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Various radiologic examinations and other diagnostic tools exist for evaluating gastrointestinal diseases. When symptoms of gastrointestinal disease persist and no underlying anatomic or structural abnormality is identified, the diagnosis of functional gastrointestinal disorder is frequently applied. Given its physiologic and quantitative nature, scintigraphy often plays a central role in the diagnosis and treatment of patients with suspected functional gastrointestinal disorder. Most frequently, after functional gallbladder disease is excluded, gastric emptying scintigraphy (GES) is considered the next step in evaluating patients with suspected gastric motility disorder who present with upper gastrointestinal symptoms such as dyspepsia or bloating. GES is the standard modality for detecting delayed gastric emptying (gastroparesis) and the less commonly encountered clinical entity, gastric dumping syndrome. Additionally, GES can be used to assess abnormalities of intragastric distribution, suggesting specific disorders such as impaired fundal accommodation or antral dysfunction, as well as to evaluate gastric emptying of liquid. More recently, scintigraphic examinations for evaluating small bowel and large bowel transit have been developed and validated for routine diagnostic use. These can be performed individually or as part of a comprehensive whole-gut transit evaluation. Such scintigraphic examinations are of particular importance because clinical assessment of suspected functional gastrointestinal disorder frequently fails to accurately localize the site of disease, and those patients may have motility disorders involving multiple portions of the gastrointestinal tract. The authors comprehensively review the current practice of gastrointestinal transit scintigraphy, with diseases and best imaging practices illustrated by means of case review. ©RSNA, 2024 See the invited commentary by Maurer and Parkman in this issue.
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Gastroenteropatias , Trânsito Gastrointestinal , Cintilografia , Humanos , Cintilografia/métodos , Trânsito Gastrointestinal/fisiologia , Gastroenteropatias/diagnóstico por imagem , Motilidade Gastrointestinal/fisiologia , Adulto , Esvaziamento Gástrico/fisiologiaRESUMO
Parkinsonian syndromes are a heterogeneous group of progressive neurodegenerative disorders involving the nigrostriatal dopaminergic pathway and are characterized by a wide spectrum of motor and nonmotor symptoms. These syndromes are quite common and can profoundly impact the lives of patients and their families. In addition to classic Parkinson disease, parkinsonian syndromes include multiple additional disorders known collectively as Parkinson-plus syndromes or atypical parkinsonism. These are characterized by the classic parkinsonian motor symptoms with additional distinguishing clinical features. Dopamine transporter SPECT has been developed as a diagnostic tool to assess the levels of dopamine transporters in the striatum. This imaging assessment, which uses iodine 123 (123I) ioflupane, can be useful to differentiate parkinsonian syndromes caused by nigrostriatal degeneration from other clinical mimics such as essential tremor or psychogenic tremor. Dopamine transporter imaging plays a crucial role in diagnosing parkinsonian syndromes, particularly in patients who do not clearly fulfill the clinical criteria for diagnosis. Diagnostic clarification can allow early treatment in appropriate patients and avoid misdiagnosis. At present, only the qualitative interpretation of dopamine transporter SPECT is approved by the U.S. Food and Drug Administration, but quantitative interpretation is often used to supplement qualitative interpretation. The authors provide an overview of patient preparation, common imaging findings, and potential pitfalls that radiologists and nuclear medicine physicians should know when performing and interpreting dopamine transporter examinations. Alternatives to 123I-ioflupane imaging for the evaluation of nigrostriatal degeneration are also briefly discussed. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Intenzo and Colarossi in this issue.
