Clinical Nuclear Medicine

PURPOSE: This study aimed to optimize the analysis of cingulate island sign (CIS) to improve its diagnostic accuracy in discriminating dementia with Lewy bodies (DLB) from Alzheimer disease (AD). PATIENTS AND METHODS: Patients with DLB (n = 80), AD (n = 75), and normal controls (n = 22) with 18F-FDG PET imaging were enrolled in this study. Sixty-two DLB patients also underwent dopaminergic PET scans. The optimized/conventional CIS ratios and metabolism in associated brain regions were evaluated by diagnostic accuracy among groups and correlation with cognitive/dopaminergic dysfunction...

PURPOSE: The purpose of this prospective study was to assess the effectiveness of knee joints treatment by radiosynoviorthesis with the use of 90Y based on ultrasound and clinical analysis. MATERIALS AND METHODS: Ninety-seven patients were qualified for treatment from October 2016 to June 2017, and observation period lasted until December 2017. Bioethics Committee of the Medical University of Silesia approved this study. The effectiveness of knee joints treatment with the use of 90Y was based on 927 ultrasound measurements of fluid and 927 synovial thickness in 3 sites of the suprapatellar recess, 309 assessments of patient's disability documented in Lequesne questionnaire, 309 assessments of pain on visual analog scale, as well as 103 overall self-assessment...

BACKGROUND: We aimed to evaluate the interobserver agreement rates in patients scanned with C-X-C motif chemokine receptor 4 (CXCR4)-directed PET/CT, including the rate of patients eligible for CXCR4-targeted radioligand therapy (RLT) based on scan results. METHODS: Four independent observers reviewed 50 CXCR4-targeted [68Ga]pentixafor PET/CT of patients with various solid cancers. On a visual level, the following items were assessed by each reader: overall scan impression, number of organ and lymph node (LN) metastases and number of affected organs and LN regions...

We report on a patient diagnosed with an aggressive pancreatic neuroendocrine tumor (NET G3; Ki67 = 60%), who underwent pancreatic resection with partial removal of liver lesions. The patient refused chemotherapy. Dual-tracer imaging with 18F-FDG and somatostatin receptor (SSTR)-targeted PET/CT was conducted. Radiotracer accumulation on both imaging modalities in bilobar hepatic lesions was observed. "Cold" somatostatin analogues with four cycles of peptide receptor radionuclide therapy (PRRT) were initiated, leading to partial response...

It is well-known that physiological FDG uptake in the skeletal muscles is affected by serum insulin levels and the extent to which the muscles contract before the examination. Patients are instructed to refrain from strenuous exercise, talking too much, and taking meals at least 4 hours before the administration of the tracer. Even if the patient does not intend to exercise, muscular accumulation related to specific behaviors can still be visualized in the images. In this manuscript, we present FDG PET/CT images from 4 cases reflecting the mode of transportation used by the patients to visit the hospital...

A 68-year-old woman was referred for an 18F-FDG PET/CT for evaluation of arthralgia and raised inflammatory markers, which demonstrated intense FDG activity (SUVmax, 25.5) at numerous periarticular and extra-articular sites including the cervical and lumbar interspinous bursae, lumbar facet joints, bilateral ischial tuberosities, and greater trochanters and the aorta consistent with active polymyalgia rheumatica.

A 50-year-old woman underwent 18F-FDG PET/CT to evaluate possible abdominal malignancy, which was revealed by CT. The images showed a large cystic-solid lesion with peripherally increased FDG activity in the left mid-abdomen. Histopathology of the excised lesion confirmed a jejunal cavernous hemangioma. We reported a rare case of jejunal cavernous hemangioma with FDG accumulation on PET/CT, mimicking malignancy.

Keloids are pathological scars from exuberant fibroproliferative collagen response and excessive extracellular matrix production usually extending beyond the original wound margins. Although keloids are mostly of dermatological concern, they could be incidentally depicted on scintigraphic planar and PET/CT imaging and could mimic other types of skin diseases. The authors present a case of chest wall keloids documented on 18F-piflufolastat PET/CT during the evaluation of prostate cancer recurrence.

Pleuroperitoneal fistula is a rare entity found in approximately 1.6% of patients with peritoneal dialysis. The pathophysiology is unknown, and it is usually associated with increased abdominal pressure. Upon pleural fluid analysis, a transudate with elevated glucose concentration is found, and the patients present with acute dyspnea, cough, and decrease in the ultrafiltration rate. We present the case of an 81-year-old woman with history of peritoneal dialysis presenting with recurrent pleural effusion. A peritoneal scintigraphy with 99mTc was performed confirming the diagnosis of pleuroperitoneal fistula...

We present the 68Ga-DOTATATE and 68Ga-FAPI (fibroblast activation protein inhibitor) PET/CT findings of a 61-year-old man diagnosed with atypical World Health Organization grade II multiple meningiomas. The patient has been stable for 2 years following multiple surgeries and external radiotherapy because of recurring disease until he recently described frequent headaches, and a follow-up examination confirmed new meningioma lesions on MRI. However, the patient was inoperable and was referred for 68Ga-DOTATATE PET/CT to determine eligibility for salvage peptide receptor radionuclide therapy...

