A Case of Metastatic Pulmonary Calcification Detected on 99mTc-MDP Bone Scan and 99mTc-FAPI Scan.

ABSTRACT: A 59-year-old woman with recent history of weakness, loss of appetite, and significant weight loss was referred for malignancy workup. On the first day, the patient underwent a 99mTc-MDP scan, which revealed diffuse pulmonary uptake in both lungs. Two days later, 99mTc-FAPI scan was performed and showed diffuse pulmonary uptake in the planar and SPECT/CT images. The study present an interesting case demonstrating FAPI-ligand uptake in metastatic pulmonary calcification.

The First Case of 99mTc-FAPI Uptake in Optic Nerve Sheath Meningioma.

ABSTRACT: This case study presents the first demonstration of FAPI ligand uptake in a patient with optic nerve sheath meningioma. The patient, a 23-year-old woman who had previously undergone surgery for refractory optic meningioma, was referred to our department for 177Lu-DOTATATE therapy. After 3 cycles of 177Lu-DOTATATE administration, her proptosis significantly decreased. Two months after her last therapeutic cycle, a 99mTc-FAPI scan was performed. The scan revealed a mass with moderately increased uptake in the left retro-orbital region. This study is believed to be the first to demonstrate FAPI ligand uptake in a patient with optic nerve sheath meningioma.

Comparison of 8th and 7th editions of TNM staging in terms of mortality, persistent disease, and response to treatment in patients with differentiated thyroid cancer.

OBJECTIVE: To compare the eighth and seventh editions of TNM staging (TNM-8 and TNM-7) on disease-related mortality, persistent disease, and response to treatment in patients with differentiated thyroid cancer (DTC). METHODS AND MATERIALS: We studied 400 patients (79% female) with DTC with a mean age of 40.93±14.11 years. TNM staging was recorded according to the 7th and 8th editions and patients were followed for at least 1 year and response to therapy was recorded according to ATA response categorization. RESULTS: The mean follow up time was 42.5±15.24 months. Overall, 108 patients (27%) were down-staged using the TNM-8, mainly due to the changes in the age cut-off (14.5%), N (9.25%), and T categorization (3.25%). All patients in stage III and 82.8% in stage IV were down-staged. The mean Tg levels were significantly higher in stages III and IV in TNM-8 compared to TNM-7. Four disease-related death were recorded during follow up, all in stage IV according to TNM-7, while one was in stage II according to TNM-8. One year after treatment, persistent disease was detected in 12% and 77% of patients in stage III according to the 7th and 8th editions, respectively (P= 0.04). Similarly, biochemical incomplete response one year after treatment was seen in 7.3% and 87% in stage III disease using 7th and 8th editions (P = 0.006) that fell to 2.4% and 22% in the last visit respectively (P = 0.04). CONCLUSION: Persistent disease and incomplete response to therapy were more common in stages III and IV in TNM-8 compared to TNM-7. The eighth edition was a better predictor of persistent disease in stages III and IV disease.

Evaluation of Salivary Function Post-Partial Superficial Parotidectomy.

Introduction: Parotid pleomorphic adenomas necessitate surgical intervention, with a growing emphasis on preserving salivary function post-surgery due to its critical role in maintaining oral health and overall quality of life. This study aims to evaluate a surgical method meticulously designed to preserve salivary function following partial superficial parotidectomy, utilizing Technetium-99m scintigraphy. Materials and Methods: This single-center prospective cohort study was conducted in Mashhad, Iran, between 2022 and 2023. The study encompassed 40 patients diagnosed with parotid pleomorphic adenomas, ages 20 to 64, undergoing partial superficial parotidectomy. The salivary function was evaluated using Technetium-99m scintigraphy three weeks post-operation. Results: Most participants underwent right parotid surgery (62.5%, n=25) instead of left parotid surgery (37.5%, n=15). The outcomes of the partial superficial parotidectomy indicated no complications during the three-week post-operative period. Saliva secretion rates on the operated side were preserved across the cohort. A significant difference in saliva secretion rates was observed between the operated and contralateral sides (P<0.01) for both right and left parotid surgery groups. No significant correlation was found between the time elapsed post-surgery and saliva secretion rates (P=0.48). Conclusion: Our study demonstrated that the superficial parotidectomy technique is notably effective when focused on preserving the salivary function of the deep parotid gland. Not only does it maintain saliva secretion on the operated side, but it also boasts an admirable safety profile. There were no recorded complications, and duct preservation was achieved in most instances.

