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A 71-year-old man presented with nausea, vomiting, headache, and neck swelling two months after cervical spine surgery. Initial brain computed tomography and magnetic resonance imaging revealed ventricular dilation, suggestive of hydrocephalus. However, radionuclide cisternography subsequently demonstrated cerebrospinal fluid (CSF) leakage into a prevertebral cyst, rather than normal pressure hydrocephalus, thereby confirming communication between the prevertebral cyst and the spinal canal. These findings suggest that the patient's postoperative symptoms were likely attributable to CSF leakage, underscoring the diagnostic utility of cisternography in differentiating postoperative complications following cervical spine surgery.

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We present the case of a 27-year-old woman with a history of left breast invasive ductal carcinoma who developed mandibular osteosarcoma, as documented by 2 MDP bone scans. She had undergone a radical mastectomy, chemotherapy, radiotherapy, and intravenous zoledronic acid therapy. An initial bone scan 1 year later showed increased MDP uptake in the right mandible, suggesting drug-related osteonecrosis, but concurrent CT scans were normal. A follow-up bone scan performed 16 months later demonstrated increased MDP uptake in both mandibles. Subsequent partial mandibulectomy confirmed conventional osteosarcoma.

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A 63-year-old man presented with transient global amnesia, urinary incontinence, and a visual field deficit. MRI revealed a heterogeneous mass in the left parieto-occipital lobe, diagnosed as glioblastoma multiforme (GBM). Following craniotomy, chemotherapy with temozolomide and radiotherapy were initiated. Two months after radiotherapy, MRI indicated possible tumor recurrence, leading to a change in treatment. Despite further interventions, the patient exhibited new-appearing symptoms and a significant increase in mass size. A 99m Tc-FAPI-46 scintigraphy showed avidity in the tumoral recurrence. This case highlights the potential of this novel, low-cost imaging technique for assessing eligibility for potential radio-ligand therapy in resource-limited countries.

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We present a 34-year-old woman diagnosed with primary mucinous adenocarcinoma of the bladder, confirmed after transurethral resection. Two years postinitial diagnosis, despite chemotherapy, she developed pulmonary and skeletal metastases, leading to progressive symptoms including cough, hemoptysis and refractory bone pain. She was evaluated via 99m Tc-FAPI-46 scintigraphy, which showed significant uptake in metastatic lesions, suggesting suitability for radio-ligand therapy. However, the patient's condition deteriorated rapidly, and she passed away before treatment could be initiated. This case underscores the sensitivity of FAPI-targeted imaging in mucinous adenocarcinoma of the bladder and highlights the need for further investigation into its therapeutic applications.

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A 67-year-old man was referred for initial staging of prostate adenocarcinoma (Gleason score 4+3, 7/12 cores positive). A 99m Tc-PSMA scintigraphy revealed localized uptake in the right prostate lobe (miTNM: T 2m N 0 M 0 , and PRIMARY score: 5) and increased uptake in a hypo-dense splenic lesion (PSMA-RADS-3C), which was subsequently confirmed as a hemangioma on further evaluations. This case underscores the potential for false-positive 99m Tc-PSMA uptake in splenic hemangiomas, highlighting the importance of considering this possibility in clinical practice.

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A 62-year-old man with echocardiographic findings suggestive of cardiac amyloidosis and positive 99m Tc-pyrophosphate ( 99m Tc-PYP) scintigraphy was ultimately diagnosed with Fabry disease confirmed by genetic testing. This case highlights myocardial 99m Tc-PYP uptake in Fabry cardiomyopathy, expanding the differential diagnosis of non-amyloid cardiomyopathies associated with myocardial radiotracer retention.

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We present a case of a 58-year-old woman with a history of breast cancer who developed medication-related osteonecrosis of the jaw following a dental extraction. Notably, a 99m Tc-FAPI-46 scintigraphy revealed increased FAPI uptake at the site of osteonecrosis. This scan also identified skeletal metastases that had been previously undetected by a 99m Tc-MDP scan. This case demonstrates the potential of FAPI imaging in enhancing the detection of skeletal metastatic lesions. Our experience highlights the novelty of 99m Tc-FAPI uptake in jaw osteonecrosis and suggests its potential advantages for diagnosing metastatic breast cancer, especially in resource-limited countries where 68 Ga-FAPI PET/CT might not be available.