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Radioisótopos do Iodo , Nortropanos , Transtornos Parkinsonianos , Humanos , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Transtornos Parkinsonianos/diagnóstico por imagem , Transtornos Parkinsonianos/metabolismo , Tomografia Computadorizada de Emissão de Fóton Único/métodosRESUMO
Meckel diverticulum, the most common congenital anomaly of the gastrointestinal tract, results from the aberrant involution of the omphalomesenteric duct and accounts for more than 50% of unexplained lower gastrointestinal bleeding in the pediatric population. The most accurate imaging tool to identify a Meckel diverticulum containing ectopic gastric mucosa is the Technetium-99m pertechnetate Meckel scan, a scintigraphic study with a reported accuracy of 90% in the pediatric population. In addition to depicting a Meckel diverticulum with ectopic gastric mucosa, careful attention to the normal biodistribution of the radiotracer can lead to the identification of unexpected pathology with implications for patient management. This article serves to review the embryological origin and anatomical features of Meckel diverticulum, highlight the role of scintigraphy in evaluating Meckel diverticulum, and discuss the proper imaging technique when performing this test. We will focus on pitfalls that can lead to an erroneous diagnosis as well as incidental findings that can affect patient management.
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Divertículo Ileal , Doenças Musculoesqueléticas , Criança , Humanos , Divertículo Ileal/diagnóstico por imagem , Distribuição Tecidual , Compostos Radiofarmacêuticos , Cintilografia , Hemorragia Gastrointestinal/diagnóstico por imagem , Pertecnetato Tc 99m de SódioRESUMO
PURPOSE: Diverse radionuclide imaging techniques are available for the diagnosis, staging, and follow-up of phaeochromocytoma and paraganglioma (PPGL). Beyond their ability to detect and localise the disease, these imaging approaches variably characterise these tumours at the cellular and molecular levels and can guide therapy. Here we present updated guidelines jointly approved by the EANM and SNMMI for assisting nuclear medicine practitioners in not only the selection and performance of currently available single-photon emission computed tomography and positron emission tomography procedures, but also the interpretation and reporting of the results. METHODS: Guidelines from related fields and relevant literature have been considered in consultation with leading experts involved in the management of PPGL. The provided information should be applied according to local laws and regulations as well as the availability of various radiopharmaceuticals. CONCLUSION: Since the European Association of Nuclear Medicine 2012 guidelines, the excellent results obtained with gallium-68 (68Ga)-labelled somatostatin analogues (SSAs) in recent years have simplified the imaging approach for PPGL patients that can also be used for selecting patients for peptide receptor radionuclide therapy as a potential alternative or complement to the traditional theranostic approach with iodine-123 (123I)/iodine-131 (131I)-labelled meta-iodobenzylguanidine. Genomic characterisation of subgroups with differing risk of lesion development and subsequent metastatic spread is refining the use of molecular imaging in the personalised approach to hereditary PPGL patients for detection, staging, and follow-up surveillance.
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Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Medicina Nuclear/normas , Feocromocitoma/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/normas , Guias de Prática Clínica como Assunto , Neoplasias das Glândulas Suprarrenais/radioterapia , União Europeia , Humanos , Radioisótopos do Iodo/uso terapêutico , Medicina Nuclear/organização & administração , Feocromocitoma/radioterapia , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos/farmacocinética , Compostos Radiofarmacêuticos/normas , Compostos Radiofarmacêuticos/uso terapêutico , Sociedades Médicas/normas , Somatostatina/análogos & derivadosRESUMO
OBJECTIVE: In this article, we describe the concepts of ventilation-perfusion planar, SPECT, and SPECT/CT and outline the advantages of integrated ventilation-perfusion SPECT/CT over planar imaging. We present an overview of the traditional and new applications of ventilation-perfusion scintigraphy. CONCLUSION: SPECT/CT has improved the diagnostic accuracy of ventilation-perfusion imaging and opened the door for a new spectrum of applications.
