Clinical Nuclear Medicine

The 68Ga-FAPI (fibroblast activation protein inhibitor) radiotracer is a novel and versatile tool in nuclear medicine, exhibiting potential for use in various conditions due to its significant upregulation in cancerous and inflammatory conditions, particularly those involving fibrotic and infectious processes. In this report, we present the case of a patient with papillary thyroid carcinoma who underwent total thyroidectomy and iodine therapy. He was referred because of high thyroglobulin despite negative diagnostic radioiodine imaging (TENIS syndrome)...

Immune checkpoint inhibitors can revive exhausted helper T-cells, and inflammatory cell reactivation may cause autoimmune disease-like conditions. Drug-induced arthritis is an immune-related adverse event, but the diagnostic approach is undefined. We present the diagnostic utility of 99mTc-MDP bone scintigraphy for nivolumab-induced inflammatory arthritis. A 67-year-old man with hypopharyngeal carcinoma presented bilateral multiple metacarpophalangeal joint pain and swelling at each nivolumab administration...

A 2-year-old girl with history of high-risk neuroblastoma underwent 123I-MIBG, which showed increased 123I-MIBG in the left side of the head. Contrast-enhanced MRI and cerebral spine fluid cytology confirmed the diagnosis of leptomeningeal metastasis.

An 18-month-old otherwise healthy girl presented with 1 month of neck swelling. Based on ultrasonography that showed diffusely enlarged heterogeneous thyroid gland, a presumed diagnosis of thyroid cancer was made. Subsequent core needle biopsy revealed Langerhans cell histiocytosis extensively involving the thyroid. 18F-FDG PET/MR was performed for staging and to evaluate the local extent of the disease in the neck. PET/MR demonstrated a hypermetabolic neck mass inseparable from the thyroid gland. The mass encased the major vessels, trachea, and esophagus without compression or invasion...

BACKGROUND: Given their neuroendocrine origin, head and neck paragangliomas (HNPGLs) can be imaged with somatostatin receptor (SSTR)-directed PET/CT. We aimed to determine whether the in vivo PET signal can differentiate between varying HNPGL subtypes. PATIENTS AND METHODS: Fourteen patients with HNPGL received pretherapeutic SSTR-PET/CTs using 68Ga-DOTATOC. Six (42.9%) patients had a jugular paraganglioma (PGL-J), 5 (35.7%) were diagnosed with carotid paraganglioma (PGL-Cs), and the remaining 3 patients (21...

A 61-year-old right-handed man presented with decreased cognitive function, short-term memory, fluent speech disorders, and grammatical errors for 1 year. The patient underwent PET imaging with 11C-PIB, 18F-FDG, and 18F-APN-1607. The 11C-PIB PET showed no amyloid accumulation; the 18F-FDG PET showed hypometabolism in the bilateral frontal lobe, temporal lobe, and midbrain; and the 18F-APN-1607 PET showed tau accumulation in the brainstem, basal ganglia, and left inferior frontal gyrus. These findings suggested a diagnosis of nonfluent variant primary progressive aphasia...

This pilot study aimed to confirm the presence of infectious agents in infection foci using PET/CT imaging with 68Ga-DOTA-UBI (29-41) in 7 patients with chronic osteomyelitis and with indications for surgical cleaning at the site of the infection focus. The whole-body PET/CT was performed on Biograph mCT 40 PET/CT scanner (Siemens Healthineers); the image began 45-60 minutes postinjection of the radiotracer (148-260 MBq). This study demonstrated that, in 6 patients in whom the PET/CT was classified as positive for identified infectious foci, confirmed by culture of the secretion sample collected during surgery, only 1 patient in antibiotic therapy was negative...

Nonrecurrent inferior laryngeal nerve (NRILN) is a rare anatomical variant, which significantly increases the risk of nerve injury during neck surgery, for example, thyroidectomy or parathyroidectomy (PTX). The absence of the brachiocephalic trunk and presence of arteria lusoria (AL) are strong predictors of NRILN in the right neck. FCH PET/CT is now a recognized imaging modality in hyperparathyroidism (HPT). We report 2 patients with primary or renal HPT in whom FCH PET detected right HFPTs and low-dose noncontrast CT evidenced AL...

A 2.6-cm solid cystic lesion in the pancreatic head was found in a 51-year-old woman on CT. A pancreatic neuroendocrine tumor was suspected, and a 68Ga-DOTATATE PET/MRI was performed, which showed increased tracer uptake in the lesion. However, postsurgical pathologic examination indicated a pancreatic serous cystadenoma. Here, we reported a case of microcystic pancreatic serous cystadenoma that could be misdiagnosed as a pancreatic neuroendocrine tumor on a 68Ga-DOTATATE PET/MRI.

The role of 68Ga-DOTATATE PET/CT in the evaluation of neuroendocrine tumors is well defined. Nevertheless, 68Ga-DOTATATE uptake may be seen in some tumors other than neuroendocrine tumors as a reflection of tumor blood supply and somatostatin receptor expression. Although 68Ga-DOTATATE uptake has been described in a number of nonneuroendocrine tumors, no case of 68Ga-DOTATATE uptake in esophagus adenocarcinoma has been reported. We present the case of a 52-year-old man who had a metastatic esophageal adenocarcinoma showing 68Ga-DOTATATE uptake...