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PTEN hamartoma tumor syndrome (PHTS) encompasses a group of inherited disorders caused by germline mutations in the PTEN gene, which functions as a tumor suppressor. We report the case of a 10-year-old girl presenting with neck swelling. Initial ultrasound revealed nodular changes in the thyroid gland. Laboratory results indicated a euthyroid state, with normal calcitonin levels. However, thyroid scintigraphy demonstrated markedly pathologic findings, including cold, nonfunctioning nodules, raising suspicion for an underlying neoplastic or syndromic cause. This prompted further investigation through biopsy and molecular analysis, which confirmed a pathogenic PTEN mutation, establishing the diagnosis of PHTS.

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Low-grade myofibroblastic sarcoma (LGMFS) is a rare mesenchymal tumor, infrequently found in the abdominal cavity, where it may exhibit more aggressive behavior. This case report presents a 15-year-old boy with LGMFS manifesting as a large abdominal mass. Following neoadjuvant therapy and surgical resection, recurrence was detected via follow-up imaging. We employed 99m Tc-FAPI-46 scintigraphy, representing its first reported application in LGMFS. The FAPI scintigraphy exhibited uptake in all tumoral lesions identified on contrast-enhanced CT scan, underscoring the potential of FAPI in the evaluation of this rare entity.

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BACKGROUND: Congenital diaphragmatic hernia (CDH) significantly impacts long-term pulmonary function. This study aimed to compare fetal MRI-derived lung volumes with nuclear medicine perfusion scintigraphy (NMPS) data to identify correlations and improve prognostication and management for children with CDH. STUDY DESIGN: This retrospective single-center pilot cohort study included infants born between 2019 and 2022 with prenatally diagnosed left-sided CDH who underwent both fetal MRI and postnatal NMPS. Lung volumes were converted to a percentage of total lung volume for comparison with lung perfusion percentages. Relationships between fetal MRI and NMPS ratios were assessed using paired t-tests and Pearson correlation. RESULTS: Thirteen children met the inclusion criteria. The prenatal and postnatal ratios of left, right, and left/right lung were significantly different between fetal MRI and NMPS (p < 0.001). A not statistically significant trend toward positive correlation was observed. CONCLUSION: There was no significant correlation between fetal MRI lung volume and postnatal NMPS lung perfusion, which supports obtaining perfusion studies as a part of risk-stratified follow-up. Larger multicenter studies are needed to confirm these preliminary findings. TYPE OF STUDY: Retrospective observational single-center cohort study. LEVEL OF EVIDENCE: III.

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Tumor differentiation is a biologic process that significantly influences molecular imaging patterns and therapeutic response. This review examines how tumor differentiation shapes theranostic strategy across thyroid, neuroendocrine, and prostate cancers, with particular attention to the inverse association between tumor differentiation and glucose metabolism. In thyroid and neuroendocrine tumors, well-differentiated disease retains tissue-specific transporters and receptors, such as the sodium-iodide symporter and somatostatin receptors, enabling function-based imaging and targeted therapy. Well-differentiated neuroendocrine tumors upregulate somatostatin receptor expression. Conversely, poorly differentiated tumors in these categories lose these specialized features and exhibit enhanced glycolytic metabolism, resulting in increased [18F]FDG uptake. In prostate cancer, the differentiation-metabolism relationship is more complex. Prostate-specific membrane antigen (PSMA) is a membrane protein expressed on the apical surface of endothelial cells in prostate and nonprostate tissue. It is weakly expressed in normal prostate tissue but upregulated in prostate cancer and several solid malignancies. Within prostate adenocarcinoma, PSMA expression generally increases with higher Gleason score and tumor aggressiveness, making dedifferentiating tumors and metastatic disease highly PSMA-avid on imaging and suitable for PSMA-targeted therapy. However, in treatment-emergent neuroendocrine prostate cancer, PSMA expression may be lost despite intense [18F]FDG uptake, reflecting lineage plasticity rather than classical dedifferentiation. This tumor-specific differentiation-driven model has significant implications for patient management, treatment planning, and prognosis. Understanding these tumor-specific differentiation patterns allows clinicians to optimize diagnostic imaging and therapeutic strategies in precision oncology and personalized medicine.

