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Clinical Nuclear Medicine

Sebastian Hoberück, Enrico Michler, Daniel Kaiser, Anne Röhnert, Klaus Zöphel, Jörg Kotzerke
A 79-year old man with prostate cancer under active surveillance for 5 years was referred for a PSMA-PET/MRI for re-evaluation because of a rising prostate-specific antigen value. PET/MRI revealed a ribbonlike tracer accumulation in a healing fracture of the distal radius. This case illustrates that PSMA expression may occur in healing bone fractures in the distal radius. It can be assumed that benign causes of tracer accumulations in the upper extremities are missed in PET/CT due to elevated position of the arms during image acquisition...
June 12, 2018: Clinical Nuclear Medicine
Manjiri Karlekar, Sanjeet Kumar, Swati Jadhav, Anurag Lila, Tushar Bandgar, Nalini Shah
Sellar and suprasellar paragangliomas are rare. We report the case of a 19-year-old man with sellar paraganglioma with parasellar and posterior pontine extension, requiring multiple transcranial surgeries and radiotherapy. The lesion was avid on Ga DOTANOC PET-CT scan substantiating its neuroendocrine nature.
June 12, 2018: Clinical Nuclear Medicine
Salvatore Annunziata, Annarosa Cuccaro, Alessio Rizzo, Silvia Chiesa, Francesco DʼAlò
A 57-year-old man had a diagnosis of a bronchial mucosa-associated lymphoid tissue lymphoma in the left lung and monoclonal gammopathy. The patient underwent whole-body C-methionine PET/CT, in order to evaluate the amino acid avidity of the lesion and to stage the bronchial mucosa-associated lymphoid tissue lymphoma. C-methionine uptake was detected in the lung lesion and in the mediastinal lymph nodes.
June 12, 2018: Clinical Nuclear Medicine
Zhanli Fu, Meng Liu, Xueqi Chen, Xing Yang, Qian Li
An F-FDG PET/CT was performed on a 43-year-old woman with photosensitive skin rash, abnormal liver function, and pancytopenia, which demonstrated prominent hepatomegaly, splenomegaly, and diffuse liver F-FDG avidity. The liver biopsy revealed intrahepatic cholestasis with biliary fibrosis resulting from the deposition of protoporphyrin. X-linked erythroid-specific 5-aminolevulinate synthase gene analysis proved the diagnosis of X-linked protoporphyria.
June 12, 2018: Clinical Nuclear Medicine
Priyanka Verma, Gaurav Malhotra, Ritesh Agrawal, Sunita Sonavane, Vilas Meshram, Ramesh V Asopa
PURPOSE OF THE REPORT: Prostate-specific membrane antigen (PSMA) overexpression is not restricted to prostate cancer, but it has also been demonstrated in gliomas, lung cancer, and in tumor neovasculature. Systematic studies exploring PSMA uptake in thyroid tumors are lacking. The aim of this pilot study was to assess PSMA expression in patients with metastatic differentiated thyroid cancer (mDTC). MATERIALS AND METHODS: Ten patients of mDTC harboring 32 lesions (5 men; age range, 38-65 years; mean age, 50 years) underwent prospective evaluation with radioiodine (I), F-FDG PET, and Ga-PSMA-HBED-CC PET scans as per the institution protocol...
June 12, 2018: Clinical Nuclear Medicine
Paulo Schiavom Duarte, José Flávio Gomes Marin, José Willegaignon De Amorim De Carvalho, Marcelo Tatit Sapienza, Carlos Alberto Buchpiguel
We report a case of a medullary thyroid carcinoma noncalcified brain metastasis characterized on Ga-dotatate PET/CT but not on an F-fluoride PET/CT performed 1 month later. Subsequent F-fluoride PET/CT studies performed 7 and 19 months after the Ga-dotatate PET/CT study demonstrated focal uptake in the metastasis. The CT images of the last PET/CT study also depicted a small focus of calcification beginning in the metastatic site.
June 12, 2018: Clinical Nuclear Medicine
Abdullah Al-Zaghal, Thomas J Werner, Poul F Høilund-Carlsen, Abass Alavi
Tracheobronchial calcifications are common in adults and considered as a physiological process of aging with no clinical significance in otherwise asymptomatic, healthy individuals. We are presenting a case of tracheobronchial tree calcifications as detected on F-NaF PET/CT in a 75-year-old woman. Many previous publications have reported the accumulation of NaF in extraosseous organs; these observations further set new directions in the evaluation of the metabolic activity of macrocalcification and microcalcification using molecular imaging probes...
