal angiomatosis. This case highlighted the importance of including diffuse skeletal hemangiomatosis in the differential diagnosis of multiple hypermetabolic skeletal lesions on 18F-FDG PET/CT. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Imaging and Treatment of Post–90Y Radioembolization Radiation Dermatitis
90Y microspheres have been widely used for treatment of liver-dominant malignancies. There have been a few case reports of radiation dermatitis post–inadvertent falciform artery 90Y radioembolization and a few retrospective studies with prophylactic coiling or use of ice packs prior to radioembolization. Our patient had inadvertent falciform artery radioembolization, which was not predicted on pretherapy angiography or 99mTc–macroaggregated albumin SPECT/CT but was localized on posttherapy 90Y PET/CT and treated with topical betamethasone valerate 0.1% BD and ice packing immediately postprocedure. He subsequent...
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

SPECT/CT Findings in Scapular Notching After Reverse Shoulder Arthroplasty
We present SPECT/CT findings in 7 cases of symptomatic SN in reverse shoulder arthroplasty patients. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Heterogeneous Uptake of 18F-FDG and 68Ga-PSMA-11 in Hepatocellular Carcinoma
We present the case of an 87-year-old man with a history of melanoma metastatic to the lungs found to have an FDG-negative liver lesion that was initially thought to be benign. Follow-up CT revealed growth of the liver lesion despite excellent response to nivolumab therapy of the pulmonary melanoma metastases. Biopsy of the lesion confirmed primary hepatocellular carcinoma. Follow-up 18F-FDG PET/CT showed minimal FDG uptake, slightly above liver background, and subsequent 68Ga-PSMA-11 PET/MR showed focal, intense uptake of radiotracer in a different region of the tumor. These imaging findings support intratumor metabolic h...
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

18F-Fluciclovine PET/CT Detection of Recurrent Prostate Carcinoma in Patients With Serum PSA ≤ 1 ng/mL After Definitive Primary Treatment
Conclusions Detection of recurrent prostate cancer using 18F-fluciclovine PET/CT is possible in patients with low but rising PSA levels of 1 ng/mL or less. In such patients, local and nodal recurrences are more common than distant metastasis, and Gleason score greater than 7 is associated with positive scan results. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Original Articles Source Type: research

Concordance Between Intracervical and Fundal Injections for Sentinel Node Mapping in Patients With Endometrial Cancer?: A Study Using Intracervical Radiotracer and Fundal Blue Dye Injections
Conclusions Our study shows that lymphatic drainage to the pelvic area from the uterine corpus matches the lymphatic pathways from the cervix, and both intracervical and fundal injections of SN mapping materials go to the same pelvic SNs. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Original Articles Source Type: research

Diffuse Intense Intestinal FDG Activity in a Patient With Familial Adenomatous Polyposis
Familial adenomatous polyposis is a rare autosomal dominant intestinal syndrome with a high rate of malignant transformation. Here, we report a 20-year-old woman with a diagnosis of familial adenomatous polyposis by pathologic examination after colonoscopy biopsy, who underwent an 18F-FDG PET/CT to assess the extent of this disease. The images showed diffuse elevated FDG uptake along the entire colorectum. Additionally, focal enlarged lymph nodes with increased FDG uptake were noted. These findings promoted proctocolectomy and lymphadenectomy. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

