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Clinical Nuclear Medicine

Christof Rottenburger, Dimitrios Papantoniou, Dalvinder Mandair, Martyn Caplin, Shaunak Navalkissoor
Glucagonoma is an extremely rare, glucagon-secreting neuroendocrine tumor of the pancreas. Only sparse data are available about the characteristics of this tumor in somatostatin receptor imaging and only for the situation of initial diagnosis. We present a series of 3 glucagonoma patients who underwent at least 1 Ga-DOTATATE PET/CT scan. All patients were diagnosed by either histology and/or elevated serum levels of glucagon. The presented cases suggest that somatostatin receptor-based imaging can probably be used for re-evaluation of disease status in patients with glucagonoma in a similar way as it is already established for neuroendocrine tumors of other origin...
February 9, 2018: Clinical Nuclear Medicine
Zhanli Fu, Guoqian Chen, Meng Liu, Ziao Li, Qian Li
A large mass in the abdomen was revealed by ultrasonography on a 68-year-old woman presenting with abdominal pain and weight loss. To exclude the malignancy, an F-FDG PET/CT was performed, which showed a solitary soft tissue mass with heterogeneous F-FDG avidity at the root of small bowel mesentery. Because of the elevation of inflammatory markers and serum IgG4 level, IgG4-related sclerosing mesenteritis was suspected, which was proved by the subsequent biopsy. The mass gradually shrunk and ultimately disappeared in 6 months after a low-dose steroid therapy...
February 9, 2018: Clinical Nuclear Medicine
Hongyan Yin, Yan Xiu, Rongkui Luo, Hongwei Zhang, Hongcheng Shi
A 32-year-old woman presented with 3 months' history of rapid enlargement of the left breast and superficial ulceration. Staging F-FDG PET/CT performed after admission demonstrated a hypermetabolic mass in the left breast, with smaller hypermetabolic areas in the left axillary and internal mammary lymph nodes, as well as in the sternum. Postoperatively, the mass was diagnosed as metaplastic squamous cell carcinoma of the breast.
February 9, 2018: Clinical Nuclear Medicine
Gianpiero Manca, Federico Davini, Elisa Tardelli, Annalisa De Liperi, Fabio Falaschi, Franca Melfi, Patrick M Colletti, Domenico Rubello, Duccio Volterrani, Giuseppe Boni
PURPOSE: Incidental solitary pulmonary nodules (SPNs) have become an increasingly common CT finding worldwide. Although there are currently many imaging strategies for evaluating SPNs, the differential diagnosis and management of SPNs remains complex because of overlap between benign and malignant processes. Moreover, transbronchial or percutaneous CT-guided biopsies do not always allow definitive diagnoses. In such cases, video-assisted thoracic surgery (VATS) has become the preferred surgical procedure for diagnosis and, in selected cases, for treatment of indeterminate SPNs...
February 9, 2018: Clinical Nuclear Medicine
Ling Wang, Xiaona Jin, Fang Li
Collagen injection has been used as dermal filler in plastic and cosmetic surgery. A technetium Tc methylene diphosphonate bone scintigraphy was performed in a 47-year-old woman as part of the breast cancer evaluation. The images showed intense methylene diphosphonate activity on both sides of the frontal head, where she received collagen injection 1 year prior. The activity was visualized again in all 3 follow-up bone scans over the subsequent 3 years.
February 9, 2018: Clinical Nuclear Medicine
Arun Sasikumar, Ajith Joy, M R A Pillai, Karuna Elza Oommen, R Jayakumar
A 64-year-old woman underwent completion thyroidectomy with upper tracheal ring resection and right-sided neck dissection for papillary carcinoma of the thyroid infiltrating the trachea and was given I radioiodine treatment. Three years later, she presented with hemoptysis. On evaluation, she had increased serum thyroglobulin and negative iodine scan (TENIS). F-FDG PET/CT scan did not identify any site of disease. One year later, Ga-PSMA scan done revealed a moderate focal tracer-avid intratracheal soft tissue; biopsy revealed it to be metastatic papillary carcinoma of the thyroid...
February 9, 2018: Clinical Nuclear Medicine
Yang Wang, Aisheng Dong, Bo Yang, Jianping Lu
Castleman's disease of the kidney is extremely rare. We present a case of Castleman's disease in the left kidney with multiple para-aortic enlarged lymph nodes. Both the renal lesion and para-aortic lymph nodes showed hypervascularity on enhanced CT and minimally increased FDG uptake on FDG PET/CT, mimicking renal cell carcinoma with para-aortic nodal metastases. This case suggests that Castleman's disease should be considered as a rare differential diagnosis in patients with a hypervascular and hypermetabolic renal lesion...
