18Fluorine-fluorodeoxyglucose PET-CT findings in a case of rarely seen metastatic adult extrarenal Wilms' tumor of retroperitoneum presenting as lower limb edema.

Wilms' tumor also called as nephroblastoma is commonly seen extracranial solid tumor involving kidneys in children. Rarely, Wilms' tumor can arise from ectopic nephrogenic remnants located outside the kidneys. Extrarenal Wilms' tumor comprises 3% of total Wilms' tumor with its incidence even less common in adults. We report the staging and restaging fluorodeoxyglucose positron emission tomography-computed tomography findings in a case of locally advanced metastatic extrarenal adult Wilms' tumor involving the retroperitoneum.

Interictal 18F- FDG PET/computed tomography brain in a case of frontoethmoidal encephalocele.

Encephaloceles, also known as meningoencephaloceles, are a group of neurological disorders characterized by herniation of the cerebral parenchyma along with overlying meninges through openings in the skull bone. They can be seen following congenital defect in neural tube closure or acquired defect in the skull bone. We report a case of acquired frontoethmoidal encephalocele presenting with drug-refractory epilepsy. Interictal FDG PET-computed tomography done for lateralization and localization of seizure focus showed right-sided frontoethmoidal encephalocele associated with hypometabolism in the adjacent right frontopolar cortex, concordant with ictal onset on electroencephalogram.

Suprapatellar bursitis presenting as unilateral "Hot" patella sign on 99mTc-methylene diphosphonate skeletal scintigraphy.

"Hot" patella sign is a less commonly seen finding in bone scintigraphy defined as increased tracer activity in the patella greater than the ipsilateral distal femur and ipsilateral proximal tibia. We present a case of suprapatellar knee bursitis manifesting as unilateral "hot" patella sign on three-phase 99mTc-methylene diphosphonate bone scintigraphy. This case portrays the image findings of suprapatellar bursitis on three-phase bone scintigraphy.

Squamous Cell Carcinoma of Thymus Presenting as Constrictive Pericarditis Diagnosed With 18F-FDG PET/CT.

Constrictive pericarditis refers to focal or global thickening of pericardium causing impedance to diastolic filling and increased systemic venous pressure. We discuss a case of thymic carcinoma presenting as constrictive pericarditis. A 70-year-old man experiencing shortness of breath underwent Doppler echocardiography for further evaluation. Echocardiography was suggestive of thickened nodular pericardium with minimal pericardial effusion, and Doppler features were suggestive of constrictive pericarditis. F-FDG PET/CT done to exclude malignancy reveals locally advanced thymic carcinoma spreading along the pericardial sheath with metabolically active rib metastases.

18F-FDG PET/CT Brain in a Case of Agrammatic/Nonfluent Variant of Primary Progressive Aphasia (Broca's Aphasia).

Primary progressive aphasia is a neurodegenerative variant of frontotemporal lobe degeneration presenting with isolated selective impairment of language domain, not secondarily due to stroke. We present a case of middle-aged female patient who underwent F-FDG PET of the brain for evaluating progressively declining speaking ability associated with altered fluency of speech and occasional mutism. F-FDG PET revealed asymmetric hypometabolism involving the left inferior frontal gyrus along with left anterior cingulate gyrus suggestive of Broca's aphasia.

FDG PET/CT in Isolated Mediastinal Immunoglobulin G4-Related Disease.

Immunoglobulin G4-related disease is a fibroinflammatory condition that has the tendency to involve almost every organ of the body. We report the case of a young asymptomatic man with right suprahilar opacity on chest radiograph detected during routine annual health check-up. Mediastinoscopic sampling of the lesion was inconclusive. F-FDG PET/CT done to characterize the lesion revealed hypermetabolic mass with areas of necrosis in the right paratracheal location. Histopathologic examination from the FDG PET/CT-guided biopsy sample was suggestive of immunoglobulin G4-related disease.

Hepatobiliary Scintigraphy-Role in Preliminary Diagnosis and Management of Biliary Tract Injuries.