FDG PET/CT Findings of a Synovial Sarcoma in a Renal Transplant
A 48-year old man who underwent renal transplantation 2 years ago due to chronic renal failure underwent FDG PET/CT to determine the etiology of multiple lesions in the renal transplant incidentally found on routine examination. The images demonstrated several foci of the abnormally increased activity in the transplanted kidney with SUVmax of 7.5. Surgical pathology demonstrated multiple synovial sarcoma in the transplanted kidney. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Diffuse Bone Metastases in Pancreatic Neuroendocrine Tumor Shown on Octreoscan
A 32-year-old man with a pancreatic neuroendocrine tumor and known liver metastasis presented with diffuse back pain. Workup octreoscan showed newly developed diffuse bone metastases, in addition to the persistent liver metastases. The bone metastases were later confirmed on MRI spine images. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Splenic Hemangioma as a Potential Pitfall on PSMA-Targeted 18F-DCFPyL PET/CT
A 69-year-old man with biochemical recurrence after radical prostatectomy underwent 6 months of androgen deprivation therapy. Upon discontinuation of androgen deprivation therapy, serum prostate-specific antigen rose again to 0.69 ng/mL, and 18F-DCFPyL PET/CT was performed to identify the site of recurrence. However, only an intense focus of uptake in the spleen could be found. Subsequent contrast-enhanced MRI findings were pathognomonic for splenic hemangioma. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Focal Myositis of the Leg Presenting as Fever of Unknown Origin Detected by FDG PET/CT
We present one case of focal myositis involving the left proximal vastus lateralis and vastus intermedius, and left soleus showing intense FDG uptake on FDG PET/CT. This case indicates that focal myositis should be considered as a differential diagnosis in patients with focal hypermetabolic muscular lesions, including benign and malignant tumors, necrotizing autoimmune myopathy, nodular fasciitis, myositis ossificans, and muscular sarcoidosis. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

68Ga-DOTATATE in Benign Prostate Hyperplasia
A 79-year-old man had carcinoid syndrome and bilateral pulmonary nodules, which were biopsy confirmed as well-differentiated neuroendocrine tumor. PET/CT with 68Ga-[DOTA-Tyr3]-octreotate (68Ga-DOTATATE) showed multiple 68Ga-DOTATATE–avid bilateral pulmonary nodules, left hilar lymph node, as well as diffuse increased 68Ga-DOTATATE uptake in the prostate. A review of the history revealed that this patient had elevated prostate-specific antigen level. The prostate biopsy did not reveal evidence of prostate cancer but showed benign prostate hyperplasia. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Colon Visualization on Bone Scan Due to Recto-abscess Fistula From Urinoma
The accumulation of the bone-seeking agent in the bowel during a bone scan is rare. A 68-year-old man with colon cancer underwent bone scintigraphy for staging. Whole-body images revealed an abnormal accumulation of hot radioactivity in the abdominal cavity and the colon. Abdominal CT showed a recto-abscess fistula between the rectum and the urinoma. Incidental visualization of colonic radioactivity suggested the presence of a fistula between the bowel and the urinoma, explaining the peculiar finding of the bone-seeking agent in the bowel. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

A Nodular Lesion of the Foot Detected by 18F-FDG PET/CT in Mycosis Fungoides: A Plantar Wart
A 34-year-old Japanese woman presented with widespread scaly erythema that had enlarged over 2 years. A skin biopsy revealed the diagnosis of mycosis fungoides (patch stage, T1b N0 M0 B0), a most frequent cutaneous T-cell lymphoma. 18F-FDG PET/CT scan unexpectedly showed intense uptake on the left sole, which suggested a tumorous mycosis fungoides lesion (SUVmax = 6.2). Careful examination revealed the mass to be a typical plantar wart of 2 cm in diameter that the patient had not recognized. With repeated cryotherapy, the wart disappeared in 6 months, and follow-up 18F-FDG PET/CT showed no abnormal uptake on the left sole....
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Parapharyngeal Ganglioneuroma Detected by 18F-FDG PET/CT in a Patient With Hodgkin Lymphoma
A 38-year-old woman with anterior mediastinal Hodgkin lymphoma underwent 18F-FDG PET/CT, revealing abnormal uptake at the left retrostyloid parapharyngeal space. After chemotherapy, follow-up PET/CT showed regression of previously avid lesions but not the left retropharyngeal mass. Subsequent MRI revealed findings suggestive of neurogenic tumor. Transoral biopsy revealed ganglioneuroma, which is uncommon in the parapharyngeal space, although usually of benign nature. This case therefore highlights the importance of PET/CT in both initial diagnostic screening for tumor development and posttreatment evaluation of ambiguous l...
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

