We present a rare case of vas deferens involvement in high-grade prostate adenocarcinoma, detected by both [68Ga]Ga-PSMA PET/CT and [99mTc]Tc-PSMA SPECT/CT imaging. A 68-year-old male with elevated PSA (Gleason score 4+5) showed locoregional disease involving the prostate, left seminal vesicle, and distal vas deferens on both PET/CT and SPECT/CT scans, with no regional or distant metastasis. This case highlights the value of PSMA imaging in detecting unusual metastatic patterns as well as the clinical utility of [99mTc]Tc-PSMA SPECT/CT as an accessible alternative to PET/CT. The supplementary file reviews additional reports of PSMA-avid metastases in male genital structures.
Osteomas are benign, slow-growing bone tumors, most frequently found in the nose and paranasal sinuses. We report the case of a 69-year-old male with a history of low-risk prostate adenocarcinoma who was under active surveillance. He was referred for [99mTc]Tc-MDP bone scintigraphy and [99mTc]Tc-HYNIC-PSMA11 imaging due to a rising PSA level. Incidentally, an osteoma was identified in the left frontal sinus, demonstrating intense uptake on the bone scan and faint uptake on PSMA imaging. This case highlights the potential for PSMA ligand uptake in benign osseous lesions and underscores the importance of correlating functional and anatomical imaging to avoid misinterpretation and ensure accurate diagnosis and appropriate patient management.
Understanding the occurrence of false positive results for radioactive iodine absorption in whole body scans is crucial for differentiating these cases from actual metastases. The implementation of SPECT/CTtechnology has significantly facilitated this process for medical professionals. This study presents a case involving a 46-year-old female patient who underwent a total thyroidectomy as a treatment for thyroid cancer (papillary thyroid carcinoma), followed by radioactive iodine therapy. The post-treatment whole body scan revealed the presence of a diffuse radioiodine-avid lesion in the pelvic region, which was later identified as multiple uterine myomas through additional investigations utilizing SPECT/low-dose CT scan and MRI findings.
Large-vessel vasculitis (LVV), including Takayasu arteritis and giant cell arteritis, is a rare inflammatory condition affecting the aorta and its major branches. This case report describes a 33-year-old male with fever of unknown origin (FUO), anemia, and elevated inflammatory markers. Initial imaging was inconclusive, but Fluorodeoxyglucose Positron Emission Tomography - Computed Tomography ([18F]FDG PET-CT) revealed diffuse uptake in major arteries (carotid, subclavian, brachiocephalic, aorta, and pulmonary trunk) with an SUVmax of 6.91, indicating active vasculitis. The absence of [18F]FDG-avid lymphadenopathy ruled out malignancy or infection, while faint uptake in bilateral femoral arteries suggested systemic involvement. Physiological uptake in organs like the gastrointestinal tract and adrenal glands showed no malignancy, and axial skeleton activity was linked to anemia. This case highlights [18F]FDG PET-CT's role in early LVV detection, stressing the need for timely diagnosis to prevent irreversible vascular damage and the importance of integrating imaging with clinical evaluation for effective management.
A 69-year-old male patient diagnosed with prostate adenocarcinoma underwent whole-body bone scintigraphy utilizing [99mTc]Tc-methylene diphosphonate (MDP) for initial staging. During the procedure, an unexpected focal uptake of the radiotracer was noted, which appeared to resemble metastasis to the pubic bone or prostate cancer. However, this finding was ultimately determined to be due to a displaced bladder stone located within the prostatic urethra. This case highlights the importance of reviewing the patient's previous imaging studies, utilizing SPECT/CT imaging, and considering urinary tract stones as a potential differential diagnosis when abnormal radiotracer uptake is detected in the pelvic region below the bladder.
Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by excessive secretion of parathyroid hormone (PTH), commonly due to a parathyroid adenoma. We present a rare case of a 21-year-old female diagnosed with PHPT caused by a parathyroid adenoma Type G, an intrathyroidal variant. The patient exhibited severe skeletal manifestations, including multiple thoracic vertebral fractures, significant height reduction, and hypercalcemia (serum calcium: 11.4 mg/dL). [99mTc]Tc-MIBI SPECT/CT imaging localized the adenoma in the middle pole of the right thyroid lobe. The patient underwent successful right isthmolobectomy and parathyroidectomy, leading to normalization of PTH and calcium levels. This case highlights the importance of nuclear medicine imaging in accurately diagnosing and guiding surgical intervention for rare parathyroid adenoma subtypes.
