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Clinical Nuclear Medicine

Jay A Harolds
An important way to improve outcomes after colorectal surgery is to follow the recommendations of the enhanced recovery pathway after surgery (ERAS). The ERAS guidelines are recommendations that address certain aspects of what should be done before surgery, in the operating room, and following surgery. There is a substantial fall in complications and a decrease in the length of stay for the patient if the recommendations are followed. Elements of the ERAS program are now being adopted for other surgical procedures besides colorectal surgery...
October 19, 2016: Clinical Nuclear Medicine
Sirong Chen, Shing Kee Cheung, Ka-Nin Wong, Kwok Kee Wong, Chi-Lai Ho
A bedridden 90-year-old man with fever and elevated prostate-specific antigen (PSA) (49 ng/mL) was referred for differentiation between infection and tumor. F-FDG PET/CT was negative for infection, but Ga-PSMA PET/CT showed multiple lesions in prostate gland with infiltration to bladder wall and seminal vesicle, consistent with locally advanced prostate cancer. The lesion with the highest Ga-PSMA uptake was strongly avid for Ga-DOTATOC, suggesting neuroendocrine tumor differentiation. After hormonal therapy, PSA normalized, but chromogranin-A increased (from 251 to 398 ng/mL), inferring progression of neuroendocrine tumor differentiation...
October 18, 2016: Clinical Nuclear Medicine
Mohsen Qutbi, Babak Shafeie, Mahasti Amoui, Faraj Tabeie, Zahra Azizmohammadi, Ali Mahmoud-Pashazadeh, Hamid Javadi, Majid Assadi, Isa Neshandar Asli
BACKGROUND: Because one of the major sites for metastasis of thyroid cancers is the lung, studying the pattern of pulmonary metastasis may provide useful information for the effective treatment of these patients. In this study, by assessing the metastasis pattern, we aimed to identify the factors that may affect prognosis and response to treatment in patients with differentiated thyroid carcinoma (DTC) with pulmonary metastasis. METHODS: This retrospective study included 75 patients with DTC with pulmonary metastasis who were referred to our nuclear medicine section over a period of 10 years...
October 18, 2016: Clinical Nuclear Medicine
Mico Chan, Geoffrey Paul Schembri, Edward Hsiao
Ga prostate-specific membrane antigen (PSMA) PET/CT is increasingly used to evaluate extent of disease in prostate carcinoma. Several other benign and malignant pathologies have also been reported to demonstrate PSMA avidity. We present a case of serous cystadenoma of the pancreas showing focal uptake on PSMA PET/CT.
October 18, 2016: Clinical Nuclear Medicine
Kostas Delaunay, Florence Le Jeune, Etienne Garin, Anne Devillers, Xavier Palard-Novello
A 75-year-old man with a history of prostate cancer was referred to our department to perform F-choline (FCH) PET/CT. FCH PET/CT showed a markedly increased uptake in the right temporoparietal junction brain. Three weeks earlier, acute ischemic stroke was diagnosed in the right temporoparietal junction brain on diffusion-weighted sequence and thrombosis in a distal branch of the right middle cerebral artery on MR angiography. Choline precursors promote repair and growth of cell membranes in neurologic diseases, so FCH PET/CT uptake could be explained by repair processes during early outcome of acute ischemic stroke...
October 18, 2016: Clinical Nuclear Medicine
Zhanli Fu, Meng Liu, Jin Zhang, Ziao Li, Qian Li
Multiple renal lesions, which showed clearly demarcated low densities on contrast-enhanced CT, were revealed in a 56-year-old woman. The F-FDG avidity of the renal lesions was equal to or mildly higher than that of the renal cortex on the routine PET/CT scan, but significantly higher on the delayed scan. IgG4-related disease with renal involvement was confirmed subsequently by the measurement of serous IgG4 and the pathology of renal lesion.
October 18, 2016: Clinical Nuclear Medicine
Li Huo, Feng Feng, Quan Liao, Zhengyu Jin, Fang Li, Yupei Zhao
A 57-year-old man underwent FDG PET/CT to evaluate a mass in the head of the pancreas. The imaged revealed mildly, nonuniformly increased activity in the mass, but the exact location of the activity could not be determined on the low-dose noncontrast CT portion of the study. On subsequent PET/MRI images acquired 60 minutes after the FDG PET/CT study, the increased activity was clearly localized on the cystic wall. The pathological examination showed that the lesion was intraductal papillary mucinous neoplasm of the pancreas with high degree of dysplasia...