68Ga-DOTANOC PET/CT Detects Multifocal Hepatocellular Carcinoma
68Ga-DOTANOC PET/CT confirmed somatostatin receptor (SR) expression in hypervascularized liver lesions suggestive of neuroendocrine tumor that was later diagnosed as hepatocellular carcinoma (HCC). Being highly vascularized on CT, HCC lesions may mimic neuroendocrine tumors. Although HCC is not included among current indications for SR-PET/CT imaging, it may represent a pitfall in image interpretation when studying neuroendocrine tumor patients. Further studies are needed to better ascertain the potential diagnostic role of SR-imaging in HCC. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

A Rare Case of Neutrophil-Rich, ALK-Negative Anaplastic Large Cell Lymphoma in the Lung Mimicking a Pulmonary Abscess on 18F-FDG PET/CT
A 21-year-old man complained of cough, fever, and hemoptysis for 15 days. Peripheral neutrophil cell (33.8 × 109/L) was markedly increased, and a mass in the left lung was detected by chest radiography. 18F-FDG PET/CT was referred for characterizing the lesion and found a large mass with multiple cavities in the left lung, which had markedly high uptake of 18F-FDG, mimicking pulmonary abscess. Surprisingly, the lesion was eventually proved to be neutrophil-rich anaplastic large cell lymphoma. After 4 cycles' chemotherapy, the lesion shrank significantly. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Primary Common Iliac Artery Angiosarcoma With Multiple Bone Metastases Revealed by Dual-Time Point FDG PET/CT Imaging
Iliac artery angiosarcoma is rare, and bone metastasis as its presenting initial symptom is extremely rare. A 67-year-old man with a history of low back pain presented with multiple MRI-identified lumbar and sacrum lesions highly suggestive of bone metastasis. On subsequent PET/CT scan, in addition to multiple vertebrae and pelvis hypermetabolism, a lesion with intense focal uptake was discovered within the lumen of left common iliac artery. Dual-time point quantitative analysis revealed that the lesion-to-liver ratio of SUVmax was significantly increased in the delayed phase. Biopsy confirmed the lesion as a primary iliac...
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Hepatoblastoma Mimicking Hemangioma in Labeled Red Blood Cell Scintigraphy
We report an additional case that presented in a 15-month-old boy with hepatoblastoma showing increased labeled RBC activity mimicking hemangioma. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Whole-Body Staging of Metastatic Atypical Meningioma Using 68Ga-DOTATATE PET/CT
A 43-year-old woman with suspected recurrence of atypical meningioma World Health Organization grade II presented extensive intracranial lesions with high 68Ga-DOTATATE uptake. Moreover, numerous 68Ga-DOTATATE–positive bone, lung, and liver lesions were seen. For final diagnosis, biopsies taken from a lung lesion revealed distant metastases of the atypical meningioma. This case underlines the high diagnostic power of 68Ga-DOTATATE PET/CT for the staging of meningioma even beyond cerebral or spinal lesions; in case of distant lesions in patients with known meningioma, differential diagnosis should also contain metasta...
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Delayed Response (Partial Remission) 3 Years After Peptide Receptor Radionuclide Therapy in a Patient Participating in the NETTER-1 Trial
We report here delayed response of a midgut neuroendocrine neoplasm patient, who had stable disease after 4 cycles of PRRT and over a long period of 5 restaging admissions with excellent quality of life (full working hours), persisting for 3 years of follow-up, and presented as further partial remission according to both Response Evaluation Criteria in Solid Tumors and EORTC criteria, respectively, 36 months after the last PRRT cycle. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Quality and Safety in Health Care, Part XLV: Introduction to Burnout
Burnout not only is a serious problem for physicians, but it also adversely affects the quality and safety of health care for the patients they care for. A doctor with burnout may commit more errors, exhibit unprofessional behavior and a callous attitude to others, have diminished productivity, and cause other problems for the health care system. Furthermore, the percentage of doctors who experience at least 1 symptom of burnout is increasing. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: From the American College of Nuclear Medicine Source Type: research

