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Clinical Nuclear Medicine

Michael T Caton, Nityanand Miskin, Hyewon Hyun
A 62-year-old man with human immunodeficiency virus (HIV) on long-standing highly active antiretroviral therapy presented for F-FDG PET/CT evaluation of a pulmonary nodule. The examination showed unusual radiotracer distribution accumulating in the subcutaneous and visceral fat with low cerebral and skeletal muscle uptake. Imaging features were consistent with HIV-associated lipodystrophy, an unsuspected diagnosis that was later confirmed on physical examination. Recognition of HIV-associated lipodystrophy by the nuclear medicine physician is critical as altered biodistribution may affect diagnostic yield or be mistaken for infectious pathology...
October 15, 2018: Clinical Nuclear Medicine
Kianoush Ansari-Gilani, Navid Faraji, Robert C Gilkeson
Lipoid pneumonia is uncommon disease caused by presence of macroscopic fat in the lung parenchyma commonly originating from exogenous source secondary to aspiration or inhalation of animal fats or mineral or vegetable oils. Alternatively, it can be due to endogenous fat accumulated in the alveoli in the setting of chronic bronchial obstruction or inflammation. The imaging findings include ground-glass opacities, consolidation, nodules, and masses. Presence of macroscopic fat on CT is helpful; however it might not always be present...
October 15, 2018: Clinical Nuclear Medicine
Ying Kan, Yu Wang, Wei Wang, Jie Liu, Jigang Yang
Diffuse large B-cell lymphoma (DLBCL) was the most frequent subtype of lymphoid malignancy. Corpus callosum involvement of DLBCL was rarely reported. We present a case of DLBCL involving not only lymph nodes and bowels but also corpus callosum, detected by FDG PET/CT in a patient without neurological symptoms. After 4 cycles of systemic and intrathecal chemotherapy, all previously visualized abnormal activity disappeared on the follow-up FDG PET/CT.
October 15, 2018: Clinical Nuclear Medicine
Sophie Bourgeois, Anja Van den Eeckhaut, Frank De Geeter
We describe the F-FDG PET/CT findings in a rare case of mesenteric panniculitis caused by systemic lupus. A previous CT had raised suspicion of a space-occupying lesion in the left hypochondrium in a context of aspecific constitutional symptoms and inflammatory parameters. The diagnosis of panniculitis was confirmed at laparoscopic biopsy directed by the PET findings. Follow-up F-FDG PET/CT after 1 month of corticosteroid therapy showed complete disappearance of the abdominal hypermetabolic foci.
October 15, 2018: Clinical Nuclear Medicine
Bital Savir-Baruch, Kevin P Banks, Jonathan E McConathy, Olga P Molchanova-Cook, Ephraim E Parent, Amol Takalkar, Mark Tulchinsky, Jian Q Yu, Rathan M Subramaniam, David M Schuster
The American College of Radiology (ACR) and American College of Nuclear Medicine (ACNM) collaborated to develop a clinical practice document for the performance of fluciclovine positron-emission tomography (PET) / computed tomography (CT) in the evaluation of patients with suspected prostate cancer recurrence based on the elevation of prostate-specific antigen (PSA) level (biochemical recurrence) after prior therapy. Prostate cancer is the third leading cause of cancer death in the United States. Up to 50% of patients diagnosed with prostate cancer will develop biochemical failure after initial therapy...
October 15, 2018: Clinical Nuclear Medicine
Guohua Shen, Minggang Su, Bin Liu, Anren Kuang
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...
October 15, 2018: Clinical Nuclear Medicine
Ana María García Vicente, Angel Soriano Castrejón
No abstract text is available yet for this article.
October 15, 2018: Clinical Nuclear Medicine
Jun Zhang
A 56-year-old woman with secondary hyperparathyroidism was referred for preoperative localization of hyperfunctioning parathyroid lesions. Tc-MIBI dual-phase and SPECT/CT parathyroid scan showed multiple focal activities behind the thyroid and in the anterior mediastinum, diagnosed as parathyroid hyperplasia. However, the histopathological findings proved them to be hyperplastic parathyroid glands and remnant thymic tissue after parathyroidectomy and unnecessary thoracotomy, respectively.
