F-18 Fluorodeoxyglucose Positron Emission Tomography Computed Tomography Findings in an Interesting Case of Primary Cauda Equina Lymphoma with Literature Review.

Primary lymphomatous involvement of spinal cord, nerve roots, and cauda equina is a rare entity and comprises only 0.1% of extra-nodal lymphoma spectrum. Here, we present a case of non-Hodgkin lymphoma involving cauda equina, initially suspected as ependymoma on magnetic resonance imaging that was later confirmed on nerve root biopsy as high B cell non-Hodgkin's lymphoma of L1-S1 nerve roots. F-18 fluorodeoxyglucose positron emission tomography-computed tomography was performed for staging workup which showed abnormal metabolic activity within the spinal canal from D10-S2 with no evidence of distant organ involvement.

Unusual Metastases in Papillary Microcarcinoma of Thyroid.

Papillary carcinoma thyroid is the most common type of thyroid cancer. Papillary thyroid cancer metastasizes commonly to regional lymph nodes, distant organ involvement is to lungs and bone are rare and is associated with poor prognosis. Metastases to intra-abdominal organs are extremely rare. Here, we report a case of 50-year-old female diagnosed with papillary microcarcinoma thyroid who initially treated total thyroidectomy, later presented with metastasis to liver, bone, left adrenal gland, and bilateral lungs. The functioning metastasis was diagnosed by Iodine-131 whole-body scan and later treated with radioiodine.

F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Evaluation of Intradiploic Epidermoid Cyst.

Epidermoid cysts are benign rare congenital cysts which typically present between 3rd and 5th decade of life. They mostly arise from cerebellopontine angle or parasellar region, but sporadic cases arise from cranial dipole. Here, we present a case of 42-year-old female with painful soft swelling in the left frontal region, which on F-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography is well-circumscribed non-FDG avid lesion. The patient underwent total resection of the cyst, and the defect produced by space-occupying lesion was repaired by cranioplasty.

A Prospective Study Comparing Functional Imaging (18F-FDG PET) Versus Anatomical Imaging (Contrast Enhanced CT) in Dosimetric Planning for Non-small Cell Lung Cancer.

OBJECTIVES: 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET-CT) is a well-used and established technique for lung cancer staging. Radiation therapy requires accurate target volume delineation, which is difficult in most cases due to coexisting atelectasis. The present study was performed to compare the 18F-FDG PET-CT with contrast enhanced computed tomography (CECT) in target volume delineation and investigate their impacts on radiotherapy planning. METHODS: Eighteen patients were subjected to 18F- FDG PET-CT and CECT in the same position. Subsequently, the target volumes were separately delineated on both image sets. In addition, the normal organ doses were compared and evaluated. RESULTS: The comparison of the primary gross tumour volume (GTV) between the 18F-FDG PET-CT and CECT imaging revealed that 88.9% (16/18) of the patients had a quantitative change on the 18F-FDG PET-CT. Out of these patients, 77% (14/18) of the cases had a decrease in volume, while 11% (2/18) of them had an increase in volume on the 18F-FDG PET-CT. Additionally, 44.4% (8/18) of the patients showed a decrease by > 50 cm 3 on the 18F-FDG PET-CT. The comparison of the GTV lymph node between the 18F-FDG PET-CT and CECT revealed that the volume changed in 89% (16/18) of the patients: it decreased and increased in 50% (9/18) and 39% (7/18) on the 18F-FDG PET-CT. New nodes were identified in 27% (5/18) of the patients on the 18F-FDG PET-CT. The decrease in the GTV lymph node on the 18F-FDG PET-CT was statistically significant. The decreased target volumes made radiotherapy planning easier with improved sparing of normal tissues. CONCLUSION: GTV may either increase or decrease with the 18F-FDG PET-CT, compared to the CECT. However, the 18F-FDG PET-CT-based contouring facilitates the accurate delineation of tumour volumes, especially at margins, and detection of new lymph node volumes. The non-FDG avid nodes can be omitted to avoid elective nodal irradiation, which can spare the organs at risk and improve accurate staging and treatment.