Hybrid 11C-MET PET/MRI Combined With “Machine Learning” in Glioma Diagnosis According to the Revised Glioma WHO Classification 2016
Conclusions MET-PET/MRI imaging in pre-operatively classifying glioma entities appears useful for the assessment of IDH status. However, a larger trial is needed prior to translation into the clinical routine. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Original Articles Source Type: research

99mTc-HYNIC-TOC in the Evaluation of Recurrent Tumor-Induced Osteomalacia
Conclusions The efficacy of 99mTc-HYNIC-TOC imaging in the evaluation of patients with potential recurrent TIO is compatible to that with new patients who never received surgical resection for the culprit tumors. It can play an important role in known TIO patients who were suspected to have recurrent disease. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Original Articles Source Type: research

18F-FDG PET/CT for Prognostic Stratification of Patients With Extranodal Natural Killer/T-Cell Lymphoma
Conclusions Interim PET/CT scan displayed potential predictive value for ENKTL patients. Response assessment according to the Deauville 5-point scale may help to improve the accuracy of prediction. Patients with advanced stage (III/IV), elevated LDH or β2-MG, and a high Deauville score of 4 to 5 on the interim PET/CT scan were more likely to have reduced PFS and OS. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Original Articles Source Type: research

Diagnostic Accuracy of 18F-FDG PET/CT in Patients With Biochemical Evidence of Recurrent, Residual, or Metastatic Medullary Thyroid Carcinoma
Objective Medullary thyroid carcinoma (MTC) is a rare malignancy. Location of residual, recurrent, or metastatic disease is crucial to treatment management and outcome. We aimed to evaluate the use of 18F-FDG PET/CT in localizing MTC foci in patients with biochemical relapse. Methods This is a retrospective cohort study. Review of 51 FDG PET/CT studies of 45 patients referred to restage MTC due to increased calcitonin (Ctn) and carcinoembryonic antigen (CEA) values at follow-up. FDG PET/CT diagnostic accuracy was determined through a patient-based analysis, using histology as criterion standard when available, or othe...
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Original Articles Source Type: research

Comparisons Between PET With 11C-Methyl-L-Methionine and Arterial Spin Labeling Perfusion Imaging in Recurrent Glioblastomas Treated With Bevacizumab
Conclusions Blood flows on ASL correlated with accumulations of 11C-met on PET in recurrent glioblastoma under BEV treatment. Although 11C-met-PET offered superior accuracy for predicting patients with long PFS from time points, ASL offered reliable prediction of long PFS, provided that fluctuations in T/N ratio between consecutive scans are assessed. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Original Articles Source Type: research

The New Possibility of Lymphoscintigraphy to Guide a Clinical Treatment for Lymphedema in Patient With Breast Cancer
Conclusion SGB was found to have a better therapeutic effect in the lymphedema patients with specific lymphoscintigraphic findings compared with CDT. Lymphoscintigraphy may be helpful in selecting the appropriate approach to lymphedema treatment. Further well-designed prospective studies are warranted to validate the findings of this study. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - February 7, 2019 Category: Nuclear Medicine Tags: Original Articles Source Type: research