Osteopoikilosis (OPK) is a rare, benign sclerosing bone dysplasia often discovered incidentally during radiographic evaluations. We report the case of a 37-year-old male with bilateral hip pain and radiographic evidence of multiple sclerotic lesions, initially raising concern for osteoblastic metastasis. Laboratory findings were unremarkable. [99mTc]Tc-Methylene diphosphonate (MDP) scan performed three hours after administration of 20 mCi (740 MBq) of radiotracer showed no increased uptake at lesion sites, ruling out metastasis and supporting the OPK diagnosis. Further evaluation revealed similar radiographic findings in the patient's asymptomatic brother, confirming familial OPK. This case highlights the diagnostic importance of nuclear imaging in distinguishing OPK from metastatic disease and emphasizes the need for awareness to avoid unnecessary interventions.
This case report involves a 67-year-old woman with a 20-year history of primary mesenteric hydatid cyst (PMHD) who presented with recent right flank pain. An abdominopelvic CT scan showed severe right-sided hydroureteronephrosis caused by a large mesenteric cyst compressing the ureter. A [99mTc]Tc-DMSA scan revealed significant function loss in the right kidney, with a barely visible photopenic area in the mid-abdomen corresponding to the cyst. This case underscores the importance of careful evaluation of scintigraphic images, as overlooked photopenic zones can offer valuable insights into underlying conditions like PMHD, which can lead to renal dysfunction.
This case report illuminates the pivotal role of 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) PET/CT (Positron emission tomography integrated with computed tomography) scan in diagnosing uncommon and elusive pathologies. Through the detailed exploration of a challenging case, we underscore the significance of this imaging modality in unravelling diagnostic mysteries, guiding clinical decisionmaking, and ultimately improving patient outcomes. This case highlights the importance of considering haematological malignancies in the differential diagnosis of pyrexia of unknown origin (PUO), especially when accompanied by cytopenia and bone abnormalities. PET/CT scan revealed extent of disease involvement, it also guided to determine the site of bone marrow biopsy and to decide treatment protocol as well as in response assessment.
Prostate cancer remains a leading cause of cancer-related mortality among men worldwide. Technetium-99m methylene diphosphonate ([99mTc]Tc-MDP) bone scintigraphy is commonly employed to detect skeletal metastases due to its high sensitivity in identifying osteoblastic activity. However, [99mTc]Tc-MDP uptake in soft tissues, particularly in the prostate gland, is exceedingly rare. Here, we present a case of a 70-year-old male with acinar prostate adenocarcinoma (Gleason score 7/10) and persistent lower back pain. [99mTc]Tc-MDP scintigraphy demonstrated abnormal radiotracer uptake in the prostate gland without any evidence of bone metastases. Further evaluation through performing SPECT/CT confirmed the radiotracer uptake in the prostate gland without evidence of calcification. This rare finding emphasizes recognizing atypical imaging patterns and accurately interpreting them, which are important for clinical decisionmaking. We evaluate the patient regarding the potential mechanisms for such uptake, including dystrophic calcification and localized osteoblastic activity, and discuss the diagnostic implications and future research directions in prostate cancer imaging.
Introduction: During treatment of hormone-receptor positive breast cancers, Aromatase inhibitors (AIs) are commonly used. However, AIs are recognized to induce bone density loss and increase the risk of fractures. Recently, trabecular bone score (TBS) has been introduced to assess bone microarchitecture. Our study aimed to investigate changes in bone mineral density (BMD) and TBS in breast cancer patients treated with AIs. Methods: Fifty-one patients with a mean age 59.75 +/- 10.95 and a pathology-proven diagnosis of breast cancer underwent bone mineral densitometry (BMD) using the DXA method. BMD and TBS were recorded before and 6 months after starting treatment with AIs. Results: By comparing the bone density measurements before and six months after starting treatment with AIs, we observed a significant decrease in bone density in the lumbar region and total hip, but no significant change in TBS. Additionally, when comparing the TBS-adjusted 10-year risk probability of major osteoporosis and hip fracture (FRAX) before and six months after starting the medication, wefound no statistically significant difference between the two time points. Conclusion: This study examined bone density and T-score in the lumbar region and total hip in breast cancer patients treated with aromatase inhibitors (AIs). The results show a clear reduction in bone density after 6 months of treatment, which lead to an increased risk of fracture in these patients. Notably, TBS, FRAX and even FRAX adjusted with TBS do not exhibit significant changes over this short-term period.