Nonmalignant 68 Ga-FAPI-46 Uptake in 2 Cases of TENIS Syndrome : Comparison With 18 F-FDG.

ABSTRACT: The cancer specificity of fibroblast activation protein inhibitor (FAPI) uptake remains understudied topic, and several cases of false-positive FAPI PET/CT findings have been reported. We present 2 patients of differentiated thyroid cancer with thyroglobulin elevation and negative iodine scintigraphy syndrome who underwent 68 Ga-FAPI PET/CT and 18 F-FDG PET/CT for evaluation of any possible sites for metastatic disease. Although no focus of metastatic disease was found in these patients, remarkable findings were noticed instead. Nonmalignant FAPI uptake was evident in the gallbladder, uterus, and degenerative changes, whereas these uptake were discordant or partially concordant with those in FDG's, also CT images showed no underlying abnormality.

Theranostics of Thyroid Cancer.

Molecular imaging is pivotal in evaluating and managing patients with different thyroid cancer histotypes. The existing, pathology-based, risk stratification systems can be usefully refined, by incorporating tumor-specific molecular and molecular imaging biomarkers with theranostic value, allowing patient-specific treatment decisions. Molecular imaging with different radioactive iodine isotopes (ie, I131, I123, I124) is a central component of differentiated carcinoma (DTC)'s risk stratification while [18F]F-fluorodeoxyglucose ([18F]FDG) PET/CT is interrogated about disease aggressiveness and presence of distant metastases. Moreover, it is particularly useful to assess and risk-stratify patients with radioiodine-refractory DTC, poorly differentiated, and anaplastic thyroid cancers. [18F]F-dihydroxyphenylalanine (6-[18F]FDOPA) PET/CT is the most specific and accurate molecular imaging procedure for patients with medullary thyroid cancer (MTC), a neuroendocrine tumor derived from thyroid C-cells. In addition, [18F]FDG PET/CT can be used in patients with more aggressive clinical or biochemical (ie, serum markers levels and kinetics) MTC phenotypes. In addition to conventional radioiodine therapy for DTC, new redifferentiation strategies are now available to restore uptake in radioiodine-refractory DTC. Moreover, peptide receptor theranostics showed promising results in patients with advanced and metastatic radioiodine-refractory DTC and MTC, respectively. The current appropriate role and future perspectives of molecular imaging and theranostics in thyroid cancer are discussed in our present review.

The Future Direction of Women in Nuclear Medicine and Nuclear Medicine in Women's Health.

This work discusses the role of Nuclear Medicine for women's health, the role of women in the development of this emerging field and the various issues which arise from both. It emphasizes the importance of young women and their competing needs due to factors like pregnancy and work-related challenges. The objectives of this overview include improving imaging techniques, preserving fertility during cancer treatment, diagnosing pelvic and uterine conditions, developing radiopharmaceuticals for women's health, protecting female employees in Nuclear Medicine, and considering the role of artificial intelligence.

Initial Staging and Response Evaluation With 18 F-FDG PET/CT in a Rare Case of Nested Variant Urothelial Urethral Cancer.

ABSTRACT: Primary urothelial urethral cancer is a relatively infrequent but serious form of cancer in the urinary tract, and nested variant is extremely rare. Until now, no studies have been published regarding 18 F-FDG PET/CT in patients with primary urothelial urethral cancer. In this study, we discussed the role of 18 F-FDG PET/CT in the initial staging, treatment response evaluation, and recurrence assessment of a 53-year-old woman with nested variant urothelial urethral cancer, which could lead to timely diagnosis and evaluation of the extent of involvement, thus achieving the best treatment plan for this group of patients.

Unilateral Chronic Parotitis With 68 Ga-DOTA-FAPI-04 PET/CT and 18 F-FDG PET/CT Imaging in a Case of a Patient With Papillary Thyroid Carcinoma.

