Hyperparathyroidism (HPT) in patients with chronic kidney disease (CKD) includes secondary (sHPT) and tertiary hyperparathyroidism (tHPT). Considering that the role of preoperative imaging in the clinical setting is controversial, in the present study we have retrospectively compared pre-surgical diagnostic performances of 18F-Fluorocholine (18F-FCH) PET/CT, cervical ultrasonography (US), parathyroid scintigraphy, and 4D-CT in a group of 30 patients with CKD and HPT (18/12 sHPT/tHPT), 21 CKD G5 including 18 in dialysis, and 9 kidney transplant recipients. All patients underwent 18F-FCH, and 22 had cervical US, 12 had parathyroid scintigraphy, and 11 had 4D-CT. Histopathology was the gold standard. Seventy-four parathyroids were removed: 65 hyperplasia, 6 adenomas, and 3 normal glands. In the whole population, in a per gland analysis, 18F-FCH PET/CT was significantly more sensitive and accurate (72%, 71%) than neck US (25%, 43%), parathyroid scintigraphy (35%, 47%), and 4D-CT (40%, 47%). The specificity of 18F-FCH PET/CT (69%) was lower than that of neck US (95%) and parathyroid scintigraphy (90%), without, however, achieving significance. 18F-FCH PET/CT was more accurate than all other diagnostic techniques when sHPT and tHPT patients were considered separately. 18F-FCH PET/CT sensitivity was significantly higher in tHPT (88%) than in sHPT (66%). Three ectopic hyperfunctioning glands (in three different patients) were all detected by 18F-FCH PET/CT, two by parathyroid scintigraphy, and none by cervical US and 4D-CT. Our study confirms that 18F-FCH PET/CT is an effective preoperative imaging option in patients with CKD and HPT. These findings may be of greater importance in patients with tHPT (who could benefit from minimally invasive parathyroidectomy) than in patients with sHPT, who often undergo bilateral cervicotomy. In these cases, preoperative 18F-FCH PET/CT may be helpful in locating ectopic glands and may guide the surgical choice for gland preservation.

A 47-year-old woman with history of hepatocellular carcinoma was referred for 18F-fluorocholine PET/CT evaluation due to elevated alpha-fetoprotein. The examination showed several peritoneal uptakes and two nodular pelvic foci. Coelioscopic exploration allowed confirmation and resection of multiple peritoneal metastases from hepatocellular carcinoma while pelvic biopsies revealed endometriosis and endosalpingiosis. However, alpha-fetoprotein kept rising: subsequent 18F-fluorodesoxyglucose PET/CT exploration found no pelvic uptake, while 18F-fluorocholine PET/CT revealed intense tracer accumulation in the two pelvic masses corresponding to bilateral ovarian metastases of hepatocellular carcinoma. We highlight the importance of 18F-fluorocholine PET/CT in hepatocellular carcinoma especially in patients with confounding comorbidities such as endometriosis.

Invasive fungal infections (IFI) are life-threatening diseases including a wide and heterogeneous spectrum of opportunistic infections related to several pathogens. Candida and Aspergillus are the most frequent agents mainly affecting immunocompromised patients. Although the identification of the pathogen and/or surrogate biomarkers in targeted biological samples allows diagnosis of IFI, the systemic spread is often underestimated. In addition, despite recent advancements in the development of antifungal drugs provides new therapeutic alternatives, both toxicity and optimal duration of treatment are not completely established. Nowadays, 18F-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is used more and more in the management of patients with IFI. 18F-FDG PET/CT contributes to confirm the clinical suspicion of IFI accurately defining the sites of infection. 18F-FDG PET/CT could also assess the extent of infection allowing diagnostic biopsies guidance. Moreover, 18F-FDG PET/CT seems a valuable tool for monitoring the treatment efficacy during follow-up of patients with IFI, allowing escalation or de-escalation of antifungal drugs. The present chapter reviews the strengths and limitations of 18F-FDG PET/CT for the management of IFI patients in the daily clinical practices. It also focuses on recent developments in the preclinical field of nuclear medicine with translational purposes.

