A prospective study of 68Ga-PSMA PET/CT imaging of HCC as diagnosed on conventional imaging to evaluate for potential 177Lu-PSMA therapy.

OBJECTIVE: PSMA expression is seen in many solid tumours in addition to prostate cancer and several studies and case reports have shown PSMA expression and 68Ga-PSMA imaging of hepatocellular carcinoma (HCC). Our prospective study evaluates the role of 68Ga-PSMA in HCC patients and compares it to conventional imaging (CE-CT/MRI). METHODS: Patients with radiologically and/or histopathologically confirmed HCC were included and all had undergone serum alpha-fetoprotein (S.AFP) assessment as well as CE-CT/MRI prior to PSMA PET/CT. Acquired whole-body PET/CTs were analysed both visually and quantitatively by two experienced nuclear medicine physicians. RESULTS: Forty-one (41) patients (36 male; 5 female) with known HCC and a mean age of 53.9 ± 10.9 years underwent 68Ga-PSMA PET/CT. All patients had lesions on conventional imaging but only 38/41 patients showed 68Ga-PSMA uptake. Conventional imaging revealed 18 patients with single lesions, all of which were tracer avid. Twenty-three (23) of 41 patients had multifocal (> 2) hepatic lesions on CE-CT/MRI of which 3 patients showed no 68Ga-PSMA uptake, 7 showed tracer uptake in a single lesion only and 13 patients had multifocal tracer avid lesions. There was no correlation observed between S. AFP level and tumour SUVmax on 68Ga-PSMA PET/CT. CONCLUSION: 68Ga-PSMA PET/CT imaging of HCC may complement conventional imaging and identify patients for potential theranostic intervention.

Effect of Single dose of Methylprednisolone Injection at Stylomandibular Ligament Insertion on Pain and Various Mandibular Movements Among Patients with Ernest Syndrome: A Pilot Study.

Insertion tendinosis of stylomandibular ligament or Ernest syndrome is a rarely encountered cause of orofacial pain. The pain in this disorder originates from the stylomandibular ligament insertion site and radiates to the temporomandibular joint (TMJ), neck, shoulder, and periauricular region. Ten subjects who had undergone surgery for mandible fractures diagnosed with Ernest syndrome were considered for the present study. The origins and insertions of the stylomandibular ligament were marked and palpated using fingertip and blunt probe. The Ernest syndrome was confirmed by injecting diagnostic local anesthesia injection. A single dose of 2 ml methylprednisolone (40 mg/ml) was injected at the insertion site of a stylomandibular ligament in each subject. The effect of methylprednisolone injection on pain and various jaw movements were assessed at 1-month and 6-months after the injection. The mean pain value ranks during rest & while mouth opening in the visual analogue scale (VAS) reduced significantly after single injection (P < 0.001). The mean mouth opening increased significantly from 23.3 ± 3.94 mm before the treatment to 36.1 ± 3.07 mm at 1-week and 35.4 ± 2.17 mm at 6-months after the treatment (P < 0.001). The mandible protrusive movement increased from 4.07 ± 0.74 mm before treatment to 5.06 ± 0.62 mm at 1-week and 4.94 ± 0.62 mm at 6-months after the injection, respectively. Single dose of methylprednisolone injection at the insertion site of the stylomandibular ligament was proved effective on pain and various mandibular movements among patients with Ernest syndrome.

Comparison of 68Ga-PSMA-HBED-CC and 18F-FDG PET/CT in the Evaluation of Adenoid Cystic Carcinoma-A Prospective Study.