PURPOSE: This study was conducted to identify the role of hepatobiliary scintigraphy (HBS) in the management of biliary tract injuries. METHODS: We retrospectively studied 54 patients (28 male and 26 female patients) aged 3 to 78 years with evidence of bile leak on HBS performed between January 2015 and October 2017. Following intravenous injection of Tc-mebrofenin, dynamic images were acquired for 30 minutes followed by static images until 24 hours. SPECT/CT was performed in patients with suspicion of bile leak on the planar images. Patients were classified as those with free intraperitoneal or localized bile leak. Any abdominal drain output was documented, and its statistical significance was assessed using Mann-Whitney U test. Subsequent management was also documented. RESULTS: Of the 54 patients, 28 demonstrated free intraperitoneal bile leak and 26 localized leak on HBS. Thirty-four patients (24 with free intraperitoneal leak and 10 with localized leak) had an abdominal drain. Drain output was significantly higher in patients with free intraperitoneal leak compared with patients with localized leak (370 vs 78 mL/d per patient, P < 0.01). All patients with free intraperitoneal bile leak underwent interventional procedures such as endoscopic retrograde cholangiopancreatography and stenting or Roux-en-Y hepaticojejunostomy later on. Patients with localized bile leak were managed conservatively and were free of symptoms at 1-year follow-up. CONCLUSIONS: Our findings indicate that, in addition to detecting biliary leak, HBS may be used to identify patients with localized bile leak (48% of patients in our study) who do not require active intervention.

An Unusual Case of Anterior Abdominal wall Dialysate Leak Diagnosed with Tc99m-Sulfur Colloid Single-Photon Emission Computed Tomography/Computed Tomography Peritoneal Scintigraphy.

Peritoneal dialysis (PD) was commonly used renal replacement therapy for treating end-stage renal failure patients leading to various infectious and mechanical complications. We present a case of a 50-year-old female patient who presented with reduced dialysate return and abdominal wall edema following continuous ambulatory PD. Peritoneal scintigraphy done on suspicion of dialysate leak shows tracer accumulation in the anterior abdominal wall below the insertion of the peritoneal catheter.

Role of yttrium-90 in the management of unresectable hepatocellular carcinoma and hepatic metastases.

BACKGROUND AND AIMS: Hepatocellular carcinoma (HCC) is the sixth most common cancer and third leading cause of cancer-related death in the world. The management of unresectable HCC and hepatic metastases from various solid tumors is a clinical dilemma. There is paucity of data on the treatment of unresectable HCC and hepatic metastases with yttrium-90 (90Y) radioembolization. METHODS: Thirty patients (mean age; 55.2 years; range 43-82 years) comprising 21 patients with HCC (12 patients have cirrhosis of which 3 patients belong to Child-Pugh class A and 9 patients belong to Child-Pugh class B), 7 patients with metastasis from colorectal cancer, 1 patient with metastasis from melanoma, and 1 patient with metastasis from ovarian carcinoma underwent resin-based 90Y radioembolization between 2013 and 2015 in our study. In all the patients, after embolization of non-target vasculature, SPECT and planar scintigraphy were done with the injection of 5-6 mCi (185-222 MBq) of 99mTc-labeled macroaggregated albumin (MAA) into the hepatic artery. Then, lung shunt fraction was assessed and dose was calculated based on body surface area (BSA) method for SIR-Spheres. Post therapeutic 90Y bremsstrahlung SPECT and 90Y PET was performed within 30 hours following therapy to see the hepatic and extrahepatic  distribution of spheres. Side effects following therapy were noted in all the patients. All patients were followed up with triphasic CT liver 3 months following therapy. Therapeutic response was evaluated with necrosis criteria used for therapy response assessment in solid tumors. RESULTS: On follow up, 14 patients (46 %) developed minor side effects following treatment and resolved without active intervention. The most common side effects include mild abdominal pain in 11 patients (36 %), nausea in 8 patients (26 %), and fatigue in 6 patients (20 %). On follow up imaging at 3 months following treatment, a complete response was observed in two patients (7 %), partial response in seven patients (23 %), stable disease in 15 patients (50 %), and progressive disease in six patients (20 %). CONCLUSION: This study provides supportive evidence of the safety and efficacy on 90Y radioembolization for the treatment of unresectable HCC and hepatic metastases from various solid tumors. 90Y PET is a better radionuclide technique for assessing the hepatic and extrahepatic distribution of spheres following therapy compared to 90Y Bremsstrahlung SPECT. Thus, 90Y radioembolization is proving to be promising treatment with average disease control rates around 80 % and should be widely utilized.