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PURPOSE: Individuals with neurogenic lower urinary tract dysfunction after spinal cord injury should undergo regular scintigraphy to assess renal function. However, renal scintigraphy entails radiation exposure and is not widely available. Consequently, reliable alternative diagnostic parameters are needed. We have, thus, investigated whether renal sonography and cystatin-C measurements are consistent with renal scintigraphy results in this population. METHODS: Adult individuals with chronic spinal cord injury (duration ≥ 5 years) underwent renal sonography and cystatin-C measurement during routine consultation, followed by renal scintigraphy within six weeks. The correlation between renal sonographic parameters (arterial resistive index, renal parenchymal thickness, and kidney dimensions), serum cystatin-C, and scintigraphy clearance values was assessed using Pearson and Spearman's rank correlation coefficients. Furthermore, the classification accuracy (for scintigraphy clearance ≤ 150 ml/min) of variables with statistically significant correlation coefficients was investigated. RESULTS: Data of 8 women and 42 men (54 ± 14 years old; duration spinal cord injury 24.4 ± 14.6 years) were analyzed. There was a fair correlation between scintigraphy clearance and cystatin-C levels (r = -0.37, p = 0.013) as well as left renal resistive index (r = -0.44, p = 0.002). However, there were no correlations between scintigraphy clearance and renal parenchymal thickness (p > 0.45) as well as kidney dimensions (p > 0.13). Cystatin-C and left renal resistive index showed good classification performance (area under curve = 0.74/0.84, p < 0.00001). CONCLUSION: Individuals with reduced renal function can be identified reliably using cystatin-C serum concentration and renal arterial resistance. These parameters may serve as additional diagnostic parameters to assess renal function and to determine whether scintigraphy examination is required. CLINICAL TRIAL REGISTRATION: NCT04241666.

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The "gold standard" for neuroblastoma (NB) imaging is [¹²³I]I-meta-iodobenzylguanidine ([¹²³I]I-MIBG) scintigraphy. This article presents a case of a child with an abdominal tumor that was suspected to be neuroblastoma. At the age of 2 months, a positive [¹²³I]I-MIBG scan initially supported the diagnosis. Active surveillance was initiated, and a follow-up [¹²³I]I-MIBG study at the age of 7 months revealed no radiotracer accumulation in the tumor. Despite the imaging findings, surgery was performed, and the tumor was found to be a subdiaphragmatic pulmonary sequestration. This case highlights the importance of correlating imaging findings with clinical and laboratory data to ensure an accurate diagnosis.

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Bone scintigraphy is primarily used for the assessment of osseous structures, soft tissue uptake of Tc-99m Methylene deoxy- phosphonate (MDP) is unusual in normal circumstances and may lead to unsuspected diagnosis. We present a case highlighting the importance of studying the soft tissues to assess for findings other than osseous on bone scintigraphy in a patient with prior history of breast carcinoma.

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Askin tumour is a rare primitive neuroectodermal tumour of the chest wall belonging to Ewing family of tumours. It is diagnosed on histopathology and imaged with CT and MRI. Typical symptoms include pain, dyspnoea and weight loss. Generally has an aggressive course and is often misdiagnosed as other blue cell tumours. Standard treatment is multidisciplinary; combining chemotherapy with surgery and/or radiotherapy. Here we present a few cases of Askin tumour imaging seen on Tc-99m MDP bone scan.

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This research reports a case involving a 53-year-old man with a history of two renal transplants, each placed in one of the lower abdominal quadrants nine years apart, who underwent [99mTc]Tc-ethylene dicysteine (EC) dynamic scintigraphy to assess renal function and hydroureteronephrosis. The scintigraphy revealed an unexpected area of increased extra-renal tracer uptake in the lower pelvic region during both blood flow and functional phases of the study. Subsequent single-photon emission computed tomography/computed tomography (SPECT/CT) images localized this uptake to a fracture in the right pubic bone. This case highlights the necessity of recognizing atypical [99mTc]Tc-EC uptake patterns, which can provide critical clinical insights for the interpretation of unusual imaging findings and enhance diagnostic accuracy.

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This case describes a 16-year-old female with papillary thyroid carcinoma who demonstrated persistent iodine uptake in the mediastinum and a pulmonary lesion on post-therapeutic scintigraphy despite an excellent biochemical response. Although fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ([¹8F]FDG PET/CT) suggested a benign process, persistent uptake and rising anti-thyroglobulin antibody levels prompted repeat radioiodine therapy and thoracotomy. Histopathological examination revealed a bronchogenic cyst and a vascular malformation, with no evidence of metastatic disease. This case highlights the diagnostic challenge posed by benign thoracic lesions exhibiting iodine uptake. Recognition of such false-positive findings is essential to avoid overtreatment in patients with thyroid cancer.