PURPOSE OF STUDY: 18F-FDG PET/CT plays a major role in diagnosis and staging of head and neck cancer; however, FDG has lower uptake in adenoid cystic carcinoma (AdCC). Prostate-specific membrane antigen (PSMA) expression is found to be associated with endothelial cells or tumor neovasculature in malignant AdCC and salivary duct carcinoma. Thus, present study is aimed to compare the role of 68Ga-PSMA and 18F-FDG PET/CT in patients with primary and/or metastatic AdCC. MATERIALS AND METHODS: Histopathologically proven AdCC patients were intravenously injected with 370 MBq (10 mCi) of 18F-FDG and 111-185 MBq (3-5 mCi) of 68Ga-PSMA. Images were acquired at 60 and 45 minutes postinjection for 18F-FDG and 68Ga-PSMA, respectively, on dedicated PET/CT scanners. Visual and semiquantitative analyses of PSMA expression in regional and metastatic sites were performed by 2 experienced nuclear medicine physicians. RESULTS: Seventeen patients (7 men, 10 women) having mean age of 44 ± 14.19 years were prospectively included in the study. Of 17 patients, FDG PET/CT was performed in only 14 (82%) patients. PSMA and FDG uptakes were seen at the primary site in 16 (94%) and 13 (93%) patients, respectively, whereas 1 patient was postradical tumor excision. Lung lesions (n = 7) and lymph nodes (n = 5) were detected on both FDG and PSMA PET scans. However, cerebellar and meningeal metastasis (n = 1, 6%) and bony lesions (n = 2, 12%) were detected only on PSMA PET/CT but not visualized on FDG PET/CT scan. CONCLUSIONS: PSMA may have theranostic importance in unresectable or metastatic AdCC, besides having a role in staging/restaging.

68Ga-DOTANOC PET/CT for Screening and Surveillance of Von Hippel-Lindau (VHL) disease.

Purpose: Hereditary tumor syndrome Von Hippel-Lindau (VHL) disease is characterized by various benign and malignant tumors that are known to express somatostatin receptors (SSTR). We evaluated the role of 68Ga-DOTANOC PET/CT scan in patients with positive germline mutation of the VHL gene, presented initially or on follow-up, for the detection of recurrent or synchronous/metachronous lesions. Methods: Fourteen patients (8 males; 6 females) with mean age 30 ± 9.86 years were retrospectively analyzed, were tested positive for VHL on gene dosage analysis, and underwent 68 Ga-DOTANOC PET/CT scan for disease evaluation. The number and site of lesions were determined. The tracer uptake was analyzed semi-quantitatively by calculating the maximum standardized uptake values (SUVmax) of lesion. Results: Four of the 14 patients underwent scan for initial diagnosis as baseline, 6 patients for post-therapy disease status, and 4 patients for initial diagnosis as well as follow-up evaluation of the disease. A total of 67 lesions were detected in 14 patients. The sites of lesions were cerebellar/vertebral/spinal (17; mean SUVmax = 7.85); pancreatic neuroendocrine tumor (NET) (11; mean SUVmax = 20.64); retina (3; mean SUVmax = 10.46); pheochromocytoma (10; mean SUVmax = 16.32); paragangliomas (3; mean SUVmax = 10.65); pancreatic cyst (9; mean SUVmax = 2.54); and renal cyst (8; mean SUVmax = 1.56) and miscellaneous lesions constituted 6 lesions. Conclusion: Our results show that 68 Ga-DOTANOC PET/CT may be a useful modality for screening and follow-up of associated tumors in patients with germline gene mutation for VHL. It can be used as a one-stop imaging modality for VHL patients and may substitute for separate radiological investigations, making it more convenient for patients in terms of time and cost.

Intra-articular injection of hyaluronic acid versus platelet-rich plasma following single puncture arthrocentesis for the management of internal derangement of TMJ: A double-blinded randomised controlled trial.

The present study aimed to compare the efficacies of intra-articular injections of platelet-rich plasma (PRP) and hyaluronic acid (HA) following single needle arthrocentesis in patients with TMJ internal derangement. This double-blinded randomised controlled trial involved the enrolment of patients diagnosed with unilateral TMD, falling into either Wilkes' stages II or III. In Group A, single needle arthrocentesis was performed using Ringer's lactate serving as a control group; in Group B, intra-articular injection of 1 ml hyaluronic acid injection was given following arthrocentesis; and in Group C, autologous intraarticular injections of 1 ml of PRP was given after arthrocentesis, twice in two weeks' interval. The primary outcome variables were maximum mouth opening and pain, while TMJ clicking sounds formed the secondary outcome variable. All the outcome variables were assessed preoperatively (T0) and postoperatively after the second dose of injection at one month (T1), three months (T2), and six months (T3). The alpha level was set to p < 0.05. Ninety patients (N = 90) comprised the final sample size of the study with thirty patients(n = 30) in each treatment group. A statistically significant decrease in the management in mean pain scores was noted between T0 [mean scores were 7.30 ± 1.05 (Group A), 7.63 ± 1.12 (Group B), and 7.56 ± 1.04(Group C)] and T3 [mean scores were 2.66 ± 0.88 (Group A), 2.4 ± 0.72 (Group B), and 1.66 ± 0.66 (Group C)] time intervals between Group A and C(p < 0.001). Significant improvement was noted in preoperative maximum mouth opening (MMO) of Group A, B, and C which was 22.83 ± 3.58, 22.17 ± 4.07, and 21.37 ± 3.69, respectively to 28.90 ± 2.72, 32.17 ± 3.97, and 34.10 ± 3.80 mm, respectively at six months postoperatively (p < 0.001). A significant decrease in joint sounds was evident for all three groups(p = 0.003 for Group A, p < 0.001 for Group B, and p < 0.001 for Group C) across the time intervals. Moreover, Group C showed a significant decrease in the prevalence of joint sound compared to the other two groups at all-time intervals postoperatively when equated to baseline (p = 0.02 at T1, p = 0.009 at T2, and p = 0.002 at T3). Within the limitations of the present study, it can be concluded that intra-articular PRP may be preferable over HA whenever appropriate, following single needle arthrocentesis in the treatment of TMJ internal derangement.