ABSTRACT: The 68 Ga-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). The patient underwent 18 F-FDG and 68 Ga-DOTA-FAPI-46 PET/CT imaging for metastatic workup and treatment planning. FAPI uptake was observed in the right parotid gland (with no FDG uptake), prompting a 99m TcO 4- salivary scintigraphy. Subsequently, a diagnosis of chronic sialadenitis was made.

Effects of radioiodine therapy on fertility indicators among men with differentiated thyroid cancer: A cohort study.

Background: Following thyroidectomy, radioiodine therapy is the standard management of differentiated thyroid cancer. The effects of such treatment on testicular function remained a concern for cases and clinicians. Objective: We aimed to observe changes in fertility indicators in men treated with ablation. Materials and Methods: In this prospective cohort study, 18 men with differentiated thyroid cancer from June to December 2020 underwent thyroidectomy plus radioiodine therapy. Participants were grouped based on iodine dose (8 men with 30 mCi vs. 10 men with ≥ 150 mCi). Baseline values (VB) of the follicular stimulating hormone, luteinizing hormone, testosterone, and sperm analyses were measured 3 wk before iodine ablation and repeated 3 (V3) and 12 (V12) months later. They were analyzed once as a whole and once based on their groups via ANOVA and Friedman's tests where appropriate. Results: The mean age of participants was 35.61 ± 9.74 yr. Follicular stimulating hormone levels showed a significant trend among all participants (VB: 12.51 ± 1.72, V3: 13.54 ± 1.41, and V12: 13.10 ± 1.67 IU/mL; p < 0.001). Luteinizing hormone showed a similar pattern (VB: 4.98 ± 1.27, V3: 5.65 ± 1.29, and V12: 5.21 ± 0.95 IU/mL; p < 0.001). Testosterone levels did not differ significantly from baseline. Sperm count decreased at the first checkpoint and returned to normal after 12 months (VB: 38.22 ± 19.40, V3: 32.05 ± 17.96, and V12: 36.66 ± 18.81 million/mL; p < 0.001). Sperm motility and morphology did not change significantly. Conclusion: Our research showed that even less than 5 GBq irradiation could induce a transient testicular dysfunction in the first 3 months of therapy, but it was mostly reversible after 12 months.

Remarkable FDG Uptake in Numerous Granulomatous Panniculitis Lesions: A Case Report.

ABSTRACT: A 42-year-old woman with history of rheumatoid arthritis and erythema nodosum from 8 years ago, who was treated with CellCept and prednisolone, was admitted to the rheumatology service due to skin lesions in the upper and lower extremities. Skin excisional biopsy was performed, and the results suggested panniculitis. FDG PET/CT was performed for malignancy workup. The scan images revealed intensely increased FDG uptake in all numerous subcutaneous nodules. FDG uptake in the panniculitis lesion is rarely reported in the literature.

Evaluation of Arterial Stiffness and Its Relation to Innovative Anthropometric Indices in Persian Adults.

Background: BMI has been evaluated as an old criterion to evaluate obesity in individuals, but it does not assess abdominal obesity and lean mass. We aimed to evaluate the possible relationship of new anthropometric indices (namely, a body shape index (ABSI), the body roundness index (BRI), the visceral adiposity index (VAI), the visceral fat area (VFA), and waist-hip ratio (WHR)), with one of the known critical factors of atherosclerosis, arterial stiffness. Methods: Overall 5921 individuals were enrolled and were divided into four groups according to BMI. Novel anthropometric parameters including, ABSI, BRI, VAI, VFA, and WHR were calculated. The carotid-femoral pulse wave velocity (cf-PWV) was used to evaluate arterial stiffness. Multiple regression analysis was performed to assess the relationship between cf-PWV and innovative Anthropometric indices. Results: This study population consisted of 3109 women and 2812 males. In men with overweight, cf-PWV was significantly related to BMI, ABSI, BRI, WC, VAI, VFA, and WHR. However, among men with obesity, cf-PWV was associated with BRI, VAI, and VFA. Among women with overweight, cf-PWV was also related to all mentioned indices except ABSI; although, cf-PWV was only associated with VFA and WHR in women with obesity. Conclusion: Our results showed that VFA in women and VAI in men are strongly related to arterial stiffness and can be used to identify predictors of vascular disease or organic vascular dysfunction.

