Leprosy is a chronic infectious disease caused by Mycobacterium leprae infection in susceptible individuals. Without proper clinical diagnosis and treatment, leprosy can have a poor prognosis; however, diagnosing leprosy is challenging. We present a case of leprosy with extensive skin infiltration and involvement of the turbinate mucosa and multiple lymph nodes with increased FDG uptake on PET/CT, mimicking malignancy. Received for publication October 8, 2019; revision accepted November 18, 2019. ...
Mon Jan 20, 2020 02:00
Presacral anastomotic sinus is recognized as a complication of anastomotic leakage in patients with rectal cancer. Active inflammation in the anastomotic sinus can masquerade as pelvic recurrence of rectal cancer. We present a case of progressive inflammation in anastomotic sinus demonstrated by serial FDG PET/CT scans. Despite its benign nature, increased FDG uptake in this nonnegligible condition, which could lead to further detrimental complications including secondary cancer, may have clinical...
Mon Jan 20, 2020 02:00
A 66-year-old man with colorectal carcinoma and liver-only metastases underwent radioembolization using 90Y-loaded, resin-based microspheres. One day after radioembolization, the patient experienced severe hypertension and multiple seizures. On MRI, symmetric edematous areas in the cerebellum and the parietal and occipital lobe were observed, a typical finding for posterior reversible encephalopathy syndrome (PRES). The PRES is associated with, for example, renal failure or blood pressure fluctuations...
Mon Jan 20, 2020 02:00
Introduction The event-free survival in pediatric anaplastic large cell lymphoma (ALCL) remains at 70% irrespective of the diverse chemotherapy regimens used. There is lack of valid prognostic factors identifying high-risk patients. We investigated the prognostic value of baseline metabolic parameters and interim response on 18F-FDG PET/CT in pediatric ALCL patients. Methods We retrospectively reviewed 40 pediatric ALCL patients with paired 18F-FDG PET/CT and treated uniformly on vinblastine-based...
Mon Jan 20, 2020 02:00
Purpose The aim of this retrospective study was to determine, by dynamic acquisition, the optimal scan time of 18F-DOPA PET/CT in patients with recurrent medullary thyroid carcinoma (MTC). Methods Twenty-one patients with suspected recurrent MTC underwent dynamic 18F-DOPA PET/CT (lasting 45 minutes) followed by whole-body scan. Three different time intervals of dynamic acquisition were evaluated: ultra-early phase (2–5 minutes), early phase (5–10 minutes), and late phase (40–45 minutes)....
Mon Jan 20, 2020 02:00
A 59-year-old man with history of POEMS syndrome was found with a painless mass in the right neck for 9 months. In 18F-FDG and 68Ga-pentixafor PET/CT, there were multiple neck nodes and left inguinal nodes that showed intense 18F-FDG and 68Ga-pentixafor uptake. In addition, osteoblastic bone lesions with mild 18F-FDG and 68Ga-pentixafor uptake were noted in the pelvis, which was consistent with posttreated osseous involvement of POEMS syndrome. However, considering lymphoadenopathy with such intense...
Mon Jan 20, 2020 02:00
Juxtaglomerular cell tumor is a rare and benign tumor arising from the juxtaglomerular apparatus that overproduces renin, resulting in secondary hypertension. A 29-year-old woman was incidentally found to have a left renal mass by ultrasonography in a routine health examination. Contrast-enhanced CT results suggested renal cell carcinoma. FDG PET/CT performed for metastatic workup showed increased FDG uptake to the left renal mass and did not reveal any other abnormal FDG-avid lesions. The renal...
Mon Jan 20, 2020 02:00
An 11-year-old girl presented with vomiting, abdominal pain, nausea, and scleral icterus for 7 days. FDG PET/CT demonstrated multiple FDG-avid lesions in muscle, bone, kidney, pancreas, ovary, lymph nodes, and central nervous system. Biopsy from the lesion in the muscle of the right upper arm demonstrated ALK-positive anaplastic large cell lymphoma. The present case highlights the advantage of FDG PET/CT in better staging pediatric patients with anaplastic large cell lymphoma. Received for publication...