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Aumento da Imagem/métodos , Pneumopatias/diagnóstico por imagem , Compostos Radiofarmacêuticos/administração & dosagem , Transtornos Respiratórios/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Relação Ventilação-Perfusão , Administração por Inalação , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/instrumentaçãoRESUMO
BACKGROUND: Linear attenuation coefficients (LACs) in positron emission tomography combined with computed tomography (PET/CT) are derived from CT scans that utilize energy-integrating detectors (EID-CT). These LACs are inaccurate when iodine contrast has been injected. Photon counting detector CT (PCD-CT) may be able to improve the accuracy. PURPOSE: To investigate whether PCD-CT can improve PET/CT quantitative accuracy. METHODS: Two experiments were performed: one with CT only and one that combined PET and CT. The first experiment used an electron density phantom whose inserts were imaged with EID-CT and PCD-CT. The inserts simulated normal human tissues, including bone and iodinated blood. In the case of PCD-CT, virtual-monoenergetic images at 190 keV were created. LACs were derived in each case and compared against known values. For inserts with iodine, more accurate LACs were expected with PCD-CT. The second experiment involved a custom PET phantom with various materials simulating human tissues (blood, iodinated blood, and bone) and 18F radioactivity. Data were first acquired with an EID-CT-based PET/CT system and then separately in a PCD-CT system without PET. PET images were reconstructed using LAC from EID-CT and PCD-CT. PET image values were compared against known activity values using recovery coefficients (RC). RESULTS: In the first experiment, LAC based on EID-CT were in error by as much as 18%, whereas the corresponding PCD-CT based measurements were within 3%. In the second experiment, minimum, maximum, and mean RC were (96.1%, 115.4%, and 103.8%) for the EID-CT method, and (95.8%, 105.5%, and 101.0%) for the PCD-CT method. The consistency of PET images in body and head orientations was improved. CONCLUSIONS: PCD-CT can acquire the information needed for accurate LAC for PET reconstruction in a single spiral acquisition.
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BACKGROUND: Accurate identification of pain generators in the context of low back and spine-related pain is crucial for effective treatment. This review aims to evaluate the potential usefulness of single photon emission computed tomography with computed tomography (SPECT/CT) as an imaging modality in guiding clinical decision-making. METHODS: A broad scoping literature review was conducted to identify relevant studies evaluating the use of SPECT/CT in patients with spine-related pain. Studies were reviewed for their methodology and results. RESULTS: SPECT/CT appears to have advantages over traditional modalities, such as magnetic resonance imaging and CT, in certain clinical scenarios. It may offer additional information to clinicians and improve the specificity of diagnosis. However, further studies are needed to fully assess its diagnostic accuracy and clinical utility. CONCLUSIONS: SPECT/CT is a promising imaging modality in the evaluation of low back pain, particularly in cases where magnetic resonance imaging and CT are inconclusive or equivocal. However, the current level of evidence is limited, and additional research is needed to determine its overall clinical relevance. CLINICAL RELEVANCE: SPECT/CT may have a significant impact on clinical decision-making, particularly in cases in which traditional imaging modalities fail to provide a clear diagnosis. Its ability to improve specificity could lead to more targeted and effective treatment for patients with spinal pathology.
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ABSTRACT: 99m Tc-dimercaptosuccinic acid ( 99m Tc-DMSA) scans are used to evaluate renal cortical defects typically related to parenchymal scarring or pyelonephritis, and ectopic renal parenchyma. 99m Tc-DMSA binds to metalloproteins in proximal tubular cells and typically localizes to the renal cortex, with minimal excretion. Planar and SPECT images are obtained 2 to 4 hours after IV administration of 99m Tc-DMSA. Altered 99m Tc-DMSA biodistribution has been reported in various conditions, including renal injury, technical issues, infiltrative processes, and hematologic disorders. Here, we present a case of altered biodistribution, with hepatic and splenic radiotracer uptake in the setting of hepatosplenomegaly and hematologic abnormalities concerning for a systemic hematologic disorder/lymphohistiocytosis.
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Pielonefrite , Ácido Dimercaptossuccínico Tecnécio Tc 99m , Humanos , Distribuição Tecidual , Rim , Cintilografia , Pielonefrite/diagnóstico por imagem , Compostos RadiofarmacêuticosRESUMO
Lymphoma-related malignancies can be categorized as Hodgkin's lymphoma (HL) or non-Hodgkin's lymphoma (NHL) based on histologic characteristics. Although quite rare during pregnancy, HL and NHL are the fourth and fifth most common malignancies during the pregnancy period, respectively. Given the rarity of lymphoma among pregnant patients, radiologists are usually unfamiliar with the modifications required for staging and treatment of this population, even those who work at centers with busy obstetrical services. Therefore, this manuscript serves to not only review the abdominopelvic imaging features of lymphoma in pregnancy, but it also discusses topics including birthing parent and fetal lymphoma-related prognosis, both antenatal and postpartum, current concepts in the management of pregnancy-related lymphoma, as well as the current considerations regarding birthing parent onco-fertility.