Saphenous Vein Graft for Treatment of Peyronie's Disease, a Comparison between Single and Multiple Graft Reconstruction.

Background: Surgical reconstruction is the gold standard of treatment for Peyronie's disease (PD). Grafting procedures provide satisfactory outcomes in patients with complex curvature, short penile length, and without previous erectile dysfunction (ED). We aimed to compare two different grafting methods of reconstruction in patients with PD. Method: Fifty-two PD patients at Imam-Reza hospital of Mashhad from October 2011 to January 2019 with stable plaque, penile angulation of >60˚, complex curvature, and without ED who consented to cooperate, included in our study and divided into two groups. The first group consists of 26 patients, undergone grafting through a double-Y incision and a single saphenous graft placed within the incision. For the second group, two smaller saphenous vein grafts were placed in the two parallel incisions. ED assessed pre- and post-operational via the International index of erectile function. Penile angulation less than 20 degrees was considered a favorable outcome. Patients followed for 18 months, and sacculation, penile shortening, post-operation infection, and penile hypoesthesia were assessed as complications. We used a paired t-test to compare these two groups. Results: ED was 25% and 12% in the first and the second group, respectively. Statistics showed no difference between the two groups regarding pre and post-operational ED (P=0.1). Regarding complications during follow-up, sacculation occurred in four patients of the first group and none of the second group patients but no significant difference (P=0.23). Conclusion: We found no superiority to declare between these two procedures, although regarding the small sample size of our study, further evaluations are needed to establish more reliable results.

Incidental Synchronous 99mTc-HYNIC-TOC Avid Lesion of the Neck in a Patient with Metastatic Melanoma: A Metastatic Lymph Node or a Carotid Body Tumor Masquerading As a Lymph Node?

A 53-year-old woman with a plantar malignant melanoma lesion was referred to our tertiary clinic for sentinel lymph node mapping. Lymphoscintigraphy with 99mTc-Phytate detected ipsilateral inguinal and popliteal sentinel nodes. After total resection of nodes, the pathology report confirmed that all specimens were involved by the tumor. As part of an institutional study evaluating somatostatin receptor avidity of melanoma by 99mTc-HYNIC-TOC scan, she also underwent a whole-body octreotide scan, which surprisingly showed intense tracer uptake in the right cervical region, confining in SPECT/CT images to a mass at the C2 spinal level, adjacent to the right carotid bifurcation. Neck surgery with gamma probe after injection of another dose of 99mTc-HYNIC-TOC was performed successfully, and the pathology report was consistent with a carotid body tumor. To best our knowledge, our case is the first one in the literature, which reports an incidental paraganglioma with 99mTc-HYNIC-TOC scan which resected via radio-guided surgery, again with 99mTc-HYNIC-TOC tracer.

Body mass index, lipid profile, and hypertension contribute to prolonged QRS complex.

BACKGROUND AND AIMS: QRS prolongation is one of the most common findings in patients with underlying cardiac diseases. Recent studies have shown that QRS prolongation can be accompanied by obesity, hypertension, and hyperlipidemia, which are known risk factors for cardiovascular events. This study aimed to evaluate how obesity, hypertension, and hyperlipidemia could affect QRS duration. METHODS: A total of 4033 eligible subjects aged between 35 and 70 years were included from the Persian Cohort Study in Mashhad. ECG intervals, blood pressures, lipid profile, and BMI measures were obtained at the time of enrolment. Multiple regression analysis was performed to assess the relationship between QRS duration and BMI, hypertension, and lipid profile. RESULTS: This study population consisted of 2047 females and 1986 males with a mean age of 46.05 ± 9.50 years. Higher BMI values and heart rate were observed in women (27.12 ± 4 and 74.66 ± 8.54; P < 0.001), while height, weight, and QRS duration showed a significant increase in men (172.60 ± 7.18, 79.44 ± 12.55, and 97 ± 11.05; P < 0.001). Except for total cholesterol (P = 0.317), blood pressures and lipid profile differed significantly among women and men (P < 0.001). Furthermore, univariate analyses indicated that QRS duration was associated with age, sex, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), systolic blood pressure, diastolic blood pressure, categorical blood pressure, categorical BMI, and continuous BMI. On the backward multivariate model, TG, LDL, HDL, DBP, SBP, categorical blood pressure, categorical BMI, and continuous BMI were independently correlated with QRS duration. CONCLUSIONS: Hypertension, increased BMI, and high levels of LDL, TG, and lower HDL, as well-known risk factors of cardiovascular disease, were associated with prolonged QRS duration. These findings could be beneficial in future investigations regarding establishing the underlying heart problems.