Mon Jan 20, 2020 02:00
Purpose Prostate-specific membrane antigen (PSMA) is highly expressed in prostate cancer cells and is exploited for imaging and treatment of patients with prostate cancer. Prostate-specific membrane antigen expression is also demonstrated in the tumor-associated neovasculature endothelium. Juvenile nasal angiofibroma (JNA), being a similar highly vascular tumor, may also demonstrate significant PSMA expression, which may be utilized for its imaging and treatment. Methods In this prospective...
Mon Jan 20, 2020 02:00
Purpose Considerable discrepancies are observed between clinical staging and pathological staging after surgical resection in patients with esophageal squamous cell carcinoma (ESCC). In this study, we examined the relationships between tumor SUVs on FDG PET/CT and aggressive pathological features in resected ESCC patients. Methods A total of 220 patients with surgically resected clinical stage I–II ESCC without neoadjuvant treatment were retrospectively analyzed. SUVmax of the primary tumor...
Mon Jan 20, 2020 02:00
Immunotherapy currently represents one of the most effective therapies in metastatic melanoma. However, its indirect antineoplastic activity through the immune system has raised relevant challenges for diagnostic imaging in the evaluation of the response to treatment. Purpose The aim of this retrospective study was to compare the diagnostic accuracy of different 18F-FDG PET/CT criteria to predict therapy response and clinical outcome in melanoma patients treated with immune checkpoint inhibitors. ...
Mon Jan 20, 2020 02:00
68Ga-PSMA PET/CT imaging is an emerging imaging modality in prostate cancer. PSMA expression is also reported for nonprostate malignancies, including primary hepatocellular carcinoma. Herein, we present a case of a 74-year-ald man with recently diagnosed hepatocellular carcinoma who was referred for 18F-FDG PET/CT imaging for initial staging. The patient underwent 18F-FDG PET/CT as part of staging procedure; he also underwent 68Ga-PSMA PET/CT. PET/CT images revealed only slight 18F-FDG uptake in...
Mon Jan 20, 2020 02:00
A 55-year-old woman presented with intermittent fatigue and abdominal pain. Ultrasound and CT scan showed a large heterogeneous mass in the retroperitoneum, suggestive of malignancy. 18F-FDG PET/CT was performed for staging. PET/CT images showed a hypermetabolic retroperitoneal mass. Endoscopy revealed a mass infiltrating the duodenum. Eventually, the mass was pathologically proved to be malignant melanoma. Further extensive clinical, radiological, and endoscopic investigations proved the retroperitoneum...
Mon Jan 20, 2020 02:00
A 21-year-old man had been diagnosed with immunoglobulin G4–related disease (IgG4-RD) for 5 years, and the disease recurred 1 month ago. 18F-FDG PET/CT revealed intense FDG activity in the pituitary stalk, submandibular gland, pleura, pericardium, pancreas, liver, prostate, and multiple lymph nodes, which were considered the involvements of IgG4-RD. 68Ga-FAPI PET/CT also showed intense 68Ga-FAPI uptake in the above FDG-avid lesions except the lymph node involvement. Additionally, involvement in the...
Mon Jan 20, 2020 02:00
No abstract available
Mon Jan 20, 2020 02:00
On restaging FDG PET/CT for an 81-year-old man with oral cavity cancer, a large FDG-avid mesenteric mass suspicious for either metastasis or second primary was incidentally noted. Surgical pathology showed necrotizing granulomatous inflammation without evidence of tumor. All stains were negative for microorganisms. An elastin stain was negative as well, which excluded an origin of damaged blood vessels or vasculitis. The patient had no prior abdominal surgery or known gastrointestinal disease. Granuloma...
