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.

A dataset of [68Ga]Ga-Pentixafor PET/CT images of patients with high-grade Glioma.

This paper contains single-center prospective information showing illustrative examples of chemokine receptor-4 (CXCR4) targeting in high-grade glial brain tumors in treatment-naïve adult patients using a novel radiolabeled PET tracer: [68Ga]Ga-CXCR4 PET/CT. High-grade glioma is one of the most resistant malignancies to treatment. Despite major breakthroughs in diagnostic and therapeutic approaches, the overall 5-year survival rate remains in the 5-10% range. CXCR4 is a chemokine with the C-X-C motif that is overexpressed in high-grade gliomas. The 24 consecutive treatment- naïve enrolled patients underwent PET/CT images using the SIEMENS scanner (Biograph6 TrueV) and received the radiotracer intravenously. After approximately 60 min, the PET/CT acquisition was performed with a dedicated scanner and in 10 min time per bed position. The images were reconstructed and analyzed with the 3D-OSEM algorithm, applying point spread function (PSF) or resolution recovery algorithm (TrueX in Syngo ® software, Siemens Medical Solution), 3 iterations, and 21 subsets using a 3 mm Gaussian post-smoothing filter. These data would be potentially beneficial for automatic tumor delineation machine learning after augmented with other data retrieved from different papers as well as for differentiation between an active viable tumor vs. post-surgery/necrosis in indeterminate cases. The theranostics potential (CXCR4-tageted labeled beta emitters) is one of the most novel areas of interest for future studies.

Comparison of 18 F-NaF Imaging, 99m Tc-MDP Scintigraphy, and 18 F-FDG for Detecting Bone Metastases.

Bone is a common metastasis site in several malignancies, most importantly prostate and breast cancers. Given the significance of the early and accurate diagnosis of bone metastases for preliminary staging, treatment planning and monitoring, restaging, and survival prediction in patients with malignancy, it is critical to compare and contrast the strengths and weaknesses of imaging modalities. Although technetium-99m-labeled diphosphonates [ 99m Tc-MDP] scintigraphy has been used for assessing skeletal involvement, there is a renewed interest in fluorine-18-labeled sodium fluoride [ 18 F-NaF] bone imaging with positron emission tomography or positron emission tomography/computed tomography, since this approach provides essential advantages in bone metastases evaluation. This review study aimed to discuss the basic and technical aspects of 18 F-NaF imaging and its mechanism of action, and compare this modality with the 99m Tc-MDP bone scan and 18F-fluorodeoxyglucose using current evidence from the pertinent literature and case examples of the center in the study.

Dual-phase 68Ga-PSMA-11 PET/CT may increase the rate of detected lesions in prostate cancer patients.

BACKGROUND: This study was conducted to compare the early static (3-6 min post-injection (p.i.)) and standard whole body (1 h, p.i.) 68Ga-PSMA-11 PET/CT imaging for detection of lesions in prostate cancer (PC) patients. MATERIALS AND METHODS: In this study, PC patients suspected of recurrence underwent 68Ga-PSMA-11 PET/CT. Early static images were acquired from the pelvis and the lower abdomen 3-5 minutes after radiotracer injection and, a routine whole body scan was performed from the skull to the mid-thigh 1 h after injection. Quantitative analysis (SUVmax) was evaluated in suspicious lesions. RESULTS: Of 19 evaluated PC patients with a median age of 72 ± 1.66 years (range: 55-85 years) and prostate-specific antigen (PSA) of 1.72 ± 6.11 ng/ml (range: 0.1-100 ng/ml) (median ± SE), 16 showed positive in the whole body PET/CT. All of the patients with positive whole body scans due to pelvic involvement had positive early scan results. Totally, 22 lesions were detected in both early and delay scans in the pelvic which 16 were related to prostate involvement, 4 were related to lymph node involvement, and 2 were related to bone involvement. Moreover, in addition to the mentioned 22 lesions, early PET imaging successfully detected local recurrence in a patient who was negative on WB PET/ CT; this lesion was masked in the delay scan due to bladder activity. The median SUVmax values of the early and delay scans were 3.69 ± 1.07 (median ± SE) (range: 1.2-14.5) and 5.85 ± 1.69 (range: 3.1-23.4), respectively. (p = 0.005). CONCLUSION: Early static 68Ga-PSMA-11 PET/CT imaging might discriminate metastases from urinary bladder activity. Therefore, early static imaging in combination with whole body 60-min p.i. imaging can improve the detection of local involvement pelvic disease.

68Ga-DOTATATE and 18F-FDG PET/CT for the Management of Esthesioneuroblastoma of the Sphenoclival Region.