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INTRODUCTION: Prostate cancer (PC) remains a significant public health concern in developed countries. Following initial treatment, patients may experience biochemical recurrence of prostate cancer (BRPC), defined by an increase in prostate-specific antigen (PSA) levels. [18F]-PSMA positron emission tomography (PET) has shown greater accuracy in detecting clinical prostate cancer recurrence (CPCR), however most evidence comes from retrospective case series with limited prospective studies comparing this novel molecule to conventional diagnostic methods in developed countries. MATERIALS AND METHODS: A prospective observational, descriptive, analytical study of concordance analysis between imaging methods was conducted on a sample of patients with BRPC following curative or first-line treatment. RESULTS: Seventy-seven patients with BRPC were analyzed. Imaging studies revealed positive results in 6% of computerized tomographies (CT), 12% of bone scintigraphies (BS), 35% of [18F] choline PET scans, and notably in 84% of [18F] PSMA 1007 PET scans (X2 = 22.7, DF = 3; p <0.0001). A significant relationship was observed between the positivity of [18F] PSMA 1007 PET/CT and increasing PSA levels, reaching 100% with PSA ≥ 2 ng/mL. DISCUSSION: [18F] PSMA 1007 PET demonstrated high efficacy in localizing recurrent PC in BRPC patients compared to CT, BS, and [18F] choline PET, allowing for better restaging of patients with BRPC compared to CT, BS, and [18F] choline PET.

Introducción: El cáncer de próstata (CP) sigue siendo un importante problema de salud pública en los países desarrollados. Tras el tratamiento inicial, los pacientes pueden experimentar una recurrencia bioquímica del cáncer de próstata (RBCP) La tomografía por emisión de positrones (PET) con [18F]-PSMA ha demostrado una mayor precisión en la detección de la recurrencia del cáncer de próstata; sin embargo, la mayoría de las evidencias provienen de series de casos retrospectivos, y los estudios prospectivos son limitados. Materiales y métodos: Se realizó un estudio prospectivo, observacional, descriptivo y analítico de análisis de concordancia entre métodos de imagen en una muestra de pacientes con RBCP tras tratamiento curativo o de primera línea. Resultados: Se analizaron 77 pacientes con RBCP. Los estudios de imagen revelaron resultados positivos en un 6% de las tomografías computarizadas (TC), un 12% de los centellogramas óseos (CO), un 35% de los PET con [18F] colina y, notablemente, en un 84% de los PET con [18F] PSMA 1007 (X2 = 22.7; DF = 3; p <0.0001). Se observó una relación significativa entre la positividad del PET con [18F] PSMA 1007 y los niveles crecientes de PSA, alcanzando un 100% en pacientes con PSA ≥ 2 ng/mL. Discusión: El PET con [18F] PSMA 1007 demostró una alta eficacia en la localización del CP recurrente en pacientes con RBCP, en comparación con la TC, la CO y el PET con [18F] colina, permitiendo una mejor reestadificación de los pacientes con RBCP en comparación con los métodos convencionales.

