We report 2 cases where blood-pool SPECT/CT had a high added value compared with standard 3-phase bone scintigraphy with only delayed SPECT/CT for the etiological diagnosis of painful ankles. Two men, aged 48 and 62 years, were referred for suspicions of medial and lateral malleoli stress fractures, respectively. Although standard planar blood-pool imaging and delayed SPECT/CT were inconclusive, blood-pool SPECT/CT showed markedly increased uptake along posterior tibial tendon and peroneal tendon,...
Wed Jul 08, 2020 03:00
A 41-year-old man from South Asia presented with a several months’ history of unilateral nasal obstruction and bleeding. At nasal endoscopy, two strawberry-like, friable, polypoid masses in the upper airways were detected. The patient’s clinical trait was compatible with an infectious disease. 18F-FDG PET/MRI was performed to evaluate the disease extension. Two lesions occupying the nasal cavity and the nasopharynx, slightly hyperintense in T2-weighted sequences, with intense radiopharmaceutical...
Wed Jul 08, 2020 03:00
Common presentation of primary gallbladder carcinoma is with abdominal pain, or it may be detected incidentally in postcholecystectomy specimen for cholelithiasis. Primary gallbladder carcinoma spreads to adjacent hepatic parenchyma and locoregional nodes. Lung is a common extra-abdominal site, with other sites being relatively rare. We report a case of primary gallbladder carcinoma, which presented with elbow swelling in the absence of locoregional nodal spread detected on whole-body 18F-FDG PET/contrast-enhanced...
Wed Jul 08, 2020 03:00
The Magnet Recognition Program® and the Pathway to Excellence® program of the American Nurses Credentialing Center are not only designed to improve the working conditions of nurses, but also to elevate nursing as a profession and ultimately increase quality, safety, and outcomes for patients. There is much overlap in the programs but the Magnet Recognition Program® specifically addresses outcomes and the Pathway to Excellence® program specifically addresses the well-being of nurses. Received...
Wed Jul 08, 2020 03:00
A 67-year-old woman sustained a mild traumatic brain injury (TBI) in a traffic accident and had an initial Glasgow Coma Scale score of 13. She underwent 18F-THK5351 PET 18 days after TBI. Fused 18F-THK5351 PET/MRI showed that the location of 18F-THK5351 accumulations corresponded anatomically to intraparenchymal lesions of acute TBI on MRI. 18F-THK5351 reportedly binds to monoamine oxidase B highly expressed in astrocytes. Furthermore, TBI induces reactive astrogliosis or blood-brain barrier breakdown...
Wed Jul 08, 2020 03:00
A 66-year-old man was diagnosed with metastatic prostate cancer to the bones. The patient started 223Ra-dichloride (Xofigo) therapy in April 2019. 99mTc-MDP bone scan and 18F-fluciclovine (Axumin) PET/CT showed discordant but overall complementary findings that indicated disease progression after 5 doses of Xofigo therapy. The patient’s prostate-specific antigen increased from 33.81 ng/mL at baseline before Xofigo therapy and up to 394.3 ng/mL after the fifth dose of Xofigo treatment. Because of...
Wed Jul 08, 2020 03:00
A 33-year-old man had a diagnosis of a spitzoid melanoma by dorsal skin biopsy. During the oncological follow-up, patient underwent whole-body FDG PET/CT for restaging purpose. FDG PET/CT showed a large necrotic mass of the pituitary gland, subsequently confirming a solitary pituitary metastasis from spitzoid melanoma. Received for publication April 4, 2020; revision accepted May 8, 2020. Conflicts of interest and sources of funding: none declared. Correspondence to: Salvatore Annunziata,...
Wed Jul 08, 2020 03:00
We report the case of a fracture healing after 223Ra in an 83-year-old wheelchair-bound man with prostate castration-resistant adenocarcinoma treated due to uncontrollable pain from widespread bone metastases. The patient fractured both right tibia and fibula 15 days prior to the first 223Ra cycle. After the first cycle, there was complete remission of his metastatic bone pain; after the second cycle, he began walking with support, which helped improve fracture healing; and after the third cycle,...