Subacute Venous Infarct Mimicking Cerebral Metastasis in 18F-FDG PET/CT
A 68-year-old woman with colon carcinoma was referred to 18F-FDG PET/CT imaging for staging. In addition to primary tumor involvement, PET/CT demonstrated focal FDG uptake in the right temporal lobe suggestive of primary brain tumor or metastasis. To delineate the lesion, a brain MRI scan showed sigmoid sinus thrombosis and vasogenic edema in the right temporal lobe. The patient presented a history of right-sided headache that began 1 week before the PET/CT. Neurological examination and MRI findings were concluded as subacute venous infarct due to sigmoid sinus thrombosis and that is a potential cause for false-positive FD...
Source: Clinical Nuclear Medicine - January 9, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Juvenile Nasal Angiofibroma on 68Ga-PSMA PET/CT: Opening New Frontiers
The prostate-specific membrane antigen (PSMA) is highly expressed in prostatic cancer. However, PSMA expression is also noted in various benign and malignant nonprostatic neoplasms in the endothelial cells of tumor-associated neovasculature. We performed 68Ga-PSMA PET/CT in a 14-year-old boy with juvenile nasal angiofibroma (JNA) to explore its theranostic potential. The scan revealed high uptake in the lesion. Performance of PSMA PET/CT in JNA opens up new frontiers with respect to radiological staging, early recurrence identification, and perhaps even radioligand therapy of residual/recurrent JNAs in the future. (Source:...
Source: Clinical Nuclear Medicine - January 9, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Pleural Mesothelioma Detects by 18F-Choline PET/CT in a Patient With Biochemical Recurrence of Prostate Cancer
A 73-year-old man with a prostate cancer treated by radical prostatectomy in 2006. For a biochemical recurrence of disease (prostate-specific antigen level, 0.1 ng/mL) during hormonal therapy, patient underwent 18F-choline PET/CT that showed a significant uptake in a diffuse right pleural thickening. The patient was sent to pleurectomy decortication showing an epithelioid pleural mesothelioma. This case highlighted that a histopathological evaluation is mandatory in case of a significant radiolabeled choline uptake in pleural lesions. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Increased Muscular MDP Activity in the Lower Extremities Caused by Multiple Arterial Thromboses
Many reasons could lead to abnormal increased extraosseous tracer uptake on 99mTc-MDP bone scintigraphy. A 75-year-old man was referred a bone scintigraphy to evaluate his chest pain. The images revealed rib fractures. In addition, increased MDP activity in the muscle of the lower extremities was noted. The abnormal increased uptake in the muscles was likely related to the arterial thromboses revealed by vascular ultrasonography. The patient received interventional embolectomy. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Head and Neck Cancer Soft Tissue Radiation Necrosis—Diagnostic Challenge
A 53-year-old man with T4aN2cM0 tongue base squamous cell carcinoma received definitive chemoradiation. FDG PET/CT at 6 weeks showed partial metabolic response with soft tissue air indicating radiation necrosis at primary site and complete response in the neck. At 9 weeks, contrasted CT showed worsening but nonenhancing ulceration, area biopsied demonstrating a minute carcinoma focus with treatment effect. At 12 weeks, PET/CT showed increased primary site uptake interpreted as disease progression; however, no viable tumor was found at salvage surgery. Because nonenhancing ulceration predicts pure radiation necrosis with no...
Source: Clinical Nuclear Medicine - January 9, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Gallbladder Metastasis From Conjunctival Melanoma
Malignant conjunctival melanoma is a rare tumor. A 46-year-old woman with a history of locally recurrent left conjunctival melanoma was followed by 18F-FDG PET/CT. Four years after the local recurrence treated by orbital exenteration, the follow-up PET/CT scan showed an incidental intense FDG uptake mass infiltrating the gallbladder associated with a low uptake of an infracentimetric pulmonary nodule. The patient was completely asymptomatic with no sign of local recurrence. Laparoscopic cholecystectomy was performed, and histopathologic findings were consistent with gallbladder metastasis of melanoma. After almost 2 years ...
Source: Clinical Nuclear Medicine - January 9, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Chronic Vasitis After Mesh Herniorrhaphy: A Potential Cause of False Positive Results in 18F-FDG PET/CT Studies
We report two cases of supra-scrotal vasitis incidentally detected in patients who had undergone mesh herniorrhaphy. PET/CT in patients undergoing lymphoma work-up and health check-up revealed hypermetabolic dilatation of vas deferens in the external iliac area. There were no symptoms, and blood test results did not indicate acute inflammation. Interestingly, both had undergone herniorrhaphy for inguinal hernia. Herniorrhaphy is reported to cause vasal complications such as obstruction or inflammation, although most are asymptomatic and probably under-reported. Chronic vasitis after herniorrhaphy may be a potential cause f...
Source: Clinical Nuclear Medicine - January 9, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Incidental Finding of Intrathyroid Metastases of Prostatic Cancer on 18F-Choline PET/CT
An 85-year-old man with a 2-year history of prostate cancer, treated with radiotherapy and hormonal therapy, presented increased prostatic-specific antigen levels. 18F-choline PET/CT showed focal prostatic uptake consistent with known local recurrence, increased uptake of 2 hypodense thyroid nodules and of 2 left cervical lymph nodes, suspected as thyroid cancer. Neck ultrasound confirmed the high risk of malignancy, and a guided biopsy (of a thyroid nodule and cervical lymph node) revealed cellular infiltrates thyroid transcription factor-1 (TTF-1) negative and prostatic-specific antigen positive, confirming intrathyroid ...
Source: Clinical Nuclear Medicine - January 9, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