Prostate-specific membrane antigen (PSMA) is expressed on the neovasculature as well as to some extent on the glioblastoma cells. With this background, we report the case of a 34-year-old man with recurrent glioblastoma who was treated with 2 cycles of low-dose [177Lu]Lu-PSMA after exhausting all available treatment options in the state sector. Baseline imaging demonstrated intense PSMA signal in the known lesion, which was amenable to therapy. The prospect of [177Lu]Lu-PSMA-based therapy for glioblastoma is warranted going forward...

T-cell-redirecting bispecific antibodies represent a new standard of care for the treatment of triple-class refractory myeloma patients. Here, 2-[18F]FDG PET/CT imaging was performed on a 61-year-old woman with relapsed myeloma to determine metabolic response to talquetamab, a GPRC5DxCD3-bispecific antibody. At day 28, monoclonal (M) component assessment confirmed very good partial response (97% monoclonal protein reduction), whereas 2-[18F]FDG PET/CT imaging revealed early bone flare-up phenomena. At day 84, bone marrow aspirate, M-component assessment, and 2-[18F]FDG PET/CT demonstrated complete response, confirming the early flare-up hypothesis...

A 76-year-old man with a history of prostate cancer diagnosed in 2008 developed biochemical recurrence in 2010 and started intermittent androgen deprivation therapy. In 2021, due to rising prostate-specific antigen, an 18F-piflufolastat PSMA PET/CT was performed. It showed a radiotracer-avid sclerotic lesion in the right iliac bone and an indeterminate radiotracer-avid nodule in the umbilical region, demonstrating progressive enlargement and increased uptake on subsequent imaging. Pathologic analysis of the umbilical nodule revealed metastatic prostate cancer-a finding eponymically referred to as a Sister Mary Joseph nodule...

A 57-year-old man presented with a dry cough and renal insufficiency. Serum immunoglobulin G4 (IgG4) level was markedly elevated, and IgG4-related disease was clinically considered. 18F-FDG PET/CT revealed mild uptake in salivary glands and also moderately increased activity in renal parenchyma and prostate. 68Ga-FAPI PET/CT detected prominent and evenly distributed 68Ga-FAPI uptake in the kidney, and the pancreas, salivary gland, and prostate also showed intense activity, consistent with IgG4-related disease involving the kidney, pancreas, salivary gland, and prostate...

We report the case of a 74-year-old man who had undergone radical prostatectomy for prostatic cancer 6 months earlier. Elevated prostate-specific antigen during follow-up prompted 18F-prostate-specific membrane antigen (PSMA) ligand PET/CT (18F-PSMA-1007 PET/CT) to search for new manifestations of prostate cancer, revealing an increased focal uptake (SUVmax, 5.9) in the left cochlear/pericochlear temporal bone and equivocal PSMA-RADS-3a external iliac nodes. Comparison with cone-beam CT and MRI showed that the focal temporal bone uptake corresponded to the typical morphological features of active otospongiosis (otosclerosis) in the context of a previously known long-standing otospongiosis...

BACKGROUND: Glioblastoma (GB) is the most malignant primary brain tumor. Therefore, introduction of new treatment options is critically important. The aim of this study was to assess local treatment with α emitters [213Bi]Bi-DOTA-substance P (SP) and [225Ac]Ac-DOTA-SP. METHODS: Treatment was performed as salvage therapy in patients with recurrent primary and secondary GB. [213Bi]Bi-DOTA-SP with injected activity 1.85 GBq per cycle was used in 20 primary (48...

A 73-year-old woman was referred for 68Ga-DOTATOC PET/CT staging of a grade 2 pancreatic neuroendocrine tumor, which showed the primary pancreatic tumor, liver metastases, one left pleural metastasis, and high uptake in a mass of the right triceps brachii muscle. Two years before, she underwent 18F-FDG PET/CT and 111In-pentetreotide scan, respectively, with low and high uptake of each radiotracer in the triceps mass. Histopathological analysis revealed a solitary fibrous tumor. Immunohistochemistry showed no staining for SSTR-2 and SSTR-5, suggesting tumor overexpression of another somatostatin receptor...

No abstract text is available yet for this article.

A 53-year-old man with chronic kidney failure was referred to perform an 18F-FDOPA PET/CT to characterize a mass located on the right spermatic cord. Previously, the pathological analysis of CT-guided biopsies suggested paraganglioma or metastatic lesion of pheochromocytoma. Serum normetanephrine and serum metanephrine values were respectively 2- and 1.5-fold greater than the normal upper limit, which could be explained by the chronic kidney failure. PET/CT images revealed intense 18F-FDOPA uptake of the mass without any other pathological findings, suggesting the diagnosis of paraganglioma...

Extensive extramedullary involvement as presentation is uncommon in pediatric B-cell acute lymphoblastic leukemia. A 7-year-old boy was diagnosed with painless parotid gland enlargement. He had pancytopenia and significantly raised serum lactate dehydrogenase. Fine-needle aspiration cytology from the parotid was suggestive of lymphoid malignancy. Flow cytometry and bone marrow biopsy suggested B-cell acute lymphoblastic leukemia. 18F-FDG PET/CT revealed extensive bone marrow disease and the involvement of the spleen, pancreas, kidneys, and the parotid, submandibular, and lacrimal glands...