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Doença de Hodgkin , Linfoma não Hodgkin , Linfoma , Humanos , Feminino , Gravidez , Linfoma/diagnóstico por imagem , Linfoma/terapia , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/terapia , Doença de Hodgkin/diagnóstico por imagem , Doença de Hodgkin/terapia , Prognóstico , Período Pós-PartoRESUMO
RATIONALE: Single-photon-emission-computerized-tomography/computed-tomography(SPECT/CT) is commonly used for pulmonary disease. Scant work has been done to determine ability of AI for secondary findings using low-dose-CT(LDCT) attenuation correction series of SPECT/CT. METHODS: 120 patients with ventilation-perfusion-SPECT/CT from 9/1/21-5/1/22 were included in this retrospective study. AI-RAD companion(VA10A,Siemens-Healthineers, Erlangen, Germany), an ensemble of deep-convolutional-neural-networks was evaluated for the detection of pulmonary nodules, coronary artery calcium, aortic ectasia/aneurysm, and vertebral height loss. Accuracy, sensitivity, specificity was measured for the outcomes. Inter-rater reliability were measured. Inter-rater reliability was measured using the intraclass correlation coefficient (ICC) by comparing the number of nodules identified by the AI to radiologist. RESULTS: Overall per-nodule accuracy, sensitivity, and specificity for detection of lung nodules were 0.678(95%CI 0.615-0.732), 0.956(95%CI 0.900-0.985), and 0.456(95%CI 0.376-0.543), respectively, with an intraclass correlation coefficient (ICC) between AI and radiologist of 0.78(95%CI 0.71-0.83). Overall per-patient accuracy for AI detection of coronary artery calcium, aortic ectasia/aneurysm, and vertebral height loss was 0.939(95%CI 0.878-0.975), 0.974(95%CI 0.925-0.995), and 0.857(95%CI 0.781-0.915), respectively. Sensitivity for coronary artery calcium, aortic ectasia/aneurysm, and vertebral height loss was 0.898(95%CI 0.778-0.966), 1 (95%CI 0.958-1), and 1 (95%CI 0.961-1), respectively. Specificity for coronary artery calcium, aortic ectasia/aneurysm, and vertebral height loss was 0.969(95% CI 0.893-0.996), 0.897 (95% CI 0.726-0.978), and 0.346 (95% CI 0.172-0.557), respectively. CONCLUSION: AI ensemble was accurate for coronary artery calcium and aortic ectasia/aneurysm, while sensitive for aortic ectasia/aneurysm, lung nodules and vertebral height loss on LDCT attenuation correction series of SPECT/CT.
