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Clinical Nuclear Medicine

Apurva Sood, Ashwin Singh Parihar, Ashwani Sood, Rajender Kumar, Gaurav Prakash, Manphool Singhal, Ajay Gulati, Bhagwant Rai Mittal, Ajay Bahl, Shashank Singh
Differentiated thyroid cancer (DTC) with thyroglobulin elevation and negative I scintigraphy (TENIS) syndrome is a diagnostic and therapeutic dilemma. Treatment of differentiated thyroid cancer has an excellent outcome, but treatment options in TENIS are limited with the exception of surgically amenable disease. We present a case of TENIS syndrome with incidental detection of tumor thrombus in right pulmonary vein extending to the left atrium on F-FDG PET/CT and subsequently complicating as an occipital bleed...
August 4, 2018: Clinical Nuclear Medicine
Sophie Turpin, Marjorie Perron, Stéphanie Vairy, Sébastien Bénali, Amélie Damphousse
Pancreatic neoplasm is very rare in the pediatric population. Malignant tumors represent less than 0.2% of pediatric cancer-related mortality. Pancreas lesions can be from exocrine or endocrine origin or present themselves as cystic masses. Clinical, biological, and radiological findings usually are sufficient to establish diagnosis, but in some cases, they may be misleading. We present the case of a young patient presenting a pancreatic mass where anatomical and metabolic characteristics of the lesion were discordant to the final diagnosis...
August 4, 2018: Clinical Nuclear Medicine
Mariko Ishimura, Yuka Yamamoto, Katsuya Mitamura, Takashi Norikane, Yoshihiro Nishiyama
F-NaF is a bone-seeking positron-emitting tracer with high sensitivity and specificity for detection of osseous lesions. We report a case of primary glial tumor that showed extraosseous uptake on F-NaF PET/CT. CT revealed a mass in the right parietal lobe with calcification. F-NaF PET/CT showed abnormal tracer uptake in the brain tumor, which was subsequently confirmed to be a glioblastoma by histologic examination.
August 4, 2018: Clinical Nuclear Medicine
Zhaoting Cheng, Shuang Song, Yunfeng Han, Sijuan Zou, Xiaohua Zhu
Ga-DOTATATE PET/CT was performed in a 60-year-old man to detect culprit tumor responsible for tumor-induced osteomalacia (TIO). The images revealed multiple foci of abnormal activity in soft tissue lesion, which were not typical of tumor causing TIO in Ga-DOTATATE PET/CT. Considering other neoplastic processes, FDG PET/CT were subsequently performed, which showed all same lesions, although the lesions with highest activity were different between the scans. Pathological examination demonstrated that the patient experienced TIO caused by 1 lesion, but other lesions were due to IgG4-related lymphadenopathy...
July 27, 2018: Clinical Nuclear Medicine
Bulent Yazici, Aylin Oral, Aysegül Akgün
It is known that renal scintigraphy is the best imaging modality in the diagnosis of urinary leakage. Usually, only planar images are diagnostic but sometimes they are unclear when urinoma is small and adjacent to kidney or bladder. In other respects, planar images can be false-positive in the case of increased blood flow of abdominal wall. We suggested using SPECT/CT in differential diagnosis. An atlas of SPECT/CT is presented, which includes 3 cases that urinoma was diagnosed by SPECT/CT, which were unclear on planar images, and one case that urinary leakage suspicion on planar image was ruled out by SPECT/CT...
July 27, 2018: Clinical Nuclear Medicine
Guohua Shen, Ying Kou, Bin Liu, Anren Kuang
Subcutaneous tissue as a manifestation of generalized disease is commonly involved in lymphomas. However, only skin involvement without other sites of extracutaneous disease was rarely presented, especially in diffuse large B-cell lymphoma (DLBCL). Herein, we reported an unusual case of primary cutaneous DLBCL, solely presenting with multiple subcutaneous nodules in the abdomen and back, and these nodules showed increased FDG uptake on PET/CT images. PET/CT is very helpful for diagnosing primary cutaneous DLBCL...
July 27, 2018: Clinical Nuclear Medicine
Sharjeel Usmani, Fahad Marafi, Rashid Rasheed, Muneera Al Maraghy, Fareeda Al Kandari
Primary lung adenocarcinoma is extremely rare in the pediatric age group. We report an 18-year-old man with non-small cell lung carcinoma stage IV with brain and bone metastatic. Lung biopsy showed expression of PDL1 along with rearrangement of ALK gene at chromosome 2p23. However, neither mutation of ROS1 nor epidermal growth factor receptor overexpression was seen. Second-generation anaplastic lymphoma kinase (ALK) inhibitor (alectinib) is initiated as first line of treatment. After 8 months of treatment with alectinib, F-NaF PET/CT demonstrated resolution of bone lesions...