Comparative Role of 18F-DOPA PET/CT and 131I-MIBG Scintigraphy in Neuroblastoma and Application of Curie and SIOPEN Scoring Systems in 18F-DOPA PET/CT.

Purpose: Neuroblastoma (NB) is childhood's most common extracranial solid malignancy. We have compared two imaging modalities, 131I-MIBG and 18F-DOPA PET/CT, to evaluate NB. Also, feasibility of the application of standardised scoring systems, SIOPEN and Curie scoring systems, in 18F-DOPA PET/CT was explored. Methods: Patients with histopathology-proven NB underwent 131I-MIBG (planar and SPECT/CT) and 18F-DOPA PET/CT scans, as per standard imaging protocols. Duration between scans ranged from 1 to 30 days (median = 8 days). Number of lesions in Curie and SIOPEN scoring systems applied on both modalities was compared. Results: Forty-six patients were included (M:F = 29:17) with a median age of 36 months. Both 131I-MIBG and 18F-DOPA scans were positive in 39 patients and negative in four patients. 18F-DOPA PET/CT was positive in additional three patients, in which 131I-MIBG was negative (p = 0.25). Overall, 18F-DOPA identified significantly greater number of lesions than 131I-MIBG, especially metastatic skeletal lesions (p < 0.05). Significant difference was observed between Curie scores in the two modalities, unlike SIOPEN scores. However, when the cut-off age of 18 months was taken, no significant difference was seen in either of the scoring systems in both the scans (p > 0.05). CS and SIOPEN scores were significantly higher in bone marrow-positive patients. Conclusion: 18F-DOPA PET/CT detected more lesions than 131I-MIBG but had little impact on staging of the disease. For evaluation of NB, both scans can be used interchangeably as per the availability. Furthermore, both SIOPEN and Curie scoring systems, standardised for MIBG, can also be used to semi-quantify disease extent in 18F-DOPA PET/CT. Supplementary Information: The online version contains supplementary material available at 10.1007/s13139-022-00762-6.

99mTc-Ethambutol Scintigraphy with Single-Photon Emission Computed Tomography/Computed Tomography in Vertebral Tuberculosis.

Vertebral tuberculosis (TB) is a common form of extrapulmonary TB. Here, the slow-growing Mycobacterium bacillus reaches the disc space through the hematogenous route and leads to various complications. Radiological imaging and histopathology have been the mainstay of diagnosis, but radionuclide imaging techniques using radiolabeled antitubercular drugs have rarely found space in the clinical domain. Here, we present a case of vertebral TB, where a technetium-labeled antitubercular drug, ethambutol, was synthesized and used for imaging the bacteria in vivo. Thus, we demonstrate a rarely used potentially specific agent for tuberculous-infection imaging, which can be produced in-house, and provides rapid results.

F-18 DOPA PET/CT in pediatric patients with hyperinsulinemic hypoglycemia: A correlation with genetic analysis.