A 37-year-old woman presented with dyspepsia, bone pain, and significant weight loss. Endoscopy revealed an infiltrative gastric body mass, and histology confirmed signet ring cell gastric adenocarcinoma. A contrast-enhanced CT scan showed peritoneal carcinomatosis and multiple lytic-sclerotic skeletal metastases. A whole-body Technetium-99m methylene diphosphonate ([99mTc]Tc-MDP) scan revealed a "superscan" pattern, characteristic of widespread bone metastases. While bone scintigraphy is sensitive for detecting osteoblastic metastases, the superscan pattern can be mistaken for a normal scan, particularly in gastric cancer patients where it's an uncommon finding. Our brief review of the literature illustrates this infrequently observed phenomenon may occasionally occur in gastric cancer, especially in symptomatic patients.
An 80-year-old man with a history of abdominal pain and fatigue was evaluated for bilateral adrenal masses of unknown origin. He was referred to our department for [18F]FDG PET/CT imaging to further investigate the nature of these masses. The scan showed intense [18F]FDG uptake in both adrenal glands, which could initially be mistaken for physiological kidney uptake. A subsequent adrenal biopsy confirmed the diagnosis of B-cell lymphoma. Follow-up [18F]FDG PET/CT imaging showed complete metabolic response to treatment. This case highlights the critical role of [18F]FDG PET/CT in identifying malignant adrenal lesions and underscores the importances of considering primary adrenal lymphoma in the differential diagnosis when encountering intense, bilateral adrenal hypermetabolism.
Penis is an extremely rare site of metastases despite having very rich vascularization. Penile metastasis is frequently associated with widespread metastatic disease and poor prognosis. Despite its rarity, penile metastases must be considered even in a multi-systemic disease because patients may become symptomatic requiring palliative care. Hence, we report the adding value of [18F]FDG PET/CT as a valuable noninvasive tool in the detection of penile lesions.
Introduction: Morphological remodeling of the heart during Heart failure (HF) can be detected by gated myocardial perfusion single-photon emission computed tomography (Gated SPECT) using left ventricular shape index (LVSI). This study aimed to investigate the prognostic value of LVSI measured by Gated SPECT and echocardiography in HF patients. Methods: This prospective study involved 96 patients referred for myocardial perfusion scans, divided into two groups: those with heart failure (HF) and those without. The study analyzed cardiac sphericity indexes, including end-diastolic and end-systolic LVSI and the Eccentricity index (EI). The LVSI index was also measured by echocardiography at the end of diastole. The patients were followed for one year to evaluate the occurrence of cardiac events and underwent echocardiography at the end of this period. Results: End-diastolic and end-systolic LVSI in the resting phase were 0.70 +/- 0.10 and 0.60 +/- 0.11 in the group of patients with HF, and 0.66 +/- 0.06 and 0.45 +/- 0.06 in the group of patients without heart failure, respectively. These values had a significant correlation with the similar index in echocardiography (p-value=0.001). In the group of HF patients, 20 people experienced cardiac events during one year of follow-up. However, there was no significant relationship between the values of LVSI measured by Gated SPECT and echocardiography and the incidence of cardiac events. Conclusion: Although the values of LVSI in patients with HF were higher compared to those without HF, the indexes of heart shape change did not significantly predict the one-year prognosis of HF patients.
Introduction: Gastrin-releasing peptide receptors (GRPRs) are overexpressed in a wide range of malignancies, makingthem attractivetargets for molecular imaging and targeted therapy. The bombesin analog DO3A-CH2CO-G-[4-aminobenzoyl]- QWAVGHLM-NH2 (AMBA), has demonstrated promising potential in both diagnostic and therapeutic applications by selectively binding to GRPRs. This study aimed to estimate the absorbed dose of [113mIn]In-AMBA, based on preclinical biodistribution data and Monte Carlo simulations. Methods: AMBA peptide was radiolabeled with 113mIn prepared from an in-house developed 113Sn/113mIn generator. Biodistribution studies were performed in rats at multiple time points following the injection of [113mIn]In-AMBA. The accumulated activity in each rat organ was extrapolated to human organ. Finally, the absorbed doses in human organs were estimated by applyingthe Monte Carlo N-Particle (MCNP) software in Oak Ridge National Laboratory (ORNL) phantom using the Medical Internal Radiation Dose (MIRD) method. Results: The radiochemical purity (RCP) of [113mIn]In-AMBA exceeded 98% (HPLC). Biodistribution studies demonstrated high cumulation of activity in the GRPRexpressing organs and kidneys. The highest absorbed doses were observed in the pancreas (0.0044 mGy/MBq), and kidneys (0.0018 mGy/MBq), respectively. In contrast, non-target organs exhibited minimal uptake and rapid clearance from the animal body results in minimal absorbed dose in non-target organs (<= 0.001 mGy/MBq). Conclusion: This study demonstrates that [113mIn]In-AMBA is a safe and promising SPECT imaging agent for the detection of GRPR-positive tumors. While current findings support the safety and potential of [113mIn]In-AMBA as a GRPR-targeted SPECT agent, further validation in tumor-bearing animal models and early-phase clinical studies is required for clinical translation.