February 9, 2018: Clinical Nuclear Medicine
Irene A Burger, Andrei Gafita, Julian Müller, Benedikt Kranzbühler, Olivio F Donati, Daniel Eberli
Restaging local recurrence after high-intensity focused ultra-sound (HIFU) is based on multiparametric MRI (mpMRI). However, postinterventional changes of the tissue, such as edema or hemorrhage, are limiting tumor detection on mpMRI. We present a case of a rising prostate-specific antigen values, negative mpMRI, and a Gleason score of 4+4 on template biopsy after HIFU. On F-choline PET/MR, high focal uptake was detected at the location of positive biopsy. Re-HIFU based on the fused F-choline PET/MR images was performed, followed by a recurrence-free period of 11 months...
February 9, 2018: Clinical Nuclear Medicine
Marcus Unterrainer, Cornelius Maihoefer, Clemens C Cyran, Peter Bartenstein, Maximilian Niyazi, Nathalie Lisa Albert
In this case of suspected sphenoid wing meningioma, Ga-DOTATATE PET/CT showed a somatostatin receptor (SSR)-expressing tumor with extension to the nasopharynx and SSR-expressing cervical lymph nodes. Subsequent biopsy from the nasopharynx revealed an Epstein-Barr virus (EBV)-associated, undifferentiated World Health Organization type 3 nasopharyngeal carcinoma (NPC), a potential clinical pitfall due to the reported high SSR expression of this tumor subtype. In consideration of the high target-to-background contrast, SSR ligands might be superior to F-FDG for EBV-associated NPC PET imaging, particularly at the skull base...
February 3, 2018: Clinical Nuclear Medicine
André H Dias, Kirsten Bouchelouche
We describe a case of a 73-year-old man with newly diagnosed prostate cancer referred to Ga-PSMA PET/CT for staging. A focal uptake of PSMA was visualized in the prostate compatible with primary prostate cancer. Outside the prostate, a PSMA-avid paravertebral soft tissue mass was observed. Further investigation with MRI of the same region showed signs compatible with schwannoma. This case shows the importance of including schwannoma in the differential diagnostic evaluation of patients with Ga-PSMA-positive foci in paravertebral locations, as schwannomas may show avid PSMA uptake and may potentially lead to an incorrect diagnosis of metastasis...
February 3, 2018: Clinical Nuclear Medicine
Christian Schmidkonz, Michael Cordes, Michael Beck, Theresa Ida Goetz, Daniela Schmidt, Olaf Prante, Tobias Bäuerle, Michael Uder, Bernd Wullich, Peter Goebell, Torsten Kuwert, Philipp Ritt
BACKGROUND: Tc-MIP-1404 (Progenics Pharmaceuticals, Inc, New York, NY) is a novel ligand binding to prostate-specific membrane antigen suitable for SPECT. There are, as yet, no data concerning its use in whole-body primary staging and its interobserver variability in patients with prostate cancer (PC) prior to therapy. METHODS: A search of our clinical database from April 2013 to May 2017 yielded 93 patients with histologically confirmed cancer in whom Tc-MIP-1404 SPECT/CT had been performed for primary whole-body staging before therapy...
February 3, 2018: Clinical Nuclear Medicine
Shelvin Kumar Vadi, Rajender Kumar, Harmandeep Singh, Shrawan Kumar Singh, Bhagwant Rai Mittal
Ga-prostate-specific membrane antigen (PSMA) ligand is a well-known tracer used in prostate cancer. Nevertheless, there are reports of unusual Ga-PSMA uptake in variety of benign lesions. We report a case of prostate cancer in which Ga-PSMA PET/CT revealed tracer avidity in the enhancing walls of cystic lesions in the brain consistent with the features of neurocysticercosis. The uptake of Ga-PSMA in neurocysticercosis is not known and may be attributed to angiogenesis occurring at the periphery of these lesions...
February 3, 2018: Clinical Nuclear Medicine
Darko Pucar, Anne Marie Boustani, Richard A Bronen, Lawrence Saperstein
Immunotherapy-induced hypophysitis presents with headache, fatigue, and visual disturbances. The diagnosis is supported by imaging findings of pituitary swelling, enhancement, and hypermetabolism and established by low levels of pituitary hormones. A 64-year-old man with metastatic melanoma on nivolumab presented with a severe headache, initially attributed to sinus disease. Contrast CT was interpreted as minor sinus disease and no pituitary abnormality. Hypophysitis was eventually diagnosed and successfully treated based on PET and laboratory findings...