Bone scan with technetium 99m-methyl diphosphonate, the missing link in the initial staging of muscle-invasive bladder carcinoma.

BACKGROUND: Accurate staging is crucial to determine the type of treatment for patients with bladder cancer (BCa), especially in high-risk cases. We aimed to assess the role of bone scan in the initial staging of muscle-invasive bladder carcinoma (MIBC). MATERIAL AND METHODS: Forty-five patients with MIBC were referred to our tertiary clinic to perform a technetium 99m-methyl diphosphonate (Tc99m-MDP) bone scan from January 2019 to March 2020. The patients underwent bone scintigraphy with pelvic SPECT/CT before radical cystectomy. Whole-body scanning was performed 4 hours after Tc99m-MDP injection in both anterior and posterior views. Since the most common bone involvement site in these patients is the pelvic bones and the spine, pelvic SPECT/CT was performed in all patients. RESULTS: Frequency of skeletal metastasis was 26.7%. Only 19% of the metastases were detected by previous pelvic CT/MRI images performed for routine staging. All the reported skeletal metastases by previous anatomical imaging methods were detected in the bone scan. There was no statistically significant correlation between bone metastasis and the patient's age, lymph nodes metastasis (LNM), hydronephrosis, and muscle-invasive type. The mean serum calcium level was 8.7 ± 0.57 in patients with bone metastasis and 8.87 ± 0.99 in patients without bone metastasis, which was not statistically significant. CONCLUSION: Bone scan has higher diagnostic performance than conventional imaging methods for detecting bone metastases. It changed the management plan in 8.8% of our patients, so we conclude that performing a whole-body bone scan in the initial staging of MIBC would be helpful.

Peptide receptor radionuclide therapy (PRRT) in radioiodine-refractory thyroid cancer: A case report of significant response to lu177 DOTA-TATE treatment

SUMMARY A 59-year-old woman with follicular thyroid carcinoma underwent total thyroidectomy followed by radioiodine treatment. Following treatment, the whole-body scan did not show any abnormal radioiodine uptake. However, during the follow-up, the serum thyroglobulin (Tg) value increased without detectable thyroglobulin-antibodies. We performed a Ga-68 DOTA-TATE PET/CT showing a sternal lesion and several lung nodules with high somatostatin receptor density. Also, on the next day, FDG PET/CT was performed, which confirmed the findings. Considering the high levels of somatostatin receptor expression in such metastases, we planned lu177 DOTA-TATE therapy. After two cycles of lu177 DOTA-TATE injection, serum thyroglobulin significantly dropped, and she claimed that her sternal pain and dyspnea were much better. This was the case of a patient suffering from iodine-refractory follicular thyroid carcinoma, with somatostatin-receptor expression, treated with 177Lu-DOTA-TATE, showing a significant response.

Peptide receptor radionuclide therapy (PRRT) in radioiodine-refractory thyroid cancer: A case report of significant response to lu177 DOTA-TATE treatment.

A 59-year-old woman with follicular thyroid carcinoma underwent total thyroidectomy followed by radioiodine treatment. Following treatment, the whole-body scan did not show any abnormal radioiodine uptake. However, during the follow-up, the serum thyroglobulin (Tg) value increased without detectable thyroglobulin-antibodies. We performed a Ga-68 DOTA-TATE PET/CT showing a sternal lesion and several lung nodules with high somatostatin receptor density. Also, on the next day, FDG PET/CT was performed, which confirmed the findings. Considering the high levels of somatostatin receptor expression in such metastases, we planned lu177 DOTA-TATE therapy. After two cycles of lu177 DOTA-TATE injection, serum thyroglobulin significantly dropped, and she claimed that her sternal pain and dyspnea were much better. This was the case of a patient suffering from iodine-refractory follicular thyroid carcinoma, with somatostatin-receptor expression, treated with 177Lu-DOTA-TATE, showing a significant response.