Primary hyperparathyroidism (PHPT) due to parathyroid adenoma requires preoperative imaging for localisation, which may incidentally reveal vascular anomalies affecting surgery. A 62-year-old woman presented with recurrent epigastric pain, hypercalcemia (11.8 mg/dL), and elevated parathyroid hormone (PTH) (727 pg/mL), with ultrasound and sestamibi scan confirming right inferior parathyroid adenoma. SPECT/CT disclosed an aberrant right subclavian artery (arteria lusoria). Focused parathyroidectomy under cervical plexus block was performed after preoperative recognition of arteria lusoria, allowing cautious dissection in view of the possible association with nonrecurrent right laryngeal nerve (NRLN). Postoperative calcium/PTH normalised with symptom resolution. Arteria lusoria (~1% prevalence) associates with the nonrecurrent laryngeal nerve, mandating vigilant dissection. Routine cross-sectional imaging in PHPT aids anomaly detection for safer operative planning.
Orbital diseases frequently manifest with non-specific symptoms like proptosis, diplopia, pain, or visual disturbances, but still may be the first sign of various underlying pathologies, ranging from benign inflammation to aggressive malignancies. Early diagnosis is crucial but challenging with conventional imaging. We present a case series of fourteen patients with primary orbital or ocular complaints who underwent whole-body positron emission tomography/ computed tomography (PET/CT). Diagnoses included orbital lymphoma, leukaemia, rhabdomyosarcoma, Ewing’s sarcoma, multiple myeloma, metastatic carcinomas (breast, lung, thyroid), sebaceous and squamous cell carcinoma, hidradenocarcinoma, Erdheim-Chester disease, IgG4-related disease, and optic nerve sheath meningioma. 18 F-FDG PET/CT enabled metabolic characterisation of the orbital lesions and revealed occult systemic disease, significantly influenced staging, guided biopsy and treatment decisions. Advanced tracers such as 68 Ga-FAPI and 68 GaDOTATATE improved specificity in selected conditions. Overall, PET/CT serves as a comprehensive “one-stop” modality, integrating anatomical and metabolic data to optimise the diagnosis and management of orbital diseases.
Objectives: To compare Gaussian filtering, U-Net, and MedGAN for restoration of simulated low-count whole-body bone scintigraphy and to explore the effects of these image-processing methods on BONENAVI-derived quantitative outputs. Material and Methods: This single-centre retrospective study included 210 male patients with prostate cancer who underwent whole-body bone scintigraphy. Simulated low-count images corresponding to 70%, 50%, 30%, and 10% of the original counts were generated by Poisson resampling. Gaussian filtering was optimised for each count level, and U-Net and MedGAN were trained for image restoration. Image quality was evaluated using peak signal-to-noise ratio (PSNR) and structural similarity index measure (SSIM) against full-count reference images. An expanded auxiliary BONENAVI analysis was performed on the 30 patients from the independent held-out test set at the 30% count level to examine bone scan index and hotspot counts in full-count images, unprocessed 30%-count images, Gaussian-filtered images, U-Net-restored images, and MedGAN-restored images. Results: MedGAN showed the most consistent restoration performance across count levels. At the 30% count level, MedGAN achieved the highest PSNR (44.05 ± 5.02 dB) and SSIM (0.96510 ± 0.04230). At the 10% count level, U-Net and MedGAN showed comparable restoration performance, whereas MedGAN showed clearer advantages at the 30% and 50% count levels. In the expanded auxiliary BONENAVI analysis, 30%-count images overestimated bone scan index and hotspot counts, whereas Gaussian-filtered, U-Net-restored, and MedGAN-restored images reduced these deviations toward the full-count values to varying degrees. Conclusion: In this preliminary technical validation using simulated low-count data, MedGAN showed more consistent restoration performance than Gaussian filtering and U-Net, particularly at the 30% to 50% count levels. The expanded auxiliary BONENAVI analysis indicated that image processing affected BONENAVI-derived indices, with denoising and restoration reducing low-count-related deviations to varying degrees. These findings should not be interpreted as evidence supporting immediate routine clinical implementation, and further validation with prospectively acquired low-count or shortened-time data and reader-based diagnostic evaluation is warranted.
Parenchymal splenic metastases from solid malignancies are infrequent, often clinically silent, and usually present in the setting of widespread systemic metastases. Imaging characterisation is limited and challenging because of overlapping features with inflammatory pathologies and primary splenic neoplasms. This retrospective case series included six patients with solid malignancies who demonstrated splenic lesions on 18F-FDG PET/CT between 2016 and 2025. Imaging was evaluated for morphology, metabolic activity (SUVmax), and extra-splenic disease. Histopathological confirmation was available in one operated case, while the diagnosis in the remaining patients was based on imaging and clinical context. Primary malignancies included renal cell carcinoma (n = 2), breast carcinoma (n = 1), lung carcinoma (n = 1), hepatocellular carcinoma (n = 1), and ovarian carcinoma (n = 1). Splenic lesions were associated with systemic metastatic disease in most patients. Lesions were isodense to hypodense on CT and showed variable FDG uptake (SUVmax range: ~3.8 -15.5). In patients with widespread disease, splenic involvement was interpreted as metastatic based on imaging patterns. Histopathological confirmation was available in one case. 18 F-FDG PET/CT unveils clinically occult splenic metastases and provides whole-body disease burden. Although imaging patterns, along with clinical context, may suggest metastatic disease, histopathological confirmation is recommended for solitary or indeterminate lesions, as it may contribute to therapeutic decision-making.