A clinical study of bilateral non-obstructive acute pyelonephritis with acute kidney injury in patients of type 2 diabetes mellitus.

The aim of our study was to study the clinical profile of type 2 diabetes mellitus patients admitted with the diagnosis of acute kidney injury (AKI) due to bilateral acute non-obstructive pyelonephritis. The bilateral involvement was identified on various imaging modalities (ultrasound, computed tomography, nuclear scintigrapy). All the patients had AKI. Those with severe AKI underwent hemodialysis. The factors associated with the severity of illness were identified. Twenty-five patients of type 2 diabetes mellitus admitted with the diagnosis of AKI due to bilateral acute non-obstructive pyelonephritis were identified. On ultrasound, bilateral involvement was found in 12 patients and in 17 patients on computed tomography and eight patients on nuclear scintigraphy. Fourteen of them needed dialysis support. Bilateral acute pyelonephritis needs to be considered while evaluating the AKI in type 2 diabetes mellitus patients.

Utility of bone scintigraphy in diagnosis of post- traumatic osteitis pubis.

Minor musculoskeletal injuries usually heal within few weeks with conservative treatment, but in pelvic injuries, symptoms may persist for long duration and patient need medical attention to get relief from disturbing pain symptoms. We present a case of post-trauma osteitis pubis in a 58-year-old female, who reported with lower abdominal and left side hip joint pain since 2 months, after an episode of trivial trauma to her pelvis. Technetium-99m methylene diphosphonate bone scintigraphy was performed, which confirmed the site of injury in symphysis pubis and left hip joint, by increased radiotracer localization at both of these symptomatic sites.

Role of lymphoscintigraphy in diagnosis and management of patients with leg swelling of unclear etiology.

BACKGROUND: To study the utility of lymphoscintigraphy in detection of lymphatic obstruction in patients with leg swelling of unclear etiology, selection of site for nodo venous shunt procedure, and follow-up lymphoscintigraphic documentation of improved lymph flow in surgically treated limb. MATERIALS AND METHODS: Twenty four consecutive patients with leg swelling, 10 male, 14 female with mean age 47 years, range from 13 years to 74 years underwent lymphoscintigraphy. All patients were referred from Department of Plastic Surgery, after initial work-up, and routine investigations to rule out the other causes of leg swelling. Both clinical and scintigraphic staging performed for all patients. All clinically and scintigraphically positive patients treated with decongestive lymphatic therapy (DLT). In addition to the DLT, those patients positive for unilateral or bilateral lymphedema, consented for surgical intervention, nodo venous shunt (NVS) in their only affected or one of the two affected lower limbs. Follow-up lymphoscintigraphy performed in operated cases after 3 months to 6 months of surgery, lymphoscintigraphy images of each patient in pre and post-surgery compared. RESULTS: In 20/24 cases (83%) of clinically positive leg swelling were found to be positive for lymphedema on lymphoscintigraphy and remaining, 4/24 were scintigraphically normal. Based on the clinical and lymphoscintigraphy staging, 03/20 cases (15%) had Grade I lymphedema, 01/20 (5%) Grade II lymphedema, 06/20 (30%) Grade III and remaining 10/20 (50%) had Grade IV lymphedema. 11/20 cases of Lymphedema (55%) were managed conservatively by only DLT and in remaining 09/20 cases (45%), who were case of Grade IV, lymphedema (five patients with unilateral and four patients with bilateral disease) initially treated with DLT, and on completion of DLT, undergone for NVS procedure, in their unilaterally affected lower limb or one of the two diseased lower limbs. All nine patients showed remarkable clinical improvement in leg swelling and their follow-up lymphoscintigraphy showed normal visualization of lymphatic channels. No patient developed any recurrence. CONCLUSION: Pre-operative functional evaluation of lymphatic channels using lymphoscintigraphy, is a widely available, simple imaging test and highly useful for documentation of lymphedema in patients with leg swelling of unclear etiology and also for exact localization of inguinal lymph nodes to perform the NVS procedure. Further, it can play important role for follow-up of patients receiving DLT or DLT with surgical intervention that provides early relief from clinical symptoms.