Medullary thyroid carcinoma (MTC) is a rare neural-crest derived neuroendocrine tumor (NET) originating from the thyroid calcitonin producing cells. MTC can occur either sporadically or in the context of multiple endocrine neoplasia of type-2 (MEN2). Successful management of MTC significantly depends on the patient's conditions, tumor stage, genetic background, and the medical team's experience. Surgery remains the only curative treatment. In this chapter we describe the role of imaging at different steps of the management of MTC patients. We also emphasize the value of 18F-fluoro-dihydrophenylalanine (18F-FDOPA) positron emission tomography/computed tomography (PET/CT) in patients with persistent/recurrent disease and discuss the values of 18F-fluorodeoxyglucose (18F-FDG) and 68Ga-radiolabeled somatostatin analogs (68Ga-SSA) for prognostication and potential theragnostic approach.

Radiation-induced heart disease is a complication that occurs years after thoracic irradiation. Recent studies suggest that radiation-induced heart disease could be an earlier complication and that subclinical cardiac injury can be detected. The present case described an increased uptake of (18F)-fluorodeoxyglucose incidentally detected on positron emission tomography after left breast irradiation with slightly reversible perfusion defect on (99mTc)-tetrofosmin single photon emission computed tomography. The cardiac clinical examination was asymptomatic, and the patient had a normal angiography, suggesting a radiation-induced hibernating myocardium. The relevant question is: how far should an incidentally (18F)-fluorodeoxyglucose uptake be explored?

With the increasing availability of high-performance medical imaging for the management of patients with neuroendocrine tumors (NETs), a progressive growth of asymptomatic and incidentally detected cardiac metastases (CMs) has been observed in the recent years. In clinical practice, CMs of NENs are often incidentally detected by whole-body 68Ga-labeled somatostatin analogs or 18F-fluorodihydroxyphenylalanine positron emission tomography/computed tomography, and afterwards accurately characterized by cardiac magnetic resonance (CMR) and/or gated cardiac computed tomography when CMR is contraindicated or not available. The interpreting physician should familiarize with the main imaging features of CM, a finding that may be encountered in NETs patients more than previously thought. Herein, we present a case series of four patients with CMs from small-intestine NETs highlighting strengths and weaknesses of a multimodality imaging approach in clinical practice.

After chemoradiotherapy for glioblastoma, pseudoprogression can occur and must be distinguished from true progression to correctly manage glioblastoma treatment and follow-up. Conventional treatment response assessment is evaluated via conventional MRI (contrast-enhanced T1-weighted and T2/FLAIR), which is unreliable. The emergence of advanced MRI techniques, MR spectroscopy, and PET tracers has improved pseudoprogression diagnostic accuracy. This review presents a literature review of the different imaging techniques and potential imaging biomarkers to differentiate pseudoprogression from true progression.

A 55-year-old, menopausal woman with history of breast carcinoma was referred for recurrent abdominal pain without diarrhea. Physical examination, routine biological investigation, and serum CA15-3 were normal. Abdominal contrast-enhanced computed tomography (CT) found a 15-mm ileal hyper-vascularized lesion with mild intestinal dilation and a mesenteric mass of about 20 mm. Both ovaries were moderately enlarged without radiological overt signs of malignancy. CT findings were consistent with ileal neuroendocrine tumor (ileal-NET) with mesenteric invasion. Serum value of chromogranin A was normal. 18F-Fluorodihydroxyphenylalanine (18F-FDOPA) positron emission tomography (PET)/CT was added to the preoperative work-up 1 Addeo P. Poncet G. Goichot B. et al. The added diagnostic value of 18F-fluorodihydroxyphenylalanine PET/CT in the preoperative work-up of small bowel neuroendocrine tumors. J Gastrointest Surg. 2017; 22: 722-730 Crossref PubMed Scopus (7) Google Scholar and distinctly identified the primary ileal-NET with the mesenteric involvement. Moreover, intense and pathological 18F-FDOPA uptake was shown in both ovaries and 1 peritoneal nodule of a few millimeters in the Douglas space (Fig 1, A), suggesting ovarian metastases with peritoneal carcinomatosis. Surgical exploration found the primary tumor and the mesenteric lesion that were removed by a 20-cm ileal resection and mesenteric lymphadenectomy. Intervention was completed by bilateral salpingo-oophorectomy, omentectomy, and multiple peritoneal biopsies (Fig 1, B). Postoperative course was uneventful, and pathology confirmed a 20-mm, well-differentiated grade-2 ileal-NET (Ki-67: 4%) with mesenteric invasion, ovarian bilateral spread, and pelvic peritoneal metastases as small as a few millimeters in size (pT4N2M1, UICC 2016).