Introduction: Bone metastases are a frequent complication in various tumors such as prostate, breast, and lung carcinoma often causing progressive pain. Bone-seeking beta-emitting radiopharmaceuticals such as samarium-153-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetramethylene phosphonic acid ([153Sm]Sm-DOTMP) are potentially utilized for bone pain palliation. Methods: This research evaluated the radiation absorbed dose of [153Sm]Sm-DOTMP radiopharmaceutical for adult men based on biodistribution data in Wistar rats. The Medical Internal Radiation Dosimetry (MIRD) dose calculation method and the Sparks and Aydogan methodology were applied. Results: About 56% of the injected activity is accumulated on the surface of the trabecular and compact bones. Radiation absorbed doses of red bone marrow and osteogenic cells were estimated at 0.66 +/- 0.04 and 3.43 +/- 0.23 mGy/MBq, respectively. The maximum administrated activity was obtained at 43.3 MBq/kg (1.17 mCi/kg) of body weight with about 10.4 Gy absorbed dose of bone surface for a 70 kg adult man. The effective dose of [153Sm]Sm-DOTMP radiopharmaceutical was estimated at 0.14 +/- 0.01 mSv/MBq and the urinary bladder wall and kidneys absorbed doses were evaluated at about 0.20 +/- 0.02 mGy/MBq and 0.05 +/- 0.01 mGy/MBq, respectively. The urinary and gastrointestinal tracts were the next organs with the highest radiation absorbed dose as the main routes of excretion of radioactivity. Conclusion: This study showed that the radiopharmaceutical [153Sm]Sm-DOTMP can provide palliative care for bone metastases while delivering low undesired doses to surrounding normal tissues.
Synchronous primary tumors (SPTs) refer to the pathologically different tumors coexisting in an individual. This phenomenon is often identified during cancer evaluation using [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT). The two cases presented here highlight discrepancies in [18F]FDG uptake intensity between the SPTs. Case 1 features a breast cancer with high uptake and a second primary lung cancer with low uptake, while Case 2 describes an esophageal cancer with low uptake and an incidental paraganglioma with high uptake. [18F]FDG uptake varies by histopathological characteristics and is typically consistent within the same clonal group. A lesion showing discordant uptake relative to the primary tumor on [18F]FDG PET/CT may indicate another distinct tumor.
We present a rare case of primary breast cancer occurring within accessory breast tissue located in the left axillary region who was referred to our department for sentinel lymph node (SLN) mapping. Initial peri-tumoral injection of the radiotracer didn't show any axillary SLN. However, when the tracer was reinjection in the peri-areolar region of the normal (eutopic) breast, it successfully identified axillary sentinel node which was most clearly seen best on SPECT/CT images. This case underscores the feasibility of sentinel node mapping in cancer of ectopic breast tissue, highlighting that injection in the peri-areolar region of the eutopic breast appears to be a more effective technique.
Introduction: Since the Ordered Subset Expectation Maximization (OSEM) and Q.Clear algorithm each have advantages and disadvantages, we aimed to determine the optimal values of reconstruction protocols to achieve the best diagnostic parameters for the neurological PET brain images of BGO-based PET/CT scanners. Methods: Images of point sources, as well as Hoffman and Carlson phantoms filled with [18F]FDG radiopharmaceutical, were acquired using a PET/CT scanner. In OSEM, images were reconstructed with multiple iterations and subsets, applying 3.2 mm or 6.4 mm Gaussian filters, with PSF recovery enabled. For comparison, one reconstruction was done without PSF recovery using Iteration-Subset=12-12. In Q.Clear, (3 values from 50 to 500 in 50-step increments were used for reconstruction. Parameters such as FWHM, COV and modified RC were evaluated. A cost function identified the best results, which were blindly assessed by two nuclear medicine experts for noise, contrast, and overall image quality. Results: Quantitatively, (3=50-200 and Iteration-Subset=20-12 were the parameters whose Cost Function values were higher than Iteration-Subset =12-12, which was routinely used to reconstruct brain images in our center. Visual evaluations show that (3=200 has the lowest noise and the lowest contrast and evaluators gave the highest score for overall image quality to (3=200 and (3=150. This study has evaluated (3=200 and (3=150 as optimal for reconstructing brain images. Conclusion: This study investigated the different reconstruction algorithms to obtain the optimal parameters. The Q.clear algorithm with penalty function of (3=200 and (3=150 is recommended for brain neurological images of GE Healthcare PET/CT scanner.