June 12, 2018: Clinical Nuclear Medicine
Ana María García Vicente, Julian Perez-Beteta, Manuel Calvo García, Maikal Villena Martín, Angel Soriano Castrejón
Defining high-grade glioma resectability is a challenge; and currently, it is based on anatomical imaging. However, complete removal of contrast-enhancing tumor is difficult to define in MRI. We present three cases of patients diagnosed with high-grade glioma. Brain MRI and F-fluorocholine PET/CT were performed before and after surgery to establish the extent of resection (EOR) and residual volume. Postoperative brain MRI and PET parameters showed discordant results in all the reported cases. PET was able to assess properly the EOR; however, the rules for the EOR establishment and its prognostic implication should be validated in prospective studies...
June 12, 2018: Clinical Nuclear Medicine
Wei Ying Tham, Yee-Liang Thian, Pavanni Ratnagopal, Wanying Xie
A 57-year-old woman presented with a 3-month history of cognitive impairment, daytime somnolence, and violent sleep behavior. Her first- and second-degree relatives had similar symptoms prior to their premature deaths. Her MRI scan of the brain showed no significant abnormality. Electroencephalogram showed loss of slow-wave activity. Functional brain imaging performed with F-FDG PET was fused with her MRI scans. This demonstrated profound hypometabolism in bilateral thalami and the posterior cingulate cortex, which is pathognomonic for familial fatal insomnia...
June 5, 2018: Clinical Nuclear Medicine
Seo-Yeon Ahn, Seong Young Kwon, Sung-Hoon Jung, Jae-Sook Ahn, Su Woong Yoo, Jung-Joon Min, Hee-Seung Bom, So Yeon Ki, Hyeoung-Joon Kim, Je-Jung Lee, Sang Yun Song, Deok-Hwan Yang
PURPOSE: Primary central nervous system lymphoma (PCNSL) has a poor prognosis. There has been limited study evaluating the role of interim PET/CT in PCNSL. This prospective study investigated the interim response using sequential brain PET/CT with C-methionine (C-MET) to provide prognostic information during the treatment of PCNSL. MATERIALS AND METHODS: A total of 26 immunocompetent patients recently diagnosed with PCNSL were evaluated. Brain MRI and C-MET PET/CT were performed at the time of diagnosis and after 4 cycles of high-dose methotrexate-based induction chemotherapy...
June 5, 2018: Clinical Nuclear Medicine
Ashwin Singh Parihar, Shelvin Kumar Vadi, Rajender Kumar, Bhagwant Rai Mittal, Harmandeep Singh, Amanjit Bal, Rama Walia, Jaya Shukla, Saroj Kumar Sinha
Insulinomas are the most common functioning pancreatic neuroendocrine tumors and the leading cause of persistent hypoglycemia with hyperinsulinemia in adults. Glucagon-like-peptide-1 (GLP) receptor analogs are the latest agents being used in the detection of insulinomas, with initial reports suggesting high sensitivity due to universal GLP1 receptor expression on these tumors. PET/CT imaging in this patient using Ga DOTA-Exendin, a GLP receptor analog, proved useful for accurate localization of the culprit lesion, aiding in the definitive management of the patient...
June 5, 2018: Clinical Nuclear Medicine
John J Manov, Alexander Diaz-Bode, Russ Kuker
A 66-year old woman had a left breast mass. Biopsy showed invasive ductal carcinoma. A PET/CT scan demonstrated hypermetabolism in the left breast and atypical heterogeneously increased uptake throughout the skeleton as well as a minimally FDG-avid right adrenal myelolipoma. PET/CT 4 months later after 6 cycles of neoadjuvant chemotherapy demonstrated increased size and FDG avidity of this adrenal mass concerning for metastasis and uniformly increased skeletal FDG avidity. Biopsy demonstrated adrenal myelolipoma...
June 5, 2018: Clinical Nuclear Medicine
Sonia Mahajan, Reema Goel, Christopher Riedl, Gary A Ulaner
Mazabraud's, a syndrome consisting of fibrous dysplasia and soft tissue myxomas, is a rare disorder with less than 100 cases reported in the literature. Appearance of lesions in Mazabraud's syndrome on FDG PET/CT scan in an oncological scenario can be misinterpreted as malignancy. We present the case of a 69-year-old woman, diagnosed with metastatic colon carcinoma and suspected osseous as well as soft tissue metastases, who was later found to have concomitant Mazabraud's syndrome. This case describes the diagnostic dilemma associated with this unusual entity and importance of differentiating benign and malignant etiologies on FDG PET/CT scan...