October 15, 2018: Clinical Nuclear Medicine
Paula Fernández-Rodríguez, Juan José Martín-Marcuartu, Jose Manuel Jiménez-Hoyuela
We present a 44-year-old woman with scapular and pelvic muscle weakness, joint inflammation, and fever. Bone scintigraphy showed high uptake in proximal regions of upper and lower limbs, suspecting inflammatory myopathy and polyarticular damage. These features were the clue to request other complementary tests such as anti-aminoacyl-tRNA-synthetase antibodies and chest CT, which showed interstitial lung disease, defining an antisynthetase syndrome. Therefore, BS allows an earlier diagnosis of inflammatory muscle disease and to identify the optimal site for muscle biopsy...
October 15, 2018: Clinical Nuclear Medicine
William Y Raynor, Abdullah Al-Zaghal, Thomas J Werner, Poul F Høilund-Carlsen, Abass Alavi
Primary prostatic calculi commonly present asymptomatically in men over the age of 50 years. Individual calculi form when the secretory tube is blocked by inflammation, prostatic secretions, or corpora amylacea. Although small prostatic calculi have been described as a component of normal aging, increased prevalence of calculi has been associated with benign prostatic hyperplasia and prostatitis. We are presenting prostatic calcification in a 69-year-old man as incidentally detected on F-NaF PET/CT. Although previous publications have reported F-NaF uptake portraying calcification in soft tissue, these findings demonstrate a new domain in which to assess calcium metabolism using F-NaF PET/CT...
October 15, 2018: Clinical Nuclear Medicine
Melissa Cindy Kong, Helen Ruth Nadel
A 15-year-old boy with autism and swallowing dysfunction presented with a 6-month history of fatigue, intermittent abdominal pain, and weight loss. He later became febrile and had multiple episodes of coffee ground emesis and melena stools. An upper endoscopy showed an esophageal mass, and a subsequent F-FDG PET/CT scan confirmed this finding. PET/CT also revealed metastatic disease in local lymph nodes, thus upstaging the patient and indicating poor prognosis. Consideration of these severe results and the patient's quality of life helped guide decision making in patient management, with the ultimate decision to pursue palliative care...
October 15, 2018: Clinical Nuclear Medicine
Emine Acar, Gamze Çapa Kaya
Prostate large cell neuroendocrine tumor is a rare disease. In this case, metastatic areas showing FDG uptake, somatostatin receptor positivity, and PSMA expression are shown in F-FDG PET/CT, Ga-DOTATATE PET/CT, and Ga-PSMA PET/CT in a 70-year-old man with the diagnosis of prostate large cell neuroendocrine carcinoma.
October 15, 2018: Clinical Nuclear Medicine
Andrew John Bosserman, Dong Dai, Yang Lu
A 65-year-old man with a history of hypertension and nephrolithiasis presented with flank pain. Urographic CT demonstrated a 1.7-cm nodule arising from the bladder wall. The patient was referred for cystourethroscopy. During the procedure, the patient became hypertensive while under general anesthesia. No biopsy or resection was performed. To work up for possible bladder paraganglioma, a I-MIBG scan was ordered, and the patient was referred to endocrinology. On SPECT/CT images, the bladder nodule demonstrates marked uptake of MIBG radiotracer, confirming the diagnosis of a genitourinary paraganglioma arising from the bladder wall...
October 15, 2018: Clinical Nuclear Medicine
Vanshika Gupta, Ritu Verma, Ethel Belho, Nikhil Seniaray
A 3-year-old boy presented with intermittent abdominal pain, melena, and anemia since 2 months. Upper gastrointestinal endoscopy did not reveal any significant abnormality. The child was then referred for Tc-pertechnetate scan to rule out the presence of ectopic functioning gastric mucosa. Tc-pertechnetate scan revealed abnormal tracer accumulation in the thoracic region, which persisted in the delayed images, suspicious for being ectopic gastric mucosa. Subsequently, ultrasound and contrast-enhanced CT (CECT) scans of the chest revealed a large multiseptate cystic lesion in the retrocardiac region, corresponding to the site of increased tracer uptake on Tc-pertechnetate scan...