A Case of Tophaceous Pseudogout on 18F-FDG PET/CT Imaging
A 53-year-old man with a 10-year history of gout was admitted to our hospital due to chronic low back pain. Initial CT examinations showed a high-density mass with bone destruction of bilateral facet joints at the L3 to L5 level. MRI findings also revealed lesion with the dural sac compression. On PET/CT, the juxta-articular mass of bilateral L3 to L5 facet joints showed abnormal FDG uptake with an SUVmax of 4.2. The possible diagnosis may be gouty tophi; however, the biopsy revealed the diagnosis of calcium pyrophosphate dihydrate deposition disease, also referred to as pseudogout. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

18F-Choline PET/CT in Leptomeningeal Breast Cancer Metastases
We describe a case of 47-year-old woman affected by human epidermal growth factor receptor-2–positive breast cancer with a diffuse leptomeningeal carcinomatosis. An intense uptake of 18F-choline was reported at fused PET/MRI images in the brain, compatible with a diffuse leptomeningeal disease. This case highlights that 18F-choline PET would be used for the identification of leptomeningeal involvement in patients affected by breast cancer, as a support of MRI images. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Two Cases of 188Re Microspheres for Inoperable Hepatocellular Carcinoma
We report 2 inoperable cases of HCC treated with therapeutic dose of indigenously developed 188Re microspheres delivered to the hepatic lesions by transarterial catheterization. Follow-up CT revealed necrosis within the lesion, suggesting response to selective internal radionuclide therapy. 188Re microspheres may be a potential treatment option for inoperable HCC with or without portal vein thrombosis. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

68Ga–Prostate-Specific Membrane Antigen PET/CT: Incidental Finding of a Liposarcoma
This case highlights that liposarcoma shows 68Ga–prostate-specific membrane antigen avidity and should be included in the differential diagnosis of patients with avid muscle lesions to avoid an incorrect diagnosis of metastasis. (Source: Clinical Nuclear Medicine)
Source: Clinical Nuclear Medicine - January 9, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research

Richter Syndrome Presenting With Colon Localization
A 75-year-old man, who had been diagnosed with small lymphocytic lymphoma with cervical localization, underwent 18F-FDG PET/CT with iodinated contrast medium due to the appearance of cervical swelling suspected of illness relapse. PET/CT revealed intense 18F-FDG uptake in multiple cervical and subdiaphragmatic lymph nodes and in the left parotid. Moreover, diffuse uptake and wall thickening of the colon were evident; endoscopy with biopsy revealed a diffuse large B-cell lymphoma. Transformation into a more aggressive lymphoma occurs in 2% to 8% of small lymphocytic lymphoma, the so-called Richter syndrome. Extranodal local...
Source: Clinical Nuclear Medicine - January 9, 2019 Category: Nuclear Medicine Tags: Interesting Images Source Type: research