AIM: Persistent hyperinsulinemic hypoglycemia is a rare but life-threatening disease of infancy and childhood. 18F-DOPA PET/CT has been shown to be a useful modality in the localization of focal pancreatic lesions in these patients. We aimed to assess the role of 18F-DOPA PET/CT in such patients at our institution. MATERIALS AND METHODS: In this prospective study, 18F-DOPA PET/CT scans and clinical details of 20 children with clinical diagnosis of hyperinsulinemic hypoglycemia were reviewed. Scans were acquired at 5 min postinjection of 2-3 mCi of 18F-DOPA on dedicated PET/CT scanners (Biograph mCT, Siemens Inc and Discovery PET/CT, GE). Abdominal spot images over 1-2 bed positions were acquired. Additionally, genetic mutation status, where available, was correlated to the scan findings. RESULTS: Out of 20 children (7 female and 13 male), 13 were infants. The age of the children ranged from 3 months to 8 years. Fifteen children had undergone gene analysis, 12 were positive for mutation in ABCC8, 1 for GLUD-1, 1 for GCK mutations and 1 had not shown any mutation. 18F-DOPA PET/CT scan showed 5 focal pancreatic lesions in 5 children (1 in each), two focal lesions in 1 child and diffuse pancreatic uptake in 14 children. CONCLUSION: 18F-DOPA PET/CT is a useful modality for localizing focal pancreatic lesions in children with persistent hyperinsulinemic hypoglycemia. The detection rate is significantly higher in patients with ABCC8 paternal monoallelic recessive gene mutation. 18F-DOPA PET/CT scan consequent to findings on genetic analysis appears to be useful in planning the management of children with hyperinsulinism.

Comparison of 99mTc-methyl diphosphonate bone scintigraphy and 68Ga-DOTANOC PET/computed tomography in articular manifestation of rheumatoid arthritis.

OBJECTIVE: Tc-99m methyl diphosphonate (MDP) bone scintigraphy is used to assess disease activity in rheumatoid arthritis (RA). Somatostatin receptor (SSTR) expression in RA has been reported previously. SSTR-based PET/computed tomography (CT) may be superior to bone scintigraphy to know disease extent and in locating inflammatory joints that can be further targeted with peptide receptor radionuclide therapy thereby opening up new theranostic avenues. Based on these facts, the present study was designed to compare Tc-99m MDP bone scintigraphy and Ga-68 DOTANOC PET/CT in patients with RA. MATERIALS AND METHODS: Patients with a clinical diagnosis of RA were injected with 111-185 MBq of Ga-68 DOTANOC and 740 MBq of Tc-99m MDP intravenously. Images were acquired 30-45 min postinjection for Ga-68 DOTANOC on dedicated PET/CT scanners. Triple-phase bone scans were acquired on a dual-head gamma camera. PET/CT and MDP scan images were visually assessed by two experienced nuclear medicine physicians. RESULTS: Nineteen patients (16 women and 3 men) with a clinical diagnosis of RA were included in the study. Clinically, 196 joints in these 19 patients were diagnosed positive for RA. Of these 196 joints, Tc-99m MDP uptake was seen in 157 joints (80%). On Ga-68 DOTANOC scan, tracer uptake was seen in 151 of 196 joints (77%) with a lesion to background ratio of at least 2 in most of the joints. CONCLUSION: Ga-68 DOTANOC is equally good as an MDP scan for detection of RA with the added advantage of being used as a theranostic modality. However, further evaluation with a larger sample size and joint-to-joint comparison is warranted.

Ga-68 Prostate-Specific Membrane Antigen-HBED-CC Positron Emission Tomography/Computed Tomography in Anaplastic Thyroid Carcinoma.

Purpose: Anaplastic thyroid carcinoma (ATC) is the most aggressive thyroid cancer and there is no established treatment that works well. The study was conducted to see prostate-specific membrane antigen (PSMA) expression in ATC as a stepping stone to study its role in potential theranostics. Materials and Methods: Pathologically proven ATC patients were prospectively included in this study. Ga-68-PSMA positron emission tomography/computed tomography (PET/CT) was done to look for PSMA expression in local and distant sites 45-60 mins after injecting 2-3mCi of tracer. Results: Twenty patients were enrolled in this study. Nodal metastases were seen in all patients, while distant metastases were seen in 17/20. The mean SUVmax of primary lesion was 6.72 ± 4.6. Mean SUVmax of node and lung lesions was 5.7 ± 5.6 and 2.9 ± 1.98, respectively. Mean SUVmax of liver, mediastinum, and parotid gland was 5.95 ± 3.03, 1.54 ± 0.68, and 9.03 ± 3.75, respectively. Mean Tumor to background ratio (liver = TBRl; mediastinum = TBRm; parotid = TBRp) were 1.21, 4.49 and 0.78, respectively. Conclusion: ATC showed variable PSMA expression on Ga-68-PSMA-PET/CT and this attribute may be potentially useful in ATC theranostics.

