Evaluating therapeutic efficacy of extended shelf-life 90 Y glass microspheres in transarterial radioembolization for colorectal cancer: a quantitative FDG PET/CT analysis.

OBJECTIVES: There is a lack of sufficient evidence regarding the use of extended shelf-life (ExSL) Yttrium-90 ( 90 Y) glass radiomicrospheres in metastatic colorectal cancer (mCRC) patients. We aimed to investigate the efficacy of ExSL 90 Y glass radiomicrospheres with a personalized treatment approach by analyzing 18 F-FDG PET/CT quantitative parameters [metabolic tumor volume (MTV) and total lesion glycolysis (TLG)] separately before and after the treatment. METHODS: A total of 93 radioembolization sessions involving 77 patients were included. Simplicit 90 Y software was utilized to perform multicompartmental voxel-based dosimetry. Adverse events were recorded using the CTCAE v5.0 criteria. The survival data were recorded in detail. RESULTS: The overall disease control rate was 84.9%, with a median overall survival (OS) of 12.7 months and median progression-free survival (PFS) of 8.3 months. A statistically significant increase in treatment response rate was observed when there was an increase in absorbed tumor dose for pre-treatment unit MTV ( P  = 0.005) and TLG ( P  = 0.004) values. We didn't observe any additional side effects/vital risks that could be considered clinically significant. CONCLUSION: Our study has provided evidence on the therapeutic effectiveness and safety in terms of dose-toxicity profile of ExSL 90 Y glass microspheres in a large cohort of mCRC patients. With a personalized treatment approach, the increase in radiation dose absorbed by the tumor has shown a significant contribution to treatment response rate, as indicated by quantitative measurements obtained through 18 F-FDG PET/CT.

Bone Lipogranuloma Mimicking Metastatic Disease on 18F-FDG PET/CT.

ABSTRACT: Primary bone lipogranuloma is an extremely rare disease associated with reactive inflammatory granulomatous reaction associated with exogenous or endogenous lipids. Herein, we report a case of bone lipogranuloma with intense 18F-FDG uptake, which mimics metastatic disease on 18F-FDG PET/CT in a patient with breast cancer.

Disseminated Nocardia farcinica Infection and Treatment Response on F-18 Fludeoxyglucose Positron Emission Tomography Computed Tomography.

We report a rare case of nocardiosis with increased F-18 Fludeoxyglucose (F-18 FDG) uptake in widespread abscess foci of Nocardia farcinica infection in an immunocompromised patient on positron emission tomography computed tomography (PET/CT) imaging. A relatively infrequent cause of nocardiosis, N. farcinica is an opportunistic infection that may present with clinically aggressive disseminated disease. Whole-body F-18 FDG-PET/CT allows identifying the extent of disease, as well as monitoring response to therapy in patients with nocardiosis especially the disseminated form.

Effect of Anticoagulants in Pulmonary Thromboembolism in Post-COVID-19 Patients.

Background and objective COVID-19 may predispose to both venous and arterial thromboembolism (VTE and ATE) due to excessive inflammation, immobilization, and hypoxia. The purpose of this study is to evaluate clinical and laboratory risk factors, as well as related medications such as anticoagulants, to predict the risk of thromboembolic disease and/or death in COVID-19 patients. Methods Over a period of 14 months (from August 2020 to September 2021), a total of 145 consecutive patients with signs and symptoms suspicious of pulmonary embolism (PE) were referred for perfusion single-photon emission computed tomography/computed tomography (Q SPECT/CT). All patients had a history of SARS­CoV­2 infection, diagnosed with a positive real-time polymerase chain reaction (RT-PCR) test. Results Among the 145 patients included in the study, the risk of PE was found to be greater in elderly patients (odds ratio [OR] [95% CI]: 1.05 [1.02­1.07]; p<0.001) and in patients with higher maximum d-dimer levels (OR [95% CI]: 1.14 [1.01­1.3]; p=0.04). We also analyzed the utility of the maximum d-dimer level for predicting acute PE with receiver operating characteristic (ROC) curve analysis. For d­dimer = 0.5 mg/dL, cut-off sensitivity is 91%, specificity is 23%, and for d-dimer = 1 mg/dL, cut-off sensitivity is 79%, specificity is 43% Conclusion D-dimer titers were higher in the PE group in our study. Another significant finding was that, possibly due to thromboinflammation, anticoagulants did not prevent the development of PE in COVID-19 patients.