A 65-year-old woman was addressed for clinical and biological suspicion of ovarian cancer relapse. 18F-FDG PET/CT revealed massive peritoneal carcinomatosis. Post-chemotherapy PET/CT showed complete metabolic response in initial localizations albeit three new 18F-FDG uptakes appeared in the mesentery and in the retro-hepatic space. Close follow-up (including PET/CT scan) and surgical examination of the abdominal cavity confirmed the absence of malignancy and the benign nature of these lesions, which appeared to be peritoneal fibrosis mimicking persistent carcinomatosis.

We report the case of a 23-year-old man with nodal EMH (extramedullary hematopoiesis) occurring during treatment for a stage IIA "gray-zone" lymphoma. Although it is often related to myeloproliferative bone marrow disease, benign etiologies such as lenograstim treatment after chemotherapy can also induce EMH and be responsible for false-positive F-FDG PET/CT examinations. In this respect, GLUT overexpression in hematopoietic lineages and macrophages of the inflammatory environment are responsible for increased F-FDG uptake. Histopathologic confirmation of new hypermetabolic lesions on follow-up PET/CT may be required when the new lesions do not conform with the treatment responses in the preexisting lesions.

Abstract We report the case of a 23-year-old man with nodal EMH (extramedullary hematopoiesis) occurring during treatment for a stage IIA “gray-zone” lymphoma. Although it is often related to myeloproliferative bone marrow disease, benign etiologies such as lenograstim treatment after chemotherapy can also induce EMH and be responsible for false-positive 18F-FDG PET/CT examinations. In this respect, GLUT overexpression in hematopoietic lineages and macrophages of the inflammatory environment are responsible for increased 18F-FDG uptake. Histopathologic confirmation of new hypermetabolic lesions on follow-up PET/CT may be required when the new lesions do not conform with the treatment responses in the preexisting lesions.

Data on the diagnostic value of 18F-FDOPA PET/CT in patients with insulinoma are limited and are focused on small patient populations explored using different PET/CT protocols and the inconsistent use of carbidopa premedication. The aim of this study was to improve the current knowledge about the diagnostic value of 18F-FDOPA PET/CT combined with oral carbidopa premedication and early pancreatic imaging for tumour localization in patients with insulinoma-related hyperinsulinaemic hypoglycaemia (HH). The relationships among 18F-FDOPA quantitative uptake parameters, insulin secretion and tumour pathological features were also investigated.

The Breast JournalVolume 26, Issue 4 p. 769-770 BREAST IMAGES Unexpected breast lymphoscintigraphy findings after surgical removal of accessory mammary gland Benjamin Leroy-Freschini MD, Corresponding Author bleroyfreschini@gmail.com orcid.org/0000-0002-7787-7359 Department of Nuclear Medicine, Centre Paul Strauss, Strasbourg, France Correspondence Benjamin Leroy-Freschini, Department of Nuclear Medicine–Centre Paul Strauss, 3, Rue de la Porte de l'Hôpital, 67000 Strasbourg Cedex, France. Email: bleroyfreschini@gmail.comSearch for more papers by this authorLudivine Loussert MD, Department of Breast Surgery, Breast Institute of Orangerie, Strasbourg, FranceSearch for more papers by this author Benjamin Leroy-Freschini MD, Corresponding Author bleroyfreschini@gmail.com orcid.org/0000-0002-7787-7359 Department of Nuclear Medicine, Centre Paul Strauss, Strasbourg, France Correspondence Benjamin Leroy-Freschini, Department of Nuclear Medicine–Centre Paul Strauss, 3, Rue de la Porte de l'Hôpital, 67000 Strasbourg Cedex, France. Email: bleroyfreschini@gmail.comSearch for more papers by this authorLudivine Loussert MD, Department of Breast Surgery, Breast Institute of Orangerie, Strasbourg, FranceSearch for more papers by this author First published: 22 September 2019 https://doi.org/10.1111/tbj.13634Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume26, Issue4April 2020Pages 769-770 RelatedInformation

We report the case of a 54-year-old woman with a nonfunctioning paraganglioma arising from the gastroepiploic pedicle demonstrated by F-FDOPA PET/CT. Because gastroepiploic arcade can be assimilated to the gastric mesentery, this tumor has been classified as a mesenteric paraganglioma (PGL). Neural crest cells are a multipotent population of cells characterized by effective migratory properties potentially explaining PGL atypical localization as in the mesentery. Mesenteric PGLs are often nonfunctioning and can mimic gastric, colic, or pancreatic primary tumor because of their anatomical boundaries, making more difficult the diagnosis on preoperative imaging.