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Inteligência Artificial , Cálcio , Humanos , Estudos Retrospectivos , Dilatação Patológica , Reprodutibilidade dos Testes , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Pulmão , PerfusãoRESUMO
Lung cancer remains the leading cause of cancer-related mortality for men and women in the United States. Screening for lung cancer with annual low-dose CT is saving lives, and the continued implementation of lung screening can save many more. In 2015, the CMS began covering annual lung screening for those who qualified based on the original United States Preventive Services Task Force (USPSTF) lung screening criteria, which included patients 55 to 77 year of age with a 30 pack-year history of smoking, who were either currently using tobacco or who had smoked within the previous 15 years. In 2021, the USPSTF issued new screening guidelines, decreasing the age of eligibility to 80 years of age and pack-years to 20. Lung screening remains controversial for those who do not meet the updated USPSTF criteria, but who have additional risk factors for the development of lung cancer. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Detecção Precoce de Câncer , Neoplasias Pulmonares , Masculino , Humanos , Feminino , Estados Unidos , Adulto , Neoplasias Pulmonares/diagnóstico por imagem , Sociedades Médicas , Medicina Baseada em Evidências , Diagnóstico por Imagem/métodosAssuntos
Hiperplasia do Linfonodo Gigante/diagnóstico por imagem , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Trombocitopenia/diagnóstico por imagem , Adulto , Hiperplasia do Linfonodo Gigante/complicações , Seguimentos , Humanos , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/estatística & dados numéricos , Síndrome , Trombocitopenia/complicaçõesRESUMO
ABSTRACT: Hepatobiliary scintigraphy is a sensitive tool for the detection of a suspected bile leak following cholecystectomy. Traditionally, it has been used to identify, but not localize the source of the leak. Herein we present a case of a bile leak related to a duct of Luschka injury that was identified on dynamic hepatobiliary scintigraphy, but was less evident on a concurrently acquired MRI. This case highlights the scintigraphic features of a bile leak from an accessory duct and underscores the importance of reviewing early dynamic images to potentially identify the source of a leak.
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Bile , Doenças Biliares , Ductos Biliares , Colecistectomia , Humanos , CintilografiaRESUMO
OBJECTIVE: To assess the agreement of SUV metrics across the different clinical PET reading software platforms available at our institution. METHODS: PET/CT images were reviewed on four different FDA-approved software platforms: syngoMMWP VE36A and syngo.via VB30A (Siemens), Intellispace Portal 9.0 (Philips), and Encore 6.7 (MIM Software). A total of thirty SUV measurements were derived from ten 18F-FDG PET/CT oncology studies. A volume of interest (VOI) was drawn around the primary tumor to determine lesion SUVmax and a 3 cm diameter spherical VOI was placed in the right lobe of the liver to determine liver SUVmean and liver SUVmax. RESULTS: For lesion SUVmax, statistically significant differences were found for syngoMMWP VE36A vs syngo.via VB30A (p = 0.002), syngoMMWP VE36A vs Intellispace Portal 9.0 (p = 0.002), and syngoMMWP VE36A vs Encore 6.7 (p = 0.001), respectively. For liver SUVmax, a statistically significant difference was found for syngoMMWP VE36A vs syngo.via VB30A (p = 0.033) only, whereas for liver SUVmean, no statistically significant differences were determined. A small systematic bias was found between syngoMMWP VE36A and all other platforms for lesion SUVmax. CONCLUSION: Significant differences and systematic biases were observed when measuring lesion SUVmax using different reader software systems. Although these differences may not be clinically significant, this bias could confound outcomes for quantitative, precision-research protocols. Hence, it is important for nuclear medicine departments to take SUV metric agreement into consideration, especially when transitioning to a new clinical platform.
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Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , SoftwareRESUMO
Hepatobiliary iminodiacetic acid (HIDA) scan is one of the principal imaging modalities for the evaluation of the gallbladder and biliary tree. Congenital biliary anomalies are rare and can be difficult to recognize on HIDA scan. They may also mimic other biliary pathology. The purpose of this article is to review the spectrum of congenital gallbladder and biliary anomalies and describe their imaging appearance on HIDA scan. In addition, the diagnostic utility of functional imaging with HIDA when evaluating biliary tract anomalies is described.
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Sistema Biliar , Vesícula Biliar , Sistema Biliar/diagnóstico por imagem , Vesícula Biliar/diagnóstico por imagem , Humanos , IminoácidosRESUMO
ABSTRACT: Arterial mapping and 99mTc-macroaggregated albumin (99mTc-MAA) hepatic perfusion imaging are routinely performed before 90Y radioembolization of hepatic tumors. These procedures serve multiple purposes, including an anatomical survey of hepatic arterial anatomy, interrogating expected microsphere distribution to avoid nontargeted embolization during therapy, and evaluating for possible hepatopulmonary shunting. We present a case where 99mTc-MAA planar images revealed unexpected soft tissue uptake within the left forearm, an unexpected complication that may result from residual 99mTc-MAA in the catheter being expelled as the catheter is removed, which is particularly important to avoid during the 90Y radioembolization procedure given the risk for associated radionecrosis.