Wed Jul 08, 2020 03:00
Primary neuroendocrine tumor of the mediastinum is a relatively rare entity. In metastatic/inoperable disease, therapeutic options are limited to cytotoxic chemotherapy in poorly differentiated tumors and peptide receptor radionuclide therapy in case of well-differentiated tumors. We present the case of a 52-year-old man with mediastinal atypical carcinoid (grade II) neuroendocrine tumor showing mild somatostatin receptor expression and intense FDG avidity with progressive disease on chemotherapy....
Wed Jul 08, 2020 03:00
We report a case of a 66-year-old woman with small cell lung cancer (stage IIB, T2N1M0), who received immunotherapy with nivolumab monthly for 2 months and then presented with thyrotoxic symptoms associated with suppressed thyroid-stimulating hormone levels and elevated free thyroid hormone levels, although previous thyrotropin performed 1 month ago was normal. Thyroid uptake and scan demonstrated diffusely decreased uptake in both thyroid lobes. The 4-hour percentage uptake was 0.7%, and the 24-hour...
Wed Jul 08, 2020 03:00
This is a case of a 63-year-old man who presented with acute melena and low hemoglobin. Upper and lower gastrointestinal evaluations failed to localize the bleeding focus. 99mTc-RBC planar scintigraphy identified 2 sites of suspected bleeding in the lower abdomen area. Subsequent SPECT/CT was performed and identified the precise main focus of active bleeding, the second and third parts of the duodenum, and also described the blood accumulation in the jejunum. Esophagogastroduodenoscopy was immediately...
Wed Jul 08, 2020 03:00
A 64-year-old woman who had yellowish orange–colored, sharp-edged, and flat skin plaques and back pain for about a year was referred for 18F-FDG PET/CT imaging and her bone marrow biopsy revealed 10% to 20% atypical plasma cells suggestive of monoclonal gammopathy. PET/CT showed linear 18F-FDG uptake on the surface of the skin on the neck, axillary, chest, inframammary, and inguinal regions. Punch biopsy revealed numerous histiocyte infiltrates with large vacuoles, xanthomized cytoplasm in the dermis,...
Wed Jul 08, 2020 03:00
Olivopontocerebellar atrophy is a rare neurodegenerative syndrome associated with 2 distinct disorders: multiple system atrophy and spinocerebellar ataxia. We present a case involving a 66-year-old man with adult-onset progressing cerebellar signs reflective of a cerebellar syndrome with no significant family history and unremarkable genetic testing for spinocerebellar ataxia. This case was found to be most consistent with sporadic olivopontocerebellar atrophy, which falls under the multiple system...
Wed Jul 08, 2020 03:00
Radiation pneumonitis (RP) can be an adverse complication of radiotherapy and usually occurs as an acute reaction from 6 to 12 weeks after radiotherapy. FDG PET is described as an early and adequate barometer for RP diagnosis. Only 1 case of fluoroestradiol uptake contemporary of metabolic FDG changes attributed to RP is reported. We report a case of a breast cancer patient with asymptomatic RP, who at 1 year later, at sequelar stage on CT, showed long-term memory of RP by 18F-fluoroestradiol PET...
Wed Jul 08, 2020 03:00
The efficacy of 177Lu-DOTATATE in large neuroendocrine tumors (NETs) is reduced because of the lower energy (Eβmax 0.497 MeV) and shorter range of 177Lu. The pure β-emitter 90Y with its longer β range is more effective in larger tumors. This should be balanced with the greater risk of 90Y-DOTATATE–related nephrotoxicity. Sequential duo–peptide receptor radionuclide therapy may result in a better response with minimal adverse effects in large-volume heterogeneous NETs. A 56-year-old man with large...
Wed Jul 08, 2020 03:00
Involvement of the uterus by myeloma is an extremely rare manifestation of extramedullary multiple myeloma (MM), denoting a poor prognosis. Extramedullary MM occurs in 7% to 18% of newly diagnosed patients with MM, and 6% to 20% of patients can develop it later. We present a case of extramedullary MM of the uterus suspected on 18F-FDG PET/CT as a site of disease recurrence in a 47-year-old woman previously in remission. Further evaluation with pelvic MRI identified an infiltrative process involving...