October 15, 2018: Clinical Nuclear Medicine
Kousik Vankadari, Bhagwant Rai Mittal, Rajender Kumar, Harmandeep Singh, Anish Bhattacharya, Radha Krishan Dhiman
We present a case of decompensated liver cirrhosis with ascites, which had history of asterixis, impaired balance with swaying gait along with mild irritability since 1 month. F-fluorodeoxyglucose PET/CT (FDG-PET/CT) performed to rule out malignancy did not reveal any abnormal FDG avid lesion suspicious for malignancy but showed hypermetabolism in the bilateral basal ganglia and thalamus with reduced metabolism in cerebral cortices and cerebellum, suggesting hepatic encephalopathy.
October 15, 2018: Clinical Nuclear Medicine
Diego Alfonso López Mora, Frederic Sampedro, Valle Camacho, Alejandro Fernández, Francisco Fuentes, Joan Duch, Jesús Pérez-Perez, Saül Martínez-Horta, Juan Marín-Lahoz, Anna Domènech, Albert Flotats, Montserrat Estorch, Jaime Kulisevsky, Ignasi Carrió
OBJECTIVE: Normalization to an appropriate reference region in F-FDG PET imaging may enhance diagnostic performance in Huntington disease (HD). We aimed to identify stable brain areas that could be used to model neurometabolic degeneration in HD correlating imaging (SUVrvalues at the basal ganglia [BBGG]) and clinical parameters (disease burden score [DBS]). MATERIALS AND METHODS: We performed brain F-FDG PET/CT in 38 manifest HD patients (meanage ± SD, 54 ± 14...
October 15, 2018: Clinical Nuclear Medicine
Lars Stegger, Kambiz Rahbar, Christoph Schülke, Sebastian Huss, Christian Wenning
PET using the radiotracer F-fluorodeoxyglucose (FDG) was performed in a patient who presented with elevated thyroglobulin (Tg) levels several years after initial therapy of follicular thyroid carcinoma (oncocytic variant) and in whom high-dose radioiodine (I) failed to locate recurrent tumor or to decrease Tg levels. A focal fluorodeoxyglucose uptake in the apical septum of the heart did not have a discernible correlate in echocardiography or MRI for more than 12 months. Finally, a metastasis of the follicular thyroid carcinoma with partly squamous cell differentiation was confirmed and treated by resection and stereotactic body radiotherapy...
October 15, 2018: Clinical Nuclear Medicine
Jingnan Wang, Yiwei Zhang, Heyang Sun, Ruixue Cui
A 41-year-old man had a right frontal grade I glioma resection 17 years ago. He was tumor free since. However, 1 month ago, he presented with an uncontrollable seizure, which raised the possibility of recurrent tumor. The FDG PET/CT brain scan showed increased tracer uptake at the margin of the previous resected tumor, suggesting the possibility of tumor recurrence. However, on a repeat FDG PET brain scan confirmed by electroencephalography monitory as an interictal study, no elevated FDG uptake was revealed at this site...
October 8, 2018: Clinical Nuclear Medicine
Sebastian Hoberück, Enrico Michler, Danilo Seppelt, Jörg Kotzerke, Claudia Brogsitter
A 68-year-old woman who underwent a thyroidectomy for bilateral goiter 20 years ago was referred to our department. The examination revealed a newly occurred thyroid nodule in the right central lobe. Unexpectedly the Tc-pertechnetate scan revealed several extrathyroidal foci right-sided supraclavicular, beside a cold thyroid nodule in the right lower lobe. Consecutive surgery and histology confirmed the suspected diagnosis of follicular thyroid cancer with multiple bone metastases. Whole-body scintigraphy performed after the following radioiodine therapy indicated disseminated osseous metastases...
October 8, 2018: Clinical Nuclear Medicine
Jay A Harolds
The ability to come back from challenges such as the many factors predisposing to burnout is resilience. Individual strategies to prevent and recover from burnout can be learned and practiced. This includes mindfulness, meditation, yoga, various stress reduction techniques, coaching, counseling, mentoring, discussions in small groups, workshops, and better work life balance. Other approaches include building a support network, taking care of one's personal health, pursuing narrative medicine, engaging in reflection, emphasizing positive psychology approaches including learned optimism, encouraging a growth mindset, and volunteering...
October 8, 2018: Clinical Nuclear Medicine
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