Averilicia Passah

Metabolic Skeletal Superscan on 18F-FDG PET/CT in a Case of Acute Lymphoblastic Leukemia.

Superscan is a well-known finding described in skeletal scintigraphy characterized by intense radiotracer uptake in axial skeleton and decreased uptake in soft tissues and kidneys. Metabolic skeletal superscan has also been described in ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in various conditions. We describe here a case of 12-year-old boy who presented with a scalp swelling, progressive pallor, easy fatigability, poor appetite, and fever for 6 months. The initial diagnosis was inconclusive. ¹⁸F-FDG PET/CT revealed metabolic skeletal superscan and the final histopathological diagnosis was acute lymphoblastic leukemia.

Brain metastasis in carcinoma breast demonstrated on (68)Ga NOTA-bisphosphonate PET/CT.

Ga NOTA-bisphosphonate is a new bone-seeking PET radiotracer undergoing clinical evaluation. We report a case of a carcinoma breast who underwent Ga NOTA-bisphosphonate PET/CT for detection of skeletal metastasis. In addition to skeletal metastasis, a focal area of abnormal radiotracer uptake was noted in the brain, which was confirmed as brain metastasis on MRI.

Incidental Detection of Parathyroid Adenoma on Somatostatin Receptor PET/CT and Incremental Role of 18 F-Fluorocholine PET/CT in MEN1 Syndrome

Multiple endocrine neoplasia type 1 (MEN1) syndrome is characterized by combined occurrence of tumors of endocrine glands including the parathyroid, the pancreatic islet cells, and the anterior pituitary gland. Parathyroid involvement is the most common manifestation and usually the first clinical involvement in MEN1 syndrome, followed by gastroentero-pancreatic neuroendocrine tumors (NETs). Here we present a case where the patient initially presented with metastatic gastric NET and a single parathyroid adenoma was detected incidentally on 68Ga-DOTANOC PET/CT done as part of post 177Lu-DOTATATE therapy (PRRT) follow-up. Further 18F-fluorocholine PET/CT showed four adenomas for which the patient subsequently underwent subtotal parathyroidectomy.

Gallium-68 DOTANOC scan in a patient with suspected cardiac sarcoidosis

A 36-year-old male, a known case of systemic sarcoidosis, presented with recurrent episodes of palpitations and was admitted with sustained ventricular tachycardia. The patient had no history of risk factors or known coronary artery disease. Cardiac MRI showed global right ventricular hypokinesia along with diffuse T2 hyperintensity along the basal and mid-part of the interventricular septum. Right ventricular systolic dysfunction with EF of 35% along with mild tricuspid regurgitation was noted. Patchy irregular nodular late gadolinium enhancement was noted in the interventricular septum. Technetium 99m sestamibi (Tc 99m MIBI) scan showed small-sized moderately hypoperfused area in the basal inferior and inferoseptal wall. Gallium-68 DOTANOC scan showed an increased radiotracer uptake in the septum and the basal inferior wall. These findings were suggestive of active inflammatory foci consistent with myocardial involvement in sarcoidosis (Figure 1).

Multiple lytic lesions on F-18 fluorodeoxyglucose positron emission tomography/computed tomography not always metastatic?

Figure 1: F‐18 fluorodeoxyglucose positron emission tomography/computed tomography maximum intensity projection image (a) and fused positron emission tomography/computed tomography and computed tomography images at neck (b and c) soft‐tissue density nodule posterior to left lobe of thyroid with no significant fluorodeoxyglucose uptake (thick white arrow) and multiple lytic lesions as shown in fused positron emission tomography/computed tomography axial sections at pelvis (d) with no significant uptake (small white arrow) and at knee level (e) with increased fluorodeoxyglucose uptake (white arrow) d c b

Unusual presentation of rare cardiac tumor: The role of F-18-fluorodeoxyglucose positron emission tomography/computed tomography

Primary cardiac tumors are rare with angiosarcoma being the most common among malignant cardiac tumor. We present a case of 30-year-old female patient in whom F-18-fluorodeoxyglucose positron emission tomography/computed tomography demonstrated a necrotic mass in right atrium with multiple fluorodeoxyglucose avid lesions in both upper and lower alveolus, liver, multiple bones, and bilateral lungs. Patient underwent biopsy from gum swelling which revealed metastatic angiosarcoma.

A rare site of hyoid bone metastasis in patients with renal cell carcinoma on 18F-fluorodeoxyglucose-positron emission tomography/computed tomography scan

1. Safaei A, Figlin R, Hoh CK, Silverman DH, Seltzer M, Phelps ME, et al. The usefulness of F-18 deoxyglucose whole-body positron emission tomography (PET) for re-staging of renal cell cancer. Clin Nephrol 2002;57:56-62. 2. Kang DE, White RL Jr., Zuger JH, Sasser HC, Teigland CM. Clinical use of fluorodeoxyglucose F 18 positron emission tomography for detection of renal cell carcinoma. J Urol 2004;171:1806-9. 3. Flanigan RC, Campbell SC, Clark JI, Picken MM. Metastatic renal cell carcinoma. Curr Treat Options Oncol 2003;4:385-90. 4. Wu HC, Yen RF, Shen YY, Kao CH, Lin CC, Lee CC. Comparing whole body 18F-2-deoxyglucose positron emission tomography and technetium-99m methylene diphosphate bone scan to detect bone metastases in patients with renal cell carcinomas – A preliminary report. J Cancer Res Clin Oncol 2002;128:503-6. Sir, A 55-year-old man presented with histopathologically proven clear cell type of renal cell carcinoma (RCC). He underwent the right radical nephrectomy and received radiotherapy to bilateral pelvic bones, right femur, D7–D9 vertebrae, and right scapulae. He was on sunitinib therapy and came to our department for 18F‐fludeoxyglucose (FDG)‐positron emission tomography/computed tomography (PET/CT) scan for restaging. In the maximum intensity projection image [Figure 1a], it showed recurrence in the right renal bed and metastases to bilateral lungs and multiple skeletal sites including a rare site of hyoid bone metastases (black arrow). Transaxial PET/CT and CT images [Figure 1b and c] showed lytic lesion in hyoid bone with increased tracer uptake (white arrow), suggestive of hyoid bone metastasis.