October 18, 2016: Clinical Nuclear Medicine
Manuela Cristina Matesan, Saeed Elojeimy, Satoshi Minoshima
Molecular brain imaging I-FP-CIT SPECT is an important tool in evaluation of patients with parkinsonism. However, various neurodegenerative etiologies cannot be differentiated by I-FP-CIT SPECT alone. We present a case of progressive supranuclear palsy with abnormal I-FP-CIT SPECT and abnormal Tc-HMPAO SPECT depicted by quantitative analyses but unremarkable MRI 16 months after the onset of symptoms. Brain autopsy demonstrated presence of neuronal and glial tau pathology in both cortical and subcortical regions confirming the diagnosis of progressive supranuclear palsy...
October 18, 2016: Clinical Nuclear Medicine
Xin Cheng, Wenjia Zhu, Ruixue Cui
A 33-year-old woman presented with progressive visual loss. An MRI examination revealed a pituitary lesion which was suspicious of abscess. FDG and F-2-fluorodeoxysorbitol (F-FDS) PET were performed to differentiate malignancy from inflammation. FDS is a new tracer with potential in differentiating inflammatory tissues based on results from animal studies. However, intense tracer uptake was found in the pituitary in both PET studies. The lesion was proved to be spindle cell carcinoma following biopsy.
October 18, 2016: Clinical Nuclear Medicine
Grace Hennessy, Deepa Shetty, Han Loh, Chuong Bui, Ken Le, Robert Mansberg
A 33-year-old woman with McCune-Albright syndrome was referred for a Ga-DOTATATE PET/CT study for evaluation and staging of a biopsy-proven pancreatic tail neuroendocrine tumor. The scan demonstrated intense focal octreopeptide uptake corresponding to the known neuroendocrine tumor at the pancreatic tail/splenic hilum. There was no evidence of octreopeptide-avid metastases. Diffuse octreopeptide uptake was demonstrated in multiple bones involving the right side of the skeleton. The concurrent CT demonstrated corresponding expansile lucent changes consistent with the known fibrous dysplasia...
October 12, 2016: Clinical Nuclear Medicine
Samine Sahbai, Florin-Andrei Taran, Francesco Fiz, Annette Staebler, Sven Becker, Erich Solomayer, Diethelm Wallwiener, Christian la Fougère, Sara Brucker, Helmut Dittmann
PURPOSE: Scintigraphic mapping of sentinel lymph node (SLN) is increasingly performed in patients with endometrial carcinoma although its routine clinical use is still under investigation. The purpose of this study was to compare preoperative SLN detection by means of SPECT/CT using pericervical (PC) versus hysteroscopic peritumoral (PT) injection. PATIENTS AND METHODS: One hundred forty consecutive patients with endometrial carcinoma who underwent surgery and preoperative SLN SPECT/CT with Tc-nanocolloid were included...
October 5, 2016: Clinical Nuclear Medicine
Tapas Das, Ajit Shinto, Koramadai Karuppuswamy Kamaleshwaran, Sharmila Banerjee
Radiochemical studies and biological evaluation in animal models have shown superior radiochemical properties and better clearance pattern for Lu-DOTMP compared with Lu-EDTMP, an agent recently proven to be efficacious and safe for metastatic bone pain palliation. This prompted us to initiate the clinical evaluation of Lu-DOTMP. The images represent the whole-body scans of a prostate cancer patient (man, 67 years) with skeletal metastases recorded after administering 3.7 GBq (100 mCi) of Lu-DOTMP.
October 5, 2016: Clinical Nuclear Medicine
Thorsten Derlin, Desiree Weiberg, Jan M Sohns
Paget disease is a chronic disorder resulting in enlarged and misshapen bones, and is caused by disorganized bone remodeling. We present the case of an 85-year-old man with prostatic adenocarcinoma and known Paget disease of the right iliac bone who underwent Ga-prostate-specific membrane antigen ligand, C-acetate, and F-fluoride PET/CT for restaging of cancer. On all PET scans, increased tracer accumulation was observed in Paget disease of bone. Besides that Paget disease may mimic metastases on PET/CT using various radiotracers, including Ga-prostate-specific membrane antigen ligands and C-acetate, this case highlights the potential of multiparametric disease characterization on PET...
October 5, 2016: Clinical Nuclear Medicine
Khimling Tew, David Farlow
Sentinel lymph node biopsy is a crucial part of staging intermediate and thick melanoma. Lymphatic drainage from a tumor site can be highly variable, especially on the head, neck, and trunk. SPECT/CT fuses nuclear medicine and x-ray CT images to produce images with high anatomic detail. At our institution, SPECT/CT is performed routinely in addition to planar imaging. This article presents examples where SPECT/CT has proven helpful in image interpretation.