99mTc-Ethambutol Scintigraphy with Single-Photon Emission Computed Tomography/Computed Tomography in Lymph Node Tuberculosis: An Initial Experience.

Purpose of the Study: The purpose of the study is to evaluate 99mTc-labeled ethambutol (99mTc-EMB) as a potential diagnostic agent in lymph node tuberculosis (LNTB). Materials and Methods: A prospective pilot study was done at All India Institute of Medical Sciences, New Delhi. We included adult consenting patients who were diagnosed with LNTB and were either treatment naïve or had just started treatment. Patients were injected with 10-15 mCi of 99mTc-EMB. Whole-body anteroposterior planar imaging was done from 15 min after injection at serial intervals till 4-6 h along with one single-photon emission computed tomography-computed tomography (SPECT-CT) imaging with the help of a dual-head SPECT-CT gamma camera. The uptake of 99mTc-EMB was analyzed and corroborated with clinicoradiological findings. Results: Between January 2019 and November 2020, we recruited 23 patients who underwent 99mTc-EMB, and 19 scans were interpretable and considered for analysis. Cervical lymphadenopathy was the most common presentation (13, 68.42%), followed by mediastinal (9, 47.36%) and abdominal (4, 21.05%) nodes. Other involvement included pulmonary (8, 42.1%), gastrointestinal (3, 15.78%), and chest wall abscess and bone marrow deposits in 1 patient each. A positive scan was noted in 7 (53.84%) patients with cervical lymphadenopathy, whereas uptake in abdominal and mediastinal lymph nodes was seen in 1 (25%) and 2 (22.22%) cases, respectively. Uptake in pulmonary lesions was noted in 3 (37.5%), but uptake in hepatic and splenic lesions was not seen. Conclusion: 99mTc-EMB scan can demonstrate drug penetrance in vivo in some patients with LNTB and should be explored further with a larger sample size.

Functional outcome of two different grafting techniques in the surgical management of oral submucous fibrosis: a comparative evaluation.

OBJECTIVE: To evaluate the functional efficacy of two different grafting techniques following the fibrotomy among subjects with oral submucous fibrosis (OSMF). DESIGN: Forty consecutively treated OSMF subjects between 20 and 40 years who had grades 3 and 4a OSMF and mouth opening < 15 mm were included in the present study. All the subjects were randomly divided into two groups. In Group I, all the subjects received a buccal pad of fat sandwiched with a nasolabial flap following fibrotomy. In contrast, Group II subjects received a buccal pad of fat combined with a collagen graft. The effect of two different surgical protocols on mouth opening was evaluated clinically before the surgery (T0) and 1 month (T1), 6 months (T2), and 12 months (T3) after the surgery. RESULTS: In Group I subjects, the mouth opening increased significantly (P < 0.001) from 10.90 ± 1.971 mm at T0 to 34.25 ± 3.127 mm at T1, but reduced marginally to 32.15 ± 3.422 mm at T2, and 31.30 ± 3.358 mm at T3. In Group II, the mouth opening increased significantly (P < 0.001) from 10.85 ± 1.725 mm at T0 to 28.90 ± 3.059 mm, 29.10 ± 2.808 mm, and 28.20 ± 2.285 mm at T1, T2, and T3, respectively. At the end of 12 months of follow-up, the mean value improvement in the mouth opening (T0-T3) was 20.4 ± 3.5 mm and 17.3 ± 2.9 mm in Groups I and II, respectively, and the difference was statistically significant (P = 0.006). CONCLUSION: The buccal pad of fat sandwiched with a nasolabial flap for the reconstruction following fibrotomy had a slightly better beneficial effect on the postoperative mouth opening among OSMF subjects.

99mTc-Ethambutol Scan with SPECT/CT in Knee Joint Tuberculosis.