Mon Jan 20, 2020 02:00
Contrast CT revealed diffuse enlargement of the pancreas with a suspicious lesion in the uncinate process in a 57-year-old man who presented with jaundice. 18F-FDG PET/CT showed increased radioactivity in the enlarged pancreas with a nodular lesion with even higher uptake in the uncinate process. To differentiate autoimmune pancreatitis and pancreatic cancer, 68Ga-FAPI PET/CT was performed. It revealed intense 68Ga-FAPI uptake in the pancreas, but the FDG-avid lesion in the uncinate process was not...
Mon Jan 20, 2020 02:00
We report of a 71-year-old woman with a 2-cm somatostatin receptor–positive intrapancreatic lesion almost misdiagnosed as neuroendocrine neoplasm. By additional red blood cell scintigraphy with heat-damaged erythrocytes, the lesion was identified as an intrapancreatic accessory spleen, and unnecessary operation (which was already planned) could be avoided. This case report reminds colleagues to consider accessory spleen as differential diagnosis for somatostatin receptor–positive lesions even when...
Mon Jan 20, 2020 02:00
We present the case of a 13-year-old boy with bleeding complications from a Meckel diverticulum (MD), which was scintigraphically confirmed. A first exploratory laparoscopy was unsuccessful in identifying the diverticulum. A new 99mTc-pertechnetate scintigraphy (including SPECT/CT), 3 years later, suggested the anatomical location and was helpful during the surgical exploration for the MD by radioguided surgery. Radioguidance is helpful in pathologies characterized by small size or variable anatomical...
Mon Jan 20, 2020 02:00
Intravascular large B-cell lymphoma is a rare type of non-Hodgkin lymphoma characterized by intravascular proliferation of clonal lymphocytes within the lumen of small vessels, which is often fatal. Diffuse FDG uptake in the lung without clear/evident CT findings, “hot lung,” is quasi-pathognomonic for lung intravascular large B-cell lymphoma. In this report, we present the case of a 43-year-old man who was diagnosed as having intravascular lymphoma thanks to this rare finding. Received for publication...
Mon Jan 20, 2020 02:00
We present here a case with β-radiation–refractory metastatic neuroendocrine tumors, who demonstrated an excellent therapy response after 1 cycle of 225Ac-DOTATOC, without any significant adverse effects even after 10 cycles of β-emitter peptide receptor radionuclide therapy followed by α-peptide receptor radionuclide therapy. Received for publication September 27, 2019; revision accepted November 2, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Jingjing...
Mon Jan 20, 2020 02:00
ROS-1–positive non–small cell lung cancers (NSCLCs) are rare (approximately 1% of all NSCLCs) and require a first-line treatment by crizotinib. Crizotinib resistance is frequent within the first 12 months of treatment. Lorlatinib is a novel tyrosine kinase inhibitor of ROS-1 recently indicated for metastatic or locally advanced crizotinib-resistant NSCLC. We report the use of lorlatinib as second-line with a complete tumoral response after only 3 months of treatment. This case shows the major role...
Mon Jan 20, 2020 02:00
Background The present study aimed to better define the usefulness of 18F-FDG PET/CT in predicting pathological tumor response (PTR) and survival in patients with noncardia gastric cancer treated with preoperative chemotherapy. Methods Seventy-one patients were recruited in 6 Italian centers. The SUV of 18F-FDG PET/CT was measured at baseline and after treatment, and the difference (dSUV) was computed. The association between PET indexes and PTR, assessed by the Becker score, was evaluated...
Mon Jan 20, 2020 02:00
No abstract available
Mon Jan 20, 2020 02:00
Renal cell carcinoma (RCC) is the most common solid renal malignancy that metastasizes typically to lungs, bones, liver, adrenals, and lymph nodes. Isolated pleural metastases of RCC are extremely rare, with only few cases reported in the literature. We report one such case of a 60-year-old woman, a known case of RCC of the left kidney who underwent nephrectomy, and on follow-up, PET/CT scan revealed diffuse thick nodular hypermetabolic left pleural thickening, which was later biopsied and turned...