July 27, 2018: Clinical Nuclear Medicine
Wolfgang Roll, Burkhard Riemann, Michael Schäfers, Lars Stegger, Alexis Vrachimis
INTRODUCTION: Patients with radioiodine-refractory differentiated thyroid cancer (RrDTC) have a rather poor prognosis and are in need of novel treatments. As RrDTCs can in some cases express somatostatin receptors (SSRT), targeting of these receptors by Ga/Lu-DOTATATE could evolve as a novel theranostic option. METHODS: Five RrDTC patients with limited further therapeutic options and documented expression of SSRT using Ga-DOTATATE-PET/CT received 2 to 4 cycles of PRRT with Lu-DOTATATE...
July 27, 2018: Clinical Nuclear Medicine
Zhen Zhao, Yu Chen, Bin Liu
A 43-year-old woman with papillary thyroid cancer prepared for I ablation after total thyroidectomy. With a history of type 2 diabetes for 10 years, she recently presented with periodontitis, candidiasis, and mouth dryness. TcO4 scintigraphy was ordered to evaluate function of the salivary glands. The scintigraphy incidentally found a focal TcO4 uptake in the left supraclavicular region. The subsequent neck ultrasonography showed a hypoechoic soft tissue mass with heterogeneous hypervascularity, suggestive of hemangioma...
July 27, 2018: Clinical Nuclear Medicine
Yong Joong Kim, Yong-Il Kim
PURPOSE: We performed a meta-analysis on the therapeutic effects of prostate-specific membrane antigen (PSMA)-617 labeled with lutetium-177 (Lu-PSMA-617) in patients with metastatic castration-resistant prostate cancer (mCRPC). PATIENTS AND METHODS: The primary outcome was the therapeutic responses after the first cycle of Lu-PSMA-617 radioligand therapy. The parameters studied were the pooled proportions of any prostate-specific antigen (PSA) decline and a greater than 50% PSA decline...
July 27, 2018: Clinical Nuclear Medicine
Deling Li, Jingjing Zhang, Nan Ji, Xiaobin Zhao, Kun Zheng, Zhen Qiao, Fang Li, Lixin Lang, Andrei Iagaru, Gang Niu, Zhaohui Zhu, Xiaoyuan Chen
OBJECTIVES: Uncommon pathological subtypes of meningioma may present with severe peritumoral brain edema and mimic high-grade glioma (HGG). In a prospective cohort study of Ga-NOTA-PRGD2 PET/CT to evaluate glioma, we occasionally observed that a combination of Ga-NOTA-PRGD2 and F-FDG was able to differentiate these 2 lesion types. METHODS: From 2013 to 2016, 21 patients suspected of HGG by MRI were recruited for evaluation using Ga-NOTA-PRGD2 PET/CT. Brain F-FDG PET/CT was performed within 3 days for comparison, and the tumor was surgically removed...
July 26, 2018: Clinical Nuclear Medicine
Céline Heimburger, Caroline Bund, Pietro Addeo, Bernard Goichot, Alessio Imperiale
We report the results of F-FDOPA PET/CT in an asymptomatic MEN-1 patient with secreting pituitary prolactinoma investigated before and during dopamine agonists treatment. PET/CT showed intense and focal F-FDOPA uptake in the right part of anterior pituitary corresponding to a microadenoma on MRI imaging. Six months after the beginning of cabergoline, prolactin secretion normalized, pituitary F-FDOPA uptake completely regressed, and tumor size reduced on follow-up PET/CT and MRI, respectively.
July 26, 2018: Clinical Nuclear Medicine
Wolfgang Roll, Axel Bräuer, Matthias Weckesser, Martin Bögemann, Kambiz Rahbar
Radiolabeled ligands targeting prostate-specific membrane antigen (PSMA) are currently being established. Prostate-specific membrane antigen radioligand therapy with Lu-PSMA-617 is a promising treatment in metastasized castration-resistant prostate cancer with high efficacy and safety and seems to prolong progression-free survival and overall survival. We present Ga-PSMA PET/CT images during and after 2 therapy courses, including each 4 cycles of Lu-PSMA-617, and prostate-specific antigen-level history of a 77-year-old heavily pretreated patient with metastasized castration-resistant prostate cancer...