PURPOSE: The possibility of steroid administration inducing the extensive skeletal muscle uptake (ESMU) of FDG in PET scans was investigated. METHODS: From 8923 consecutive 18F-FDG PET/CT scans taken at our hospital, 23 scans (15 patients) met adult age and ESMU-positive inclusion criteria. Among the 15 patients, 13 with both ESMU-positive and -negative scans were examined for association with steroid administration. RESULTS: Extensive skeletal muscle uptake was associated with a history of steroid administration (χ2 test: P = 0...

PURPOSE: Gynecological cancer is the most prevalent cancer among women worldwide. We performed a meta-analysis to assess the impact of 18F-FDG PET on the management of patients with recurrent gynecological cancers, including cervical, uterine, and ovarian cancers. METHODS: We systematically searched MEDLINE and EMBASE databases for English-language publications. All published studies on the impact of PET scans on the management of patients with recurrent gynecological cancers were reviewed...

18F-FDG PET/CT scan is a well-known modality to assess distant metastases and treatment response in the patients with primary colon cancer. We are presenting an interesting case of 68Ga-PSMA-avid liver metastases in a 74-year-old man with colon cancer and recently diagnosed prostate cancer. The liver metastases were positive on initial FDG PET but lost FDG avidity on subsequent posttreatment FDG PET scans. Biopsy from the PSMA-avid liver lesions confirmed metastasis from colon origin. PSMA is expressed in various forms of tumor neovasculature other than prostate cancer with potential new applications as a theranostic agent in the future...

Contrast-enhancing renal masses are likely to be malignant in over 90% of cases due to the high diagnostic accuracy of abdominal imaging. In this situation, tumor biopsy is unnecessary and should be managed as a renal cell carcinoma. Resection remains the only potentially curative treatment. However, as in the case herein presented, comorbidities can prevent surgical resection. Radioembolization with 90Y microspheres is an intra-arterial procedure capable of delivering high doses of radiation to tumors. The present case demonstrates the concept of partial radiation nephrectomy in treating renal tumors with malignant characteristics in patients not amenable to surgery...

PURPOSE: We aimed to compare the potential value of 68Ga-FAPI-04 and 18F-FDG PET/CT in primary cervical cancer and lymph node metastases. METHODS: Patients with cervical cancer underwent both 68Ga-FAPI-04 and 18F-FDG PET/CT. Histopathology and follow-up CT or MRI results (at least 3 months of follow-up) were used as reference criteria. Paired-sample t test was used to compare the SUVmax of 18F-FDG and 68Ga-FAPI-04 PET/CT for cervical cancer primary lesions and metastatic lymph nodes...

CZT-SPECT myocardial perfusion enables quantification of myocardial blood flow (MBF). Normal values and thresholds have been accurately defined in PET but remain unclear in SPECT. The aim of this study was to report normal MBF and myocardial flow reserve values in very low-risk patients referred for coronary artery disease screening with dynamic SPECT, in comparison with patients experiencing coronary artery disease. Eighty-four patients (31 male) were analyzed. The mean 10 years risk of fatal cardiovascular events score was 2...

PURPOSE OF THE REPORT: To elucidate the PET/CT findings of pegfilgrastim-induced aortitis (PFIA) and compare them with those of other large-vessel vasculitis. METHODS: We enrolled 45 patients diagnosed with the following: PFIA, n = 8; Takayasu arteritis (TA), n = 12; giant cell arteritis (GCA), n = 6; and immunoglobulin G4-related aortitis (IgG4-A), n = 19. Records of PET/CT performed before treatment initiation were collected. The aorta and its branches were divided into 16 anatomic regions...

SMARCA4-deficient undifferentiated carcinoma is a new clinical entity characterized by SMARCA4 inactivation and has a dismal prognosis because of rapid growth. In this case, we reported 18F-FDG and 68Ga-FAPI-46 PET/CT imaging findings in a patient with SMARCA4-deficient undifferentiated carcinoma of stomach. 68Ga-FAPI-46 PET/CT showed much higher tumor-to-background contrast of primary tumor and revealed more metastatic lesions than 18F-FDG PET/CT. This case demonstrated the superiority of 68Ga-FAPI PET/CT over 18F-FDG for identifying both primary and metastatic lesions in SMARCA4-deficient undifferentiated carcinoma...

A 58-year-old woman, with a history of acute myeloid leukemia in complete response, was referred to the emergency department of our hospital for loss of consciousness. A brain MRI showed an intracranial mass suggestive for either primary brain tumor or brain metastasis. 18F-FET PET/CT revealed increased uptake of the lesion. Metastasis from acute myeloid leukemia was diagnosed after brain biopsy. Whole-body 18F-FDG PET/CT did not demonstrate other abnormal foci of 18F-FDG accumulation, whereas brain lesion had an uptake slightly below the adjacent brain...

We reported a 73-year-old man who was diagnosed with the recurrence of bladder tumor received 177Lu-FAP-2286 treatment. Encouragingly, radiological remission and alleviation of his symptom were noted. In addition, the patient did not have any adverse effects.