Mon Jan 20, 2020 02:00
A 71-year-old man with a history of high-risk prostate adenocarcinoma (Gleason score 4 + 5 = 9) treated with brachytherapy in 2016 was referred for a 68Ga–prostate-specific membrane antigen (PSMA)–HBED–CC PET/CT scan for suspected cancer recurrence on a background of slowly rising serum prostate-specific antigen (0.95 ng/mL; reference,
Mon Jan 20, 2020 02:00
We present the case of a 69-year-old man with history of prostate carcinoma treated with prostatectomy and subsequently with external beam radiotherapy and hormone therapy because of biochemical recurrences. More than 10 years after the diagnosis, follow-up 99mTc-HDP bone scans and SPECT/CT images demonstrated an incidental diagnosis of osteoblastic pleural plaques that quickly evolve to mesothelioma. PET/CT achieved the definitive diagnosis by guiding the biopsy to the highest and most accessible...
Mon Jan 20, 2020 02:00
No abstract available
Mon Jan 20, 2020 02:00
Purpose The aim of this study was to investigate the imaging diagnostic performance of 18F-fluciclovine PET/CT and pelvic multiparametric MRI (mpMRI) for prostate cancer in the setting of rising PSA after initial treatment, with a focus on detection of recurrent and metastatic prostate cancer in the pelvis. Methods Patients with prostate cancer who had fluciclovine PET and pelvic mpMRI between October 2017 and October 2018 in our center were retrospectively reviewed. Patients were included...
Mon Jan 20, 2020 02:00
Radiolabeled somatostatin receptor (SSTR) antagonists have shown promise for imaging neuroendocrine neoplasms and the superiority to SSTR agonists, with lower liver background especially for the sensitive detection of liver metastases, higher tumor-to-background ratio, and favorable pharmacokinetics. The clinical data of radiolabeled SSTR antagonists for therapy are still limited. We report our experience treating a young patient with DOTATOC-negative high-grade liver metastases of a pancreatic neuroendocrine...
Mon Jan 20, 2020 02:00
A 67-year-old asymptomatic man with biochemical recurrent prostate cancer underwent 18F-fluciclovine PET/CT for restaging to determine subsequent treatment strategy. PET/CT images were obtained from the proximal thighs to the vertex of the skull, after the intravenous administration of 362.6 MBq (9.8 mCi) of 18F-fluciclovine. PET/CT imaging demonstrated a focus of abnormally increased 18F-fluciclovine uptake corresponding to a small nodularity in the left parotid gland. Subsequent ultrasound-guided...
Mon Jan 20, 2020 02:00
Estrogen receptor–expressing breast cancer exhibits better prognosis due to responsiveness to antiestrogen treatment. Therefore, knowledge of the estrogen receptor status of a tumor is an important prognostic and predictive indicator in breast cancer. We present noninvasive imaging of estrogen receptors with 99mTc tamoxifen that can identify the active tumor and approachable sites for biopsy. It may help in selection of patients for hormone replacement therapy and in assessment of receptor status...
Mon Jan 20, 2020 02:00
Within 48 hours after surgery, disease assessment in glioblastoma is a challenge for both the clinician and the radiologist. Certain technical and logistical issues prevail in this period. 68Ga–prostate-specific membrane antigen PET/CT is a known molecular imaging marker in prostate cancer. Its role in high-grade gliomas has been recently discussed. We present a case of a 39-year-old man with recurrence glioblastoma of the right frontal lobe and underwent resurgery. After surgery, 68Ga–prostate-specific...