February 3, 2018: Clinical Nuclear Medicine
Lane T Miner, Mark Tulchinsky
Intestinal malrotation displays classic pattern of the small bowel activity on hepatobiliary scintigraphy that could lead to the diagnosis, but only if an interpreting physician looks for it. Presented are 2 cases, one demonstrates diagnostic findings during the first 60-minute phase, whereas the other reveals the diagnosis only on the later sincalide stimulation phase. The currently recommended structured reporting for hepatobiliary scintigraphy does not include examination of bowel activity pattern, which could result in a missed diagnosis...
February 3, 2018: Clinical Nuclear Medicine
Bin Liu, Sabah Servaes, Hongming Zhuang
BACKGROUND: Planar whole-body imaging with I-radiolabeled metaiodobenzylguanidine (I-MIBG) is routinely used in the follow-up evaluation of neuroblastoma. In recent years, SPECT with integrated low-dose CT (SPECT/CT) has become more accessible. We investigated how much SPECT/CT can have additional diagnostic value over planar imaging in detection of residual and recurrent neuroblastoma. METHODS: A total of 170 planar I-MIBG imaging scans with SPECT/CT follow-up scans performed in 147 patients with known high-risk neuroblastoma were retrospectively analyzed...
February 3, 2018: Clinical Nuclear Medicine
Kamran Aryana, Soroush Zarehparvar Moghadam, Roham Salek, Ghasemali Divband
A 76-year-old man with castration-resistant prostate cancer and widespread skeletal metastases underwent 2 cycles of Lu-prostate-specific membrane antigen (PSMA) 617 therapy in our department. Whole-body Lu-PSMA scan after the first cycle showed diffuse skeletal PSMA-avid lesions, whereas no PSMA uptake was evident in the kidneys with minimal PSMA uptake by salivary glands (super scan). After 6 weeks, he received the second dose of Lu-PSMA and whole-body scan after the treatment showed remarkable resolution of skeletal metastases and normal PSMA uptake by the kidneys and salivary glands...
February 3, 2018: Clinical Nuclear Medicine
Mickael Tordjman, Matthieu Dubois, Maxime de Malherbe, Yves Denoux, Quentin Gillebert
F-FDG PET/CT and MRI were performed in a 44-year-old woman to characterize a mass of the anterior tongue. MR images showed a voluminous mass, well circumscribed and enhanced heterogeneously after gadolinium chelates injection. There was an intense uptake on PET/CT. Pathological examination and molecular analysis revealed the diagnosis of clear cell sarcoma of the tongue. We present a case of clear cell sarcoma of the tongue, which includes imaging features. It is an extremely rare tumor, with only 3 cases previously reported in the literature...
February 3, 2018: Clinical Nuclear Medicine
Ashwin Singh Parihar, Abhiram Ga, Karan Sood, Rajeev Kumar Seam, Vijay Kaushal, Ashwani Sood, Nandita Kakkar, Bhagwant Rai Mittal
The detection of synchronous or metachronous malignancies is on the rise with the advent of whole-body F-FDG PET/CT. It has shown its utility in detecting second primary carcinoma in patients undergoing imaging for evaluation of primary carcinoma, influencing the management and overall survival. Primary malignant melanoma of the lung is an extremely rare entity, accounting for 0.01% of all lung tumors. It is an even rare occurrence as a synchronous malignancy. We present the case of a 33-year-old woman with primary parotid myoepithelial carcinoma and incidental detection of second primary malignant melanoma of lung during F-FDG PET/CT imaging...
February 3, 2018: Clinical Nuclear Medicine
Anna Margherita Maffione, Lucia Rampin, Paolini Rossella, Sara Pecori, Patrick M Colletti, Domenico Rubello
We report a case of Burkitt lymphoma with largely extranodal disease localizations at staging. Chemotherapy was given, thus obtaining a complete metabolic response in all previous disease sites as shown at a control PET, however associated to the appearance of new focal uptake areas in the liver; these findings were confirmed at US and MRI. Chemotherapy determined also neutropenia that was treated by filgrastim, followed by a prompt and important medullary response. Liver biopsy revealed extramedullary hematopoiesis, probably filgrastim induced...
February 3, 2018: Clinical Nuclear Medicine
Ashwin Singh Parihar, Harmandeep Singh, Rajender Kumar, Vikas Gupta, Harpreet Singh, Bhagwant Rai Mittal
Immunoglobulin G4-related disease is an autoimmune entity with multisystem involvement. F-FDG PET/CT can provide important information about disease extent and severity and also aid in treatment response evaluation. We report a case of a 57-year-old woman presenting with abdominal discomfort, belching, and loss of weight in whomF-FDG PET/CT provided valuable information in diagnosis and monitoring treatment response.
February 3, 2018: Clinical Nuclear Medicine
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