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OBJECTIVE: In patients with spina bifida (SB), even if kidney function is normal at birth, the risk of developing chronic kidney failure later in life is high due to neurogenic deficits that impair bladder emptying as the child grows. The aim of this study is to investigate the correlation between neurological deficits and structural anomalies, which dominate the clinical presentation in children with spina bifida, and renal cortical function using Tc99m-labeled DMSA (Dimercaptosuccinic acid) scintigraphy. METHODOLOGY: 206 pediatric cases (100M, 106 F; age 0-18 years, mean:7.2) with SB who underwent DMSA scintigraphy for recurrent urinary tract infections (RUI) were included in this retrospective study. In 78 cases SPECT/CT (Single Photon Emission Computed Tomography) was used for demarcation of the anatomical structures. clinical findings, renal functions, structural and neurological anomalies of the patients, the history of urinary tract surgery, the frequence of RUI and vesicoureteral reflux (VUR), the frequency of Clean Intermittent Catheterization (CIC), prophylactic antibiotic use, hypertension, proteinuria, ultrasound findings and serum urea-creatinine levels. The patients were grouped according to the severity of neurological deficits. DMSA scintigraphy findings were compared with the clinical data and the severity of ND. FINDINGS: Among 206 patients with SB, 126 had severe neurogenic dysfunction (ND), 41 had moderate ND, and 39 had no ND. A total of 117 children presented with complicated meningomyelocele at birth and underwent surgical repair. Ventriculoperitoneal shunt implantation was performed in 104 cases, while 2 had cervical SB and 1 had thoracolumbar SB. Neurogenic bladder was identified in 199 patients. Clean intermittent catheterization (CIC) was performed by 156 patients, and 134 received prophylactic antibiotic therapy. Unilateral renal agenesis was detected in 8 cases, and horseshoe kidney anomaly in 5 cases. When kidneys were evaluated separately, among a total of 404 renal units, stage ≥3 hydronephrosis was observed in 38 units, and stage ≥2 VUR was detected in 73 units on voiding cystourethrograms (VCUG). Ultrasound revealed structural renal dysmorphism in 176 renal units. The incidence of ≥stage 2 VUR on VCUG was significantly higher in children with dysmorphic kidneys compared to those without dysmorphism (26% vs. 13%, p = 0.01). A significant positive correlation was found between structural renal dysmorphism and cortical defects on DMSA scintigraphy. Cortical defects were detected in 74% of patients with dysmorphic kidneys, compared with 21% of those without ( p = 0.001). DMSA scans showed cortical damage in 66% (44 renal units) with ≥stage 3 VUR and in 38% (128 renal units) with stage ≤2 VUR on VCUG. Overall, cortical defects consistent with renal scarring were observed in 174 renal units on DMSA scintigraphy. The presence of renal cortical damage was significantly associated with the severity of ND. The rate of cortical damage was 52% in children with severe ND, 39% in those with moderate ND, and 28% in patients without ND (p = 0.008). In 78 children who underwent SPECT/CT imaging, planar DMSA images from 11 children were re-evaluated using anatomical correlation data. CT was performed as a low-dose anatomical correction procedure. CONCLUSION: This study demonstrated that renal scarring and cortical loss are common in children with spina bifida. Renal dysmorphism, vesicoureteral reflux, and neurogenic bladder contribute significantly to renal parenchymal injury. Furthermore, the severity of neurogenic dysfunction correlates with the extent of cortical loss. DMSA scintigraphy remains a reliable, non-invasive modality for the assessment of renal cortical function in children with SB. WHAT IS KNOWN: • Cortical loss in the kidneys increases mortality and morbidity in patients with spina bifida. • DMSA scintigraphy is highly valuable in demonstrating cortical function. WHAT IS NEW: • Over the past three decades, patients with spina bifida have achieved longer life expectancy due to advances in medical care. • Contrary to common belief, DMSA scintigraphy still plays an effective role in the follow-up and management of this patient group for the preservation of renal function. It remains valuable in assessing and preserving cortical function in adult patients with spina bifida.

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OBJECTIVE: Graves' disease (GD), an autoimmune disorder causing hyperthyroidism, is often diagnosed using 99mTc scintigraphy. While increased thyroidal 99mTc uptake with homogenous distribution is typical, atypical patterns (normal or heterogeneous) occur. This study aimed to investigate the determinants of these atypical uptake patterns in GD. SUBJECTS AND METHODS: Re-trospective records review identified 238 GD patients diagnosed between January 2022 and December 2024. Normal 99mTc uptake (0.4%-3%) and heterogeneous distribution patterns were defined based on scintigraphy. Relevant clinical and biochemical data were compared between typical and atypical pattern groups. RESULTS: Normal 99mTc uptake was observed in 25/238 (10.5%). Compared to increased uptake, it was associated with lower FT4, T3 levels (p < 0.01) and TRAb levels (p = 0.01) with similar prevalence of heterogeneous distribution (p > 0.05). Compared to homogeneous uptake, heterogeneous uptake subgroup (n = 30/238, 12.6%) had similar TRAb/T3 levels (p > 0.05) with lower FT4 (p = 0.04); and were more likely to have goiter grade > 1 (p < 0.05). Age, gender, smoking and thyroid eye disease were not associated with either atypical uptake pattern. In regression analysis, lower TRAb was associated with normal uptake (OR 0.798, 95% CI 0.660-0.965, p = 0.02), and goitre grade > 1 was associated with heterogeneous uptake (OR 4.34, 95% CI 1.25-15.03, p = 0.01). CONCLUSION: Atypical 99mTc uptake patterns were observed in a notable subset of GD. Normal uptake subgroup may reflect a mild evolving disease stage with lower TRAb, while heterogeneous uptake was primarily linked to increased thyroid size. These findings highlight the importance of integrating clinical and biochemical data when interpreting thyroid scintigraphy in suspected GD.