Wed Jul 08, 2020 03:00
Bing-Neel syndrome is a rare neurological complication of Waldenström macroglobulinemia. We present the case of a 71-year-old man who underwent prechemotherapy and postchemotherapy FDG PET/MRI scan for the evaluation of cerebrospinal disease. In light of limited literature and lack of consensus guidelines on the role of metabolic imaging, we aim to highlight the utility of FDG PET/MRI in the diagnosis and response assessment in Bing-Neel syndrome. Received for publication January 21, 2020; revision...
Wed Jul 08, 2020 03:00
Background Increase in incidence of neuroendocrine tumors (NETs) has been attributed in part to the availability of sensitive diagnostic modalities, such as 68Ga-DOTA-peptide PET/CT. However, it suffers from problems such as obscurement of tracer-avid lesions by physiological gut activity and collapsed gut lumen. Contrast-enhanced CT and CT enterography (CTE) do not have these drawbacks. Purpose The aim of this study was to compare the diagnostic performances of contrast-enhanced CT...
Wed Jul 08, 2020 03:00
Triplet chemotherapy (FOLFOXIRI) + bevacizumab regimen is indicated as first-line treatment of BRAFV600E-mutated metastatic colorectal cancer (mCRC). Nevertheless, its proven therapeutic efficacy in clinical trials was solely based on partial morphologic responses assessed by CT. To date, only 1 case of complete response assessed by FDG PET/CT was reported in literature in BRAFV600E-mutated mCRC, but treated with doublet chemotherapy (FOLFIRI) + cetuximab regimen. We report a complete metabolic response...
Wed Jul 08, 2020 03:00
We report the case of a 45-year-old man with thalassemia major referred for a bone scan as a workup for generalized bone pain. 99mTc-MDP SPECT CT showed multiple elongated soft tissue masses along the inner aspects of ribs and along both sides of dorsal spine with calcification and mild tracer uptake. There was also a large lobulated presacral soft tissue mass displacing the bladder and involving the adjacent pelvic bone. Biopsy of mildly avid tracer uptake in pelvic soft tissue mass was extramedullary...
Wed Jul 08, 2020 03:00
Gallbladder visualization represents a rare incidental finding when using somatostatin receptor–targeted SPECT radiopharmaceuticals such as 111In-octreotide. We present the case of a 30-year-old man with pseudomyogenic hemangioendothelioma who underwent 68Ga-DOTATATE PET/CT for restaging of metastatic disease and subsequent treatment with peptide receptor radionuclide therapy with 177Lu-DOTATATE. Posttherapeutic SPECT/CT, but not pretherapeutic or posttherapeutic PET/CT, showed gallbladder visualization,...
Wed Jul 08, 2020 03:00
Three patients with neurological disorders (cerebral infarction, progressive multifocal leukoencephalopathy, and multiple sclerosis) underwent 18F-THK5351 and 11C-L-deprenyl PET on the same day to visualize lesions undergoing astrogliosis by measuring MAO-B activity. BPND map and SUV image with 18F-THK5351 as well as Ki map, Ki/K1 map and SUV image with 11C-L-deprenyl were created. 18F-THK5351 BPND maps and SUV images clearly identified the lesions undergoing astrogliosis. 11C-L-deprenyl Ki/K1 maps...
Wed Jul 08, 2020 03:00
A 69-year-old woman presented with cognitive impairment related to attentive, executive, and mnemonic functions; progressive worsening of walking, speaking, writing, and reading ability; and double sphincter incontinence. Leukoencephalopathy, cystic lesions, and calcifications, suspected for Labrune syndrome, were observed at MRI and CT brain images. Generalized wave abnormalities were also visible at electroencephalogram. Functional brain imaging performed with 18F-FDG PET/CT demonstrated a decreased...
Wed Jul 08, 2020 03:00
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