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Embolização Terapêutica , Neoplasias Hepáticas , Albuminas , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Antebraço/diagnóstico por imagem , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Microesferas , Agregado de Albumina Marcado com Tecnécio Tc 99m , Radioisótopos de ÍtrioRESUMO
Radiation resistance in a subset of prostate tumors remains a challenge to prostate cancer radiotherapy. The current study on the effects of radiation on prostate cancer cells reveals that radiation programs an unpredicted resistance mechanism by upregulating acid ceramidase (AC). Irradiated cells demonstrated limited changes of ceramide levels while elevating levels of sphingosine and sphingosine-1-phosphate. By genetically downregulating AC with small interfering RNA (siRNA), we observed radiosensitization of cells using clonogenic and cytotoxicity assays. Conversely, AC overexpression further decreased sensitivity to radiation. We also observed that radiation-induced AC upregulation was sufficient to create cross-resistance to chemotherapy as demonstrated by decreased sensitivity to Taxol and C(6) ceramide compared to controls. Lower levels of caspase 3/7 activity were detected in cells pretreated with radiation, also indicating increased resistance. Finally, utilization of the small molecule AC inhibitor, LCL385, sensitized PPC-1 cells to radiation and significantly decreased tumor xenograft growth. These data suggest a new mechanism of cancer cell resistance to radiation, through upregulation of AC that is, in part, mediated by application of the therapy itself. An improved understanding of radiotherapy and the application of combination therapy achieved in this study offer new opportunities for the modulation of radiation effects in the treatment of cancer.
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Ceramidase Ácida/metabolismo , Neoplasias da Próstata/enzimologia , Radiossensibilizantes/farmacologia , Regulação para Cima/efeitos dos fármacos , Regulação para Cima/efeitos da radiação , Ceramidase Ácida/antagonistas & inibidores , Ceramidase Ácida/genética , Animais , Linhagem Celular Tumoral , Ceramidas/metabolismo , Ativação Enzimática/efeitos dos fármacos , Inibidores Enzimáticos/farmacologia , Humanos , Masculino , Camundongos , Camundongos Nus , Miristatos/farmacologia , Paclitaxel/farmacologia , Fosfotransferases (Aceptor do Grupo Álcool)/metabolismo , Propanolaminas/farmacologia , Neoplasias da Próstata/genética , RNA Interferente Pequeno/genética , Sensibilidade e Especificidade , Esfingosina/análogos & derivados , Esfingosina/metabolismo , Ensaios Antitumorais Modelo de XenoenxertoRESUMO
A 66-year-old man with history of papillary thyroid cancer status post total thyroidectomy underwent I-radioiodine ablation. Posttherapy I whole-body scan revealed unexpected activity within the left posterior ankle. SPECT/CT localized the radioiodine uptake to a gouty tophus in the Achilles tendon.
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Tendão do Calcâneo/diagnóstico por imagem , Gota/diagnóstico por imagem , Gota/metabolismo , Radioisótopos do Iodo , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Imagem Corporal Total , Tendão do Calcâneo/metabolismo , Idoso , Transporte Biológico , Humanos , Radioisótopos do Iodo/uso terapêutico , Masculino , Câncer Papilífero da Tireoide/radioterapia , Câncer Papilífero da Tireoide/cirurgia , TireoidectomiaRESUMO
A 49-year-old male with worsening back and right leg pain was referred for bone scan imaging. Bone scan demonstrated multifocal expansile osteoblastic bony lesions, atypical for benign osseous hemangiomas, which are commonly cold on bone scan. Multisite bone biopsies were compatible with the diagnosis of multifocal osseous hemangiomas. This case illustrates that aggressive osseous hemangiomas, a rare subtype of hemangiomas, may have variable osteoblastic activity on bone scan, ranging from mild to severe uptake.