18F-FDG PET/CT Imaging of a Grade 3 Lymphomatoid Granulomatosis in an Immunocompromised Pediatric Patient.

Lymphomatoid granulomatosis is a rare extranodal Epstein-Barr virus-driven B-cell lymphoproliferative disease, involving predominantly lung, less often skin, kidney, and central nervous system. Here, we present a pediatric case with primary immunodeficiency, diagnosed with pathologically proven pulmonary grade-III lymphomatoid granulomatosis. 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging demonstrated 18F-FDG avid pulmonary masses with central air-bronchograms and cavitations. Although the definitive diagnosis depends on biopsy, 18F-FDG PET/CT serves as a complementary imaging tool to evaluate the extent of the disease and response to treatment.

Lhermitte-Duclos Disease Related With Cowden Syndrome Mimicking Metastatic Lung Cancer on FDG PET/CT.

ABSTRACT: Cowden syndrome is characterized by multiple hamartomatous and neoplastic lesions including Lhermitte-Duclos disease, which is the main criterion for the diagnosis. Herein, we presented a patient with suspected metastatic disease referred to PET/CT, which showed mildly hypermetabolic multinodular thyroid goiter, multiple hamartomatous pulmonary, and breast nodules. Also, intense hypermetabolism was noted on the cerebellar tumor lesion. Lhermitte-Duclos disease was diagnosed based on the characteristic MRI findings, and she was followed up with a diagnosis of Cowden syndrome. Our case indicates that Cowden syndrome should be included as a differential diagnosis of abnormal FDG uptake in the multiple systemic hamartomatous tumors.

Nocardia Infection With Adrenal Gland Abscess Mimicking Metastatic Lung Cancer on FDG PET/CT.

ABSTRACT: We present FDG PET/CT findings of a human immunodeficiency virus-positive patient suspicious for lung cancer with a solitary metastasis to the adrenal gland. Wedge resection of the pulmonary nodules revealed Nocardia infection and a repeat FDG PET/CT imaging after the antibiotic treatment demonstrated complete metabolic response of the adrenal lesion and pulmonary nodules. It should be kept in mind that nocardiosis may present with FDG-avid lesions masquerading as malignancies in immunocompromised patients.

68Ga-PSMA Uptake in Brain Metastasis of Gastric Carcinoma.

ABSTRACT: A 69-year-old man with a known history of gastric and prostate adenocarcinoma was referred to 68Ga-prostate-specific membrane antigen (PSMA) PET/CT for restaging due to biochemical recurrence of prostate cancer. 68Ga-PSMA PET/CT revealed tracer accumulation in the primary prostatic lesion, lymph node, bone metastases, and brain lesion, which was later confirmed on biopsy to be metastasis of gastric carcinoma. This case reminds us of the variable spectrum of 68Ga-PSMA uptake in prostatic and nonprostatic metastatic lesions, the potential pitfalls on PET/CT images in the workup of patients with concomitant malignancies.

Bone Metastasis of Glomus Caroticum Demonstrated on 68 Ga-DOTATATE PET/CT.

ABSTRACT: A 71-year-old man who was diagnosed with carotid body paraganglioma was referred to 68 Ga-DOTATATE PET/CT for primary evaluation, which revealed unknown bony metastasis with intense 68 Ga-DOTATATE uptake. Head and neck paragangliomas are rare neuroendocrine tumors, with a 10% of malignancy rate, and identification of metastatic sites is important in staging and prognosis of the disease. We aimed to highlight the impact of 68 Ga-DOTATATE PET/CT on patient management, especially for equivocal lesions, as in our case.