We present a 48-year-old woman with an olfactory neuroblastoma who was referred for accurate staging using PET/CT. The Ga-DOTATATE PET/CT showed a 51 × 32-mm mass with an SUVmax of 7.59 in the sphenoidal sinuses, whereas radiotracer uptake on F-FDG PET/CT was similar to that of brain tissue. Ga-DOTATATE PET/CT might be especially useful in regions with difficult tumor visualization resulting from high background, such as brain tissue. The results of this case may suggest that somatostatin receptor imaging in patients with esthesioneuroblastoma may facilitate the potential application of radiotheranostic agents for the treatment of this aggressive subtype of tumors.

Advanced Case of Achalasia That Appeared on 68Ga-Prostate-Specific Membrane Antigen PET/CT.

We report a known case of severe achalasia that appeared on Ga-prostate-specific membrane antigen (PSMA) PET/CT. The patient was a known case of high-grade transitional cell carcinoma and suspicious diagnosis of prostate cancer referred for Ga-PSMA PET/CT. Ga-PSMA PET/CT showed linear increased activity in the esophageal wall as well as a distended esophagus.

Application of [68Ga]PSMA PET/CT in Diagnosis and Management of Prostate Cancer Patients.

PURPOSE: The early and accurate diagnosis of locoregional recurrence or metastasis in prostate cancer (PC) has a significant impact on treatment options. Prostatic-specific membrane antigen (PSMA) positron emission tomography (PET)/x-ray computed tomograph (CT) imaging has recently been introduced as a novel procedure in managing PC. The aim of this study was to evaluate the efficacy of [68Ga]PSMA PET/CT in managing PC patients and to compare the detection rate of PET/CT and bone scans (BSs) in detecting bone metastasis. PROCEDURES: We evaluated 415 patients with PC who underwent [68Ga]PSMA PET/CT between March 2015 and September 2018. The patients were classified into three groups: staging, biomedical recurrence (BCR), and follow-up or monitoring, based on the intent to perform PET/CT. RESULTS: We evaluated 415 patients aged 41-99 (68.25 ± 9.59). Of these patients, 344 (82.9 %) had at least one localized lesion. The detection rates were 48.3 %, 52.6 %, 74.4 %, 79.6 %, and 93.9 % for a PSA value of < 0.2 ng/ml, ≥ 0.2-< 0.5 ng/ml, ≥ 0.5-< 1 ng/ml, ≥ 1-< 2 ng/ml, and ≥ 2 ng/ml, respectively (p < 0.05). The detection rates increased significantly with higher GSs; the rates were 68.3 % (28/41), 74.5 % (73/98), 93.9 % (46/49), and 91 % (61/67) for a GS of < 7, 7, 8, and > 8, respectively (p < 0.05). An ideal cut-off value of > 1.16 ng/ml was obtained for PSA value, which equates to specificity of 75 % and sensitivity of 77 %. In comparing BSs and PET/CT, a region-based analysis showed the superiority of PET/CT over BSs for all regions expect the skull (p < 0.05). PET/CT detected 258 suspicious regions, 255 of which were metastatic and three of which were equivocal. BSs detected only 223 suspicious regions, 203 of which were metastatic and 20 of which were equivocal. CONCLUSIONS: [68Ga]PSMA PET/CT showed a high detection rate for lesions in PC patients. PSA level, GS, and a PSA doubling time of less than 6 months were shown to be the affective variables. In addition, 68Ga-PSMA PET/CT showed better performance in detecting bone lesions than BSs.

Spontaneous perforation of common bile duct in a pediatric patient: application of hepatobiliary scintigraphy.

We report a case of spontaneous biliary perforation in a 21-month old female pediatric patient with the presenting symptoms of abdominal distension, jaundice, and umbilical hernia. Hepatobiliary scintigraphy showed tracer accumulation in the peritoneal cavity. Preliminary diagnosis of spontaneous biliary perforation was confirmed during surgery. After surgical repair of the biliary leakage, the patient recovered fully. This case shows the importance of hepatobiliary scintigraphy in patients suspicious for this condition.

Family history of colorectal cancer in Iran.

BACKGROUND: Previous reports show a high proportion of young CRC patients in Iran. In this study we aim to look for the clustering of colorectal cancer in families of a series of CRC patients from Iran. METHODS: The family history of cancer is traced in 449 CRC patients of which 112 were 45 yrs or younger and 337 were older than 45 yrs at time of diagnosis. The patients were admitted in two hospitals in Tehran, during a 4-year period. RESULTS: Clinical diagnosis of HNPCC was established in 21 (4.7%) probands. Family history of CRC was more frequently reported by early-onset than by late-onset patients (29.5% vs. 12.8%, p < 0.001). Distribution of tumor site differed significantly between those with and without family history of CRC. Right colon cancer was the most frequent site (23/45, 35.4%) observed in patients with positive family history of colorectal cancer. CONCLUSION: The relatively high frequency of CRC clustering along with HNPCC in our patients should be further confirmed with larger sample size population-based and genetic studies to establish a cost effective molecular screening for the future.