May 31, 2018: Clinical Nuclear Medicine
Yi Li, Xiaoping Xu, Junyan Xu, Dan Huang
Follicular dendritic cell sarcoma is a very rare neoplasm, which is not lymphoma, but originates from a type of immune cells called follicular dendritic cells. We presented a 37-year-old woman who has suffered from obstructive jaundice, weight loss and right upper abdominal pain for 2 months. The contrast CT revealed masses located in the region of pancreatic head and lots of enlarged retroperitoneal lymph nodes, both of which were enhanced on the artery phase of CT images. Meanwhile, Tc-HYNIC-TOC SPECT/CT revealed high activity in the corresponding lesions...
May 31, 2018: Clinical Nuclear Medicine
Zhengguang Xiao, Aisheng Dong, Yang Wang
Human African trypanosomiasis imported to nonendemic countries is rare. It is very difficult to establish the correct diagnosis of human African trypanosomiasis in nonendemic areas. We present a case of human African trypanosomiasis with MRI and FDG PET/CT findings. Head MRI showed hyperintense areas in bilateral internal capsules. Abdominal and pelvic MRI showed hepatosplenomegaly and multiple enlarged lymph nodes. FDG PET/CT showed generalized hypermetabolic lymph nodes, diffuse FDG uptake of the spleen, and hepatosplenomegaly mimicking lymphoma...
May 31, 2018: Clinical Nuclear Medicine
Feng-Tao Liu, Jing-Jie Ge, Jian-Jun Wu, Ping Wu, Yilong Ma, Chuan-Tao Zuo, Jian Wang
PURPOSE: Neuroimaging indicators of Parkinson disease have been developed and applied in clinical practices. Dopaminergic imaging reflects nigrostriatal dopaminergic dysfunction, and metabolic network imaging offers disease-related metabolic changes at a system level. We aimed to elucidate the association between Parkinsonian symptoms and neuroimaging, and interactions between different imaging techniques. METHODS: We conducted a dual-tracer PET study for the combined assessments of dopaminergic binding (C-CFT) and glucose metabolism (F-FDG) in 103 participants with Parkinson disease (65 male and 38 female subjects)...
May 31, 2018: Clinical Nuclear Medicine
D'hulst Ludovic, Deroose Christophe, Strybol David, Coolen Johan, Gheysens Olivier
We report a rare case of a mediastinal malignant granular cell tumor in a 41-year-old man presenting with dyspnea, retrosternal chest pain, and recurrent pericardial effusion under treatment with corticosteroids. Because of recurrent episodes, further investigations with chest MRI and F-FDG PET/CT revealed a large infiltrating and strongly hypermetabolic mass in the mediastinum with pericarditis. Histopathology and immunohistochemical analysis showed large cells with greater pleomorphism and eosinophilic granular cytoplasm with positive staining for S100 protein and CD68 as well as high Ki67 proliferative index (15%) confirming the diagnosis of a malignant granular cell tumor...
May 25, 2018: Clinical Nuclear Medicine
Urs J Muehlematter, Niels J Rupp, Julian Mueller, Daniel Eberli, Irene A Burger
Multiparametric MRI incorporating T2-weighted, diffusion-weighted, and dynamic contrast material-enhanced sequences is currently used for detection and localization of clinically important prostate cancer (PCa). The Ga-labeled PET tracer targeting the prostate-specific membrane antigen (PSMA, Ga-PSMA-11) is a promising diagnostic approach for staging and restating PCa. Recent studies suggest that Ga-PSMA could also be used for primary PCa detection and localization. We report a case of a Ga-PSMA PET/MR-positive lesion of the peripheral zone in a 73-year-old man with a negative preceding multiparametric MRI...
May 25, 2018: Clinical Nuclear Medicine
Lea Cuppari, Laura Evangelista
A 65-year-old man with prostate cancer surgically treated in June 2016 underwent F-choline PET/CT in April 2017 for a biochemical recurrence of disease. PET/CT revealed a high tracer uptake in a solid nodulation near the left masseter muscle with a high SUVmax. The patient underwent both ultrasonography examination and fine needle aspiration cytology that confirmed the presence of an ectopic salivary gland. This case highlights that, in patients undergoing choline PET/CT, a careful analysis of the physiological biodistribution should be made by considering also the presence of accessory salivary glands...
May 25, 2018: Clinical Nuclear Medicine
Guohua Shen, Ying Kou, Bin Liu, Rui Huang, Anren Kuang
PURPOSE: The BRAF mutation is the most common and specific oncogenic event in papillary thyroid carcinoma (PTC). However, its role in radioiodine therapy decision making has yet to be established. This study aimed to evaluate the impact of the BRAF mutation on the clinical response to radioiodine therapy. METHODS: This retrospective study included PTC patients who received total thyroidectomy with lymph node dissection, radioiodine therapy, and thyroid-stimulating hormone suppression between January 2012 and March 2016...
May 14, 2018: Clinical Nuclear Medicine
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