Modalities for in vivo imaging of Mycobacterium tuberculosis are limited and inadequately studied. One such modality is 99mTc-ethambutol scintigraphy which has shown promising results for diagnosis of tuberculosis (TB). Ethambutol, one of the primary antitubercular drugs, is bacteriostatic which acts on the mycolic acid cell wall synthesis of the M. tuberculosis. However, literature on its utility is scarce. The few studies that exist have reported its sensitivity and specificity between 90%- 95% and 71%-85%. We present here a case demonstrating the role of 99mTc-ethambutol scan in knee joint TB.

Management of patients with allergy to local anesthetics: two case reports.

Lidocaine is the most commonly used local anesthetic (LA) agent in various dental as well as oral and maxillofacial procedures. Although rare, adverse effects and allergic reactions to lidocaine have been reported. In patients with suspected allergy to LA or a history of such reaction, careful history-taking and allergy testing should be performed to choose an alternative LA agent to avoid any adverse effects. Here, we present two cases of delayed hypersensitivity reaction to lidocaine, wherein the patients presented with erythema, edema, and itching. Intradermal testing confirmed allergic reaction to lidocaine, and the patients underwent successful dental treatment using an alternative LA agent. This report highlights the importance of allergy testing prior to LA use considering the serious consequences of allergy to these agents and describes the management of such patients using an alternative LA agent.

Prognostication Based on Texture Analysis of Baseline 18F Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Nonsmall-Cell Lung Carcinoma Patients Who Underwent Platinum-Based Chemotherapy as First-Line Treatment.

OBJECTIVE: Our study aims to establish the potential for tumor heterogeneity evaluated using 18F fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) texture analysis in nonsmall-cell lung carcinoma (NSCLC) patients who underwent platinum-based chemotherapy to provide an independent marker for overall survival (OS) of more than 1-year. MATERIALS AND METHODS: A total of 42 patients (34 male and 8 female) with biopsy-proven NSCLC and mean age 55.33 ± 10.71 years who underwent a baseline F-18 FDG PET/CT and received platinum-based chemotherapy as first-line treatment were retrospectively included in the study. Ten first order, 21 s order texture parameters and 7 SUV and metabolic tumor volume (MTV) based metabolic parameters were calculated. All these parameters were compared between the two survival groups based on OS ≥1 year and OS <1 year. Cut-offs of significant parameters were determined using receiver operating characteristic curve analysis. Survival patterns were compared by log-rank test and presented using Kaplan-Meier curves. Cox proportion hazard model was used to determine the independent prognostic marker for 1 year OS. RESULTS: In univariate survival analysis, 3 first order texture parameters (i.e. mean, median, root mean square with hazard ratios [HRs] 2.509 [P = 0.034], 2.590 [P = 0.05], 2.509 [P = 0.034], respectively) and 6 s order texture parameters (i.e. mean, auto correlation, cluster prominence, cluster shade, sum average and sum variance with HRs 2.509 [P = 0.034], 2.509 [P = 0.034], 3.929 [0.007], 2.903 [0.018], 2.954 [0.016] and 2.906 [0.014], respectively) were significantly associated with 1 year OS in these patients. Among the metabolic parameters, only metabolic tumor volume whole-body was significantly associated with 1 year OS. In multivariate survival analysis, cluster prominence came out as the independent predictor of 1 year OS. CONCLUSION: Texture analysis based on F-18 FDG PET/CT is potentially beneficial in the prediction of OS ≥1 year in NSCLC patients undergoing platinum-based chemotherapy as first-line treatment. Thus, can be used to stratify the patients which will not be benefitted with platinum-based chemotherapy and essentially needs to undergo some other therapy option.

Haralick texture features extracted from Ga-68 PSMA PET/CT to differentiate normal prostate from prostate cancer: a feasibility study.