July 21, 2018: Clinical Nuclear Medicine
Xin-Yun Zhang, Xiao-Yue Chen, Guo-Qiang Zhang, Quan-Yong Luo
A 54-year-old man with a history of nasopharyngeal carcinoma was treated with TPF (docetaxel + cisplatin + 5-fluorouracil) neoadjuvant chemotherapy, presented with clinical features of acute hepatic failure. F-FDG PET/CT revealed diffuse hepatic radioactivity uptake without pathological radioactivity elsewhere in the body and similar to superscan by bone scan. Increased focal uptake of FDG was more commonly seen in nasopharyngeal carcinoma with metastatic involvement of the liver. This unusual liver superscan indicated that patients with nasopharyngeal carcinoma may show diffuse hepatic involvement by cancer cells and inspired our interests...
July 21, 2018: Clinical Nuclear Medicine
Sophie Bourgeois, Willy Peetermans, Nathalie Noppe, Karolien Goffin, Olivier Gheysens
A 39-year-old man presented with severe bone pain in the tibiae and forearms in the wake of a poststreptococcal sepsis complicated with pneumonia and erysipelas 4 months earlier. Bone scintigraphy was indicative of periostitis of the tibia, ulna, and radius bilaterally, and in combination with the increased inflammatory parameters and dysproteinemia, the diagnosis of Goldbloom syndrome was made. Goldbloom syndrome is an idiopathic periosteal hyperostosis associated with dysproteinemia and elevated inflammatory parameters...
July 21, 2018: Clinical Nuclear Medicine
Mette Abildgaard Pedersen, Kirsten Bouchelouche, Mikkel Holm Vendelbo
Prostate cancer cells have abundant expression of the cell surface protein prostate-specific membrane antigen (PSMA). In recent years, PET radioligands detecting this protein has therefore gained substantial interest in prostate cancer staging. It turned out that PSMA expression can be evident in both malignant and benign lesions, and we have previously reported that pulmonary opacities and bronchiectasis can be avid on Ga-PSMA PET/CT. Here, we present a case with Ga-PSMA accumulation in nonobstructive middle lobe syndrome, which further indicate that benign changes in the lungs may be falsely interpreted as malignant disease...
July 21, 2018: Clinical Nuclear Medicine
Nir Hod, Aryeh Shalev, Daniel Levin, Reut Anconina, Dina Ezroh Kazap, Sophie Lantsberg
We present a case of an adolescent girl with a cardiac mass which was characterized as malignant on FDG PET/CT. In addition, FDG PET/CT revealed multiple hypermetabolic pulmonary lesions. The final diagnosis was primary cardiac angiosarcoma with pulmonary metastases, a rare malignancy especially in female patients at this age group. We emphasize the potential role of FDG PET/CT in patients with a cardiac neoplasm and present a literature review of FDG uptake in benign versus malignant cardiac tumors.
July 21, 2018: Clinical Nuclear Medicine
Shelvin Kumar Vadi, Rajender Kumar, Bhagwant Rai Mittal, Ashwin Singh Parihar, Harmandeep Singh, Shashank Singh, Surinder Rana
Immunoglobulin G4-related disease (IgG4-RD) with multisystem involvement is known to mimic various malignancies and can be diagnosed with high clinical suspicion. We hereby report an atypical case of IgG4-RD, who presented as an inflammatory pseudotumor resembling gall bladder malignancy with hepatic, omental, and subcutaneous involvement. The characteristic tracer uptake pattern described on FDG PET/CT may not be always present in IgG4-RD, especially in the setting of postabdominal surgery. FDG PET/CT revealed the disease progression despite glucocorticoids and aided in response evaluation after second-line drug, rituximab...
July 21, 2018: Clinical Nuclear Medicine
Melissa Cindy Kong, Helen Ruth Nadel
A 9-year-old girl presented with facial rash, angioedema, fevers, and night sweats. She was diagnosed with chronic active Epstein-Barr virus infection and placed on chronic steroid treatment. F-FDG PET/CT performed 3 weeks following presentation revealed diffuse subcutaneous soft tissue FDG activation throughout the entire body, with likely localization to white subcutaneous adipose tissue. This highly unusual appearance may have been due to the patient being treated with corticosteroids at the time of the scan...
July 21, 2018: Clinical Nuclear Medicine
Ashwin Singh Parihar, Bhagwant Rai Mittal, Shelvin Kumar Vadi, Rajender Kumar Basher, Anil Bhansali
Ectopic Cushing syndrome constitutes approximately 10% of all patients with Cushing syndrome. The clinical features of hypercortisolism result from elevated levels of adrenocorticotropic hormone produced by a tumor. The present case presented with clinical and biochemical parameters suggestive of Cushing syndrome with normal pituitary and adrenals on imaging. Ga-DOTANOC PET/CT done to localize an ectopic adrenocorticotropic hormone-producing tumor revealed metastatic medullary carcinoma of the thyroid as the culprit lesion...
July 21, 2018: Clinical Nuclear Medicine
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