October 5, 2016: Clinical Nuclear Medicine
Don Nguyen, Rishi Maheshwary, Anuj Rajput, Cassie Tran, Vijay Kudithipudi
Gastroesophageal junction adenocarcinoma on esophagogastroduodenoscopy biopsy. Initial PET-CT showed no definite evidence of distant metastatic disease. One month after radiation treatment, repeat PET-CT showed interval decrease in size of gastroesophageal mass but new multifocal FDG avidity in the caudate and left hepatic lobes. Correlation with contrast-enhanced CT and US images was negative, making metastasis less likely. Ultrasound-guided biopsy confirmed radiation-induced hepatitis, which caused false positively increased FDG uptake from inflammatory changes...
October 5, 2016: Clinical Nuclear Medicine
Mehdi Helali, Céline Heimburger, Serge Rohr, Bernard Goichot, Alessio Imperiale
The localization of small bowel (SB) neuroendocrine tumors (NETs) remains a diagnostic challenge in clinical practice. In about a third of cases, SB-NETs are multiple at diagnosis. However, the sensitivity of conventional presurgical diagnostic investigations is not exhaustive. F-FDOPA (6-L-F-fluorodihydroxyphenylalanine) PET seems to be a valuable diagnostic technique for the detection of midgut NETs. According to our experience, a delayed PET/CT acquisition centered on abdominopelvic region and performed after oral hydration may improve the detection of primary tumor and the identification of patients with multifocal SB-NETs who could benefit from a more accurate intraoperative palpation of the entire SB...
October 5, 2016: Clinical Nuclear Medicine
Rosa Maria Paragliola, Giampaolo Papi, Rosa Maria Lovicu, Alfredo Pontecorvi, Salvatore M Corsello
Ectopic thyroid tissue is an abnormality caused by aberrant thyroid gland embryogenesis during its passage from the floor of the primitive foregut to its final position. The most frequent place of ectopic thyroid tissue is the base of tongue, whereas lateral thyroid gland is a very rare finding. The present case describes a case of thyroid dysgenesis, caused by a submandibular ectopic thyroid gland. Thyroid scintigraphy was crucial for the diagnosis: in fact, the patient was asymptomatic, and the diagnosis was performed only on the basis of subclinical hypothyroidism...
October 5, 2016: Clinical Nuclear Medicine
Anirban Mukherjee, Krishan Kant Agarwal, Chandrasekhar Bal, Rakesh Kumar
Neuroendocrine tumors (NETs) are rare heterogeneous neoplasm of variable aggressiveness. A 55-year-old woman underwent Ga-DOTANOC PET-CT for suspected NET, which revealed DOTANOC-avid soft tissue mass in the second part of the duodenum with multiple hepatic metastases. Another non-DOTANOC-avid abdominal mass and hypodense lesion in segment VI of the liver were noted. For further evaluation, FDG PET-CT was performed, which revealed increased uptake in the abdominal mass and lesion in segment VI of the liver...
October 5, 2016: Clinical Nuclear Medicine
Arun Sasikumar, Ajith Joy, Raviteja Nanabala, Madhavan Unni, Padmanabhan Tk
We describe a case of metastatic clear cell renal cell carcinoma with intensely tracer concentrating lesions in left suprarenal region, mediastinal lymph nodes, lytic bone lesions, thyroid nodules, and mild abnormal tracer-avid lung nodules in Ga-prostate-specific membrane antigen (PSMA) PET/CT. On the other hand F-FDG PET/CT showed mild to no significant abnormal uptake in these lesions. Complimentary uptake pattern was observed in Ga-PSMA and F-FDG PET images in thyroid lesions and D5 vertebral lesion. This case highlights the possibilities of imaging clear cell renal cell carcinoma with Ga-PSMA and opens the possibility of treatment with Lu-PSMA...
October 5, 2016: Clinical Nuclear Medicine
Chadwick L Wright, Jun Zhang, Katherine Binzel, Evan J Wuthrick, Michael V Knopp
Imaging of Y internal pair production with conventional photomultiplier detector PET technology has been previously reported for patients with malignant/metastatic liver lesions treated with Y radioembolization (RE). We present a 54-year-old man with unresectable liver metastases from rectal carcinoma (involving the right and left lobes) who was referred for Y RE and subsequently imaged using new solid-state digital photon counting technology (Vereos 64 Time-of-Flight PET/CT; Philips, Cleveland, OH). Despite imaging at 26 hours following RE, digital PET/CT provides improved image quality and Y-to-background contrast as well as accurate visualization of Y biodistribution when compared with Bremsstrahlung SPECT/CT...
October 5, 2016: Clinical Nuclear Medicine
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