Mon Jan 20, 2020 02:00
Pseudomyogenic hemangioendothelioma is a rare vascular tumor described as a fibroma-like variant of epithelioid sarcoma. There were scant publications about FDG PET/CT findings of pseudomyogenic hemangioendothelioma. A 20-year-old man with biopsy-confirmed pseudomyogenic hemangioendothelioma of the left tibia had FDG PET/CT for evaluation of the lesion extent and metastasis, which demonstrated numerous, multilayer FDG-avid lesions of the left lower extremity below the knee. Although pathologic examination...
Mon Jan 20, 2020 02:00
Focal nodular fat sparing of the liver may show, on PET/CT imaging, prominent tracer uptake over a background of less metabolic features of steatosis. This finding, already reported with 18F-FDG, may mimic primary or secondary neoplasms of the liver. The authors present an additional case of nodular fat-sparing hepatic parenchyma exhibiting 11C-choline avidity during PET/CT assessment for biochemical recurrence of prostate cancer. Received for publication July 26, 2019; revision accepted October...
Mon Jan 20, 2020 02:00
Immunoglobulin G4–related disease is a fibroinflammatory condition that has the tendency to involve almost every organ of the body. We report the case of a young asymptomatic man with right suprahilar opacity on chest radiograph detected during routine annual health check-up. Mediastinoscopic sampling of the lesion was inconclusive. 18F-FDG PET/CT done to characterize the lesion revealed hypermetabolic mass with areas of necrosis in the right paratracheal location. Histopathologic examination from...
Mon Jan 20, 2020 02:00
A girl diagnosed with neuroblastoma at 33 months underwent 123I-MIBG scan after surgery and chemoradiotherapy. Although MIBG scan showed complete response, the bone marrow biopsy showed refractory disease. Therefore, she underwent 68Ga-DOTATATE PET/CT, which revealed bone marrow involvement and 68Ga-DOTATATE–avid brain metastasis. Rare physiological pineal gland uptake was also depicted. 68Ga-DOTATATE PET/CT showed active progressive disease earlier, before it was detectable with MIBG scan. For patients...
Mon Jan 20, 2020 02:00
Amyloidosis is a rare hereditary or acquired protein deposition disorder with different etiologies, characterized by pathological protein deposition essentially in nearly any organs or tissues. There are 2 major forms: primary and secondary amyloidosis. Moreover, it is possible to have systemic or localized disease. The localized form of amyloidosis affecting the small intestine is rare, and it is characterized by the formation of precursor proteins at the site of the lesion. We report a case of...
Mon Jan 20, 2020 02:00
We report a known case of severe achalasia that appeared on 68Ga–prostate-specific membrane antigen (PSMA) PET/CT. The patient was a known case of high-grade transitional cell carcinoma and suspicious diagnosis of prostate cancer referred for 68Ga-PSMA PET/CT. 68Ga-PSMA PET/CT showed linear increased activity in the esophageal wall as well as a distended esophagus. Received for publication September 13, 2019; revision accepted October 6, 2019. Conflicts of interest and sources of funding: none...
Mon Jan 20, 2020 02:00
A 62-year-old man with a history of locally advanced poorly differentiated adenocarcinoma of the gastroesophageal junction had received induction chemotherapy and concurrent chemoradiation. A 6-month follow-up FDG PET/CT revealed nearly resolved primary malignancy, but new hypermetabolic mediastinal lymph node metastasis and abnormal hypermetabolism in the cerebellum region. Brain MRI and lumbar puncture confirmed leptomeningeal metastasis. Received for publication November 20, 2019; revision accepted...
Mon Jan 20, 2020 02:00
A 46-year-old man underwent 99mTc-pyrophosphate scan to evaluate possible infiltrative myocardiopathy revealed by echocardiography. The images did not show abnormal cardiac activity. However, diffuse abnormal activity in the liver and spleen was noted. Pathological examination from the specimen acquired from hepatic biopsy demonstrated amyloidosis, light chain type. Received for publication September 28, 2019; revision accepted October 4, 2019. Conflicts of interest and sources of funding: This...
Mon Jan 20, 2020 02:00
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