OBJECTIVE: Role of texture parameters on the basis of Ga-68 PSMA PET/CT in prostate cancer (Pca) is largely unexplored. Present work done is a preliminary study that aims to evaluate the role of Haralick texture features on the basis of Ga-68 PSMA PET/CT in Pca in which texture features were used to differentiate between normal prostate and Pca tissue. METHODS: The study retrospectively enrolled patients in two groups: group 1 included 30 patients with biopsy-proven adenocarcinoma prostate and median age 64 years (range: 50-82 years) who underwent baseline Ga-68 PSMA PET/CT prior to therapy; group 2 included 24 patients with pathologies other than Pca and median age 53.5 years (range: 18-80 years) who underwent Ga-68 PSMA PET/CT as part of another study in our department. Patients in group 2 did not have any prostate pathology and served as controls for the study. The segmented images of prostate (3-D image) were used to calculate 11 Haralick texture features in MATLAB. SUVmax was also evaluated. All parameters were compared among the two groups using appropriate statistical analysis and P value <0.05 was considered significant. RESULTS: All 11 Haralick texture features, as well as SUVmax, were significantly different among Pca and controls (P < 0.05). Among the texture features, contrast was most significant (P value of Mann-Whitney U <0.001) in differentiating Pca from normal prostate with AUROC curve of 82.9% with sensitivity and specificity 83.30% and 73.30%, respectively at cut-off 0.640. SUVmax was also significant with AUROC curve 94.0% and sensitivity and specificity 62.5% and 90%, respectively at cut-off 5.7. A significant negative correlation of SUVmax was observed with contrast. CONCLUSION: Haralick texture features have a significant role in differentiating Pca and normal prostate.

Rare Brain Metastasis in Parotid Adenoid Cystic Carcinoma Detected on 68Ga-PSMA PET/CT.

ABSTRACT: We present the case of a 45-year-old woman with known adenoid cystic carcinoma of the right parotid gland, postexcision and postoperative radiation therapy. She was followed up on 18F-FDG PET/CT, which revealed minimal local residual disease and bilateral lung nodules, for which chemotherapy was initiated. Postchemotherapy, 18F-FDG PET/CT showed residual lung metastases. As a part of ongoing project, 68Ga-PSMA PET/CT done revealed additional focal uptake in the right cerebellum, missed on FDG PET/CT. The brain lesion was confirmed upon MRI.

Efficacy of Prolotherapy in Temporomandibular Joint Disorders: An Exploratory Study.

INTRODUCTION: Temporomandibular joint (TMJ) disorders can be treated by both conservative and surgical approaches. Conservative interventions with predictable benefits can be considered as first-line treatment for such disorders. Dextrose prolotherapy is one of the most promising approaches in the management of TMDs, especially in refractory cases where other conservative management has failed. AIM: To study the efficacy of prolotherapy and to establish it as an effective procedure in patients with TMJ disorders, to provide long-term solution to chronic TMJ pain and dysfunctions. PATIENTS AND METHODS: We conducted a study on 25 patients suffering from various TMJ disorders who were treated with prolotherapy, the solution consisting of 1 part of 50% dextrose (0.75 ml); 2 parts of lidocaine (1.5 ml); and 1 part of warm saline (0.75 ml). The standard programme is to repeat the injections three times, at 2-week interval, which totals four injection appointments over 6 weeks with 3-month follow-up. RESULTS: There was appreciable reduction in tenderness in TMJ and masticatory muscles with significant improvement in mouth opening. The effect of the treatment in improving clicking and deviation of TMJ was found to be statistically significant (P < 0.05). There were no permanent complications. CONCLUSION: Our study concluded that prolotherapy is an effective therapeutic modality that reduces TMJ pain, improves joint stability and range of motion in a majority of patients. It can be a first-line treatment option as it is safe, economical and an easy procedure associated with minimal morbidity.

Glandular Odontogenic Cyst of Anterior Maxilla - A Rare Case Report.

Rationale: Glandular odontogenic cyst (GOC) is a rare type of cyst of the jaws, which shares histological features with that of lateral periodontal cyst, botryoid cyst, radicular cyst with mucous metaplasia, or low-grade mucoepidermoid carcinoma, making it difficult to come to a definitive diagnosis. Not many cases of GOC have been reported in the literature. Patient Concerns: A 40-year-old male patient presented with pain in the upper right front tooth region. Mild extraoral swelling, obliterating the right nasolabial fold, was present. Tenderness on percussion was present in involved teeth. Diagnosis: On histopathological examination, GOC was confirmed featuring pseudostratified columnar cells with cilia, goblet cells, and mucous cells. Treatment: Complete enucleation of the cyst was done. Outcomes: No recurrence was noted on 1-year follow-up. Take-away Lessons: Due to high recurrence rate and aggressive nature of the cyst, it is important to plan proper management and long-term follow-up.