Hybrid Renal Cortical Imaging with Single Photon Emission Computerized Tomography/Computed Tomography in a Pediatric Patient with Severe Caudal Regression Syndrome.

Caudal regression syndrome (CRS) or sacral agenesis is a rarely seen malformation with a varying degree of structural abnormalities, including multiorgan system dysfunctions, reported with higher incidence among children of mothers with diabetes, as in this case. Spinal anomalies can range from coccyx hemiagenesis to the total absence of lower lumbar vertebrae and sacrum in most severe cases. Herein, we have presented a 9-year-old patient with CRS who had renal failure. Technetium-99m dimercaptosuccinic acid renal scintigraphy revealed bilaterally non-functioning kidneys with no renal cortical uptake. Renal anomalies in CRS with vertebral, anorectal, cardiac, trachea-esophageal, renal, and limb anomalies association include one-sided renal agenesis, multicystic dysplastic kidneys, and ureter duplications.

68Ga-Tetraazacyclododecane Tetraacetic Acid-DPhe1-Tyr3-Octreotate Positron Emission Tomography/Computed Tomographic Findings of Large-Cell Neuroendocrine Carcinoma of the Lung in a Child.

Primary lung cancers in children are rare, and most children are diagnosed incidentally while being investigated for another medical problem. The diagnosis of primary lung tumors in children is very difficult because many children are asymptomatic until the advanced stages of the disease and nonspecific imaging findings. Although the usage of 68Ga-tetraazacyclododecane tetraacetic acid-DPhe1-Tyr3-octreotate (68Ga-DOTATATE) positron emission tomography/computed tomography (PET/CT) in adult patients is well known, it is a relatively new imaging modality for the pediatric patient group. Herein, we presented a unique case of large-cell neuroendocrine carcinoma of the lung in a child on 68Ga-DOTATATE PET/CT.

Brown Tumors Secondary to Tertiary Hyperparathyroidism Masquerading as Lytic or Sclerotic Skeletal Metastases on Preoperative/Postoperative 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: A Case Report.

Tertiary hyperparathyroidism (TH) is a rare condition that develops from secondary hyperparathyroidism in cases when the secretion becomes autonomous. Brown tumors (BTs) are rare skeletal lesions of hyperparathyroidism that may mimic cancer metastasis. We report a case of a patient who was diagnosed with TH with multiple BTs which mimics osteolytic/osteoblastic metastases that were evaluated with two fluorodeoxyglucose positron emission tomography scans with an interval of 23 months in the preoperative and postoperative period.

Detection of Chyle Leakage Site With Lymphoscintigraphy SPECT/CT in a Patient With Chylothorax Secondary to T-Cell Lymphoblastic Leukemia.

ABSTRACT: We present a pediatric case with T-cell lymphoblastic leukemia and persistent chylothorax who was referred to lymphoscintigraphy to identify the site of leakage. Planar lymphoscintigraphy with SPECT/CT revealed hot spots at the left jugulovenous angle and the confluens of the vena brachiocephalica to vena cava, which were compatible with the sites of leakage. Hybrid imaging with SPECT/CT technique have great impact on accurate detection of the defects in the lymphatic system in patients with chylothorax.

The Role of a Bone SPECT/CT Scan in the Follow-up of a Solitary Bone Lesion in a Patient with Langerhans' Cell Histiocytosis

Langerhans' cell histiocytosis (LCH) is a rare disease observed in childhood characterized by the proliferation of Langerhans' cells resulting in focal or systemic manifestations (including the bones). Here, we present a pediatric case with a localized biopsy-proven LCH, who underwent progression from solitary to multifocal form detected on bone scintigraphy and single photon emission computerized tomography/computed tomography (SPECT/CT) performed within four months. Emphasizing on localized bone pain (predictive of osseous LCH) and local tenderness and swelling usually guides the nuclear physician to perform additional SPECT/CT with presumably an improvement of the diagnostic accuracy as demonstrated in our case.