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   Table of Contents - Current issue
July-September 2021
Volume 20 | Issue 3
Page Nos. 215-328

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Diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in anorectal melanoma Highly accessed article p. 215
Ajinkya N Bakare, Archi Agrawal, Avanish Saklani, Reena Engineer, Nilendu Purandare, Sneha Shah, Ameya Puranik, Venkatesh Rangarajan
To evaluate the diagnostic role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in initial staging and restaging of anorectal melanoma. This was a single-institution, retrospective observational study; patients for initial staging and with clinical or radiological suspicion of disease recurrence referred for PET/CT between January 2006 and December 2015 were included in the study. Diagnostic performance of PET/CT was evaluated for baseline staging and disease recurrence. A total of 61 patients who were referred for initial staging were included. PET/CT correctly detected primary lesion in 57 (93.44%) cases, regional nodes in 46 (75.4%) cases, nonregional nodes in 22 (36%) cases, and distant metastases in 25 (41%) cases. The sensitivity (SN); specificity (SP); positive predictive value (PPV); negative predictive value (NPV); and accuracy for primary lesion, regional nodes, nonregional nodes, and distant metastases were 96.6%, 100%, 100%, 50%, and 96.7%; 97.9%, 100%, 100%, 93.3%, and 98.4%; 100%, 100%, 100%, 100%, and 100%; and 100%, 100%, 100%, 100%, and 100%, respectively. A total of 24 patients were included for suspected recurrence/restaging. All the patients were treated previously by surgery, radiotherapy, or chemotherapy. PET/CT detected disease recurrence in 20 (83.3%) patients. Ten patients had recurrence at the primary site, 8 of whom also had distant metastases and 2 had only locoregional metastatic nodes. In the remaining 10 patients, there was no primary site recurrence; however, 2 patients had locoregional nodal and distant metastases and 8 patients had only distant metastases. PET/CT was false negative in 1 patient, which missed liver metastasis. SN, SP, PPV, and NPV of PET/CT was found to be 95%, 100%, 100%, and 75%, respectively, with accuracy of 96%. PET/CT demonstrates overall high diagnostic accuracy in the initial staging and detection of recurrent disease in cases of anorectal melanoma.
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Determination of administered activities for the treatment of Graves' disease with iodine-131: Proposition of a simplified dosimetric procedure p. 222
Idrissa Adamou Soli, Djibrillou Moussa Issoufou, Skander Rahabi, Ada Ali, Eric Adehossi, Salah Eddine Bouyoucef
This prospective study included 35 patients suffering from Graves' disease (GD) clinically and biologically confirmed by endocrinologists, sent to the nuclear medicine department of CHU de Bab El Oued, Algiers for iodine-131 therapy. CHU de Bab El Oued is a tertiary hospital located in the center of the capital Algiers. The aim of this study is to propose a simplified dosimetric procedure which will initiate iodine-131 therapy of GD in particular and hyperthyroidism in general in Niger. The determination of the maximum uptake was performed with a Biodex external probe at 2 h, 4 h, and 24 h after the administration of 3 MBq of liquid iodine-131. The iodine-131 activities were determined using the Marinelli formula with a predefined effective half-life (Te) of 5 days and subsequently extrapolated half-life with kaleidagraph software. The statistical analysis was performed using an excel sheet and analyzed using the software package Statistica 10 (stat Soft, Tulsa, USA). the male:female gender ratio was1:4.5 and the mean age was 42.56 years (±7.14). The body mass index was within normal range with a value of 25.25 kg2 (±0.42) and the mean average thyroid mass was equal to 24.05 (±10.53) g. The mean uptake value at 24 h was 43.24% (±17.68%) meanwhile the maximum uptake value was 46.28 (±21.13%). The estimated effective half-life (Te) was 5.44 days (±1.96) days which were different from the predefined Te of 5 days. The mean activity determined with fixed Te and 24 h uptake was 244.45 (±109.2) MBq and the mean activity calculated with both extrapolated Te and maximum uptake was 452.22 (±381.9) MBq. Empirical determination of activity in the treatment of GD gives higher activities (1.5 times) to patients than dosimetric methods based on the determination of extrapolated effective half-life.
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Correlation between imaging and tissue biomarkers of hypoxia in squamous cell cancer of the head and neck p. 228
Shreya Kunder, Abhishek Chatterjee, Subhakankha Manna, Manoj Mahimkar, Asawari Patil, Venkatesh Rangarajan, Ashwini Budrukkar, Sarbani Ghosh-Laskar, Jai Prakash Agarwal, Tejpal Gupta
The aim of this study was to correlate endogenous tissue biomarkers of hypoxia with quantitative imaging parameters derived from 18F-fluoro-misonidazole (F-MISO) and 18F-fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography (PET/CT) and clinical outcomes in locoregionally advanced head and neck squamous cell carcinoma (HNSCC). Tumor-tissue blocks of HNSCC patients with pretreatment F-MISO-PET/CT and FDG-PET/CT were de-archived for expression of hypoxia-inducible factor-1 alpha (HIF-1α) subunit, carbonic anhydrase-IX (CA-IX), and glucose transporter subunit-1 (GLUT-1) using immunohistochemistry (IHC). The intensity of staining was graded and correlated with quantitative imaging parameters and with disease-related outcomes. Tissue blocks were analyzed for 14 of 20 patients. On IHC, median H-scores for HIF-1α, CA-IX, and GLUT-1 were 130, 0, and 95, respectively. No significant correlation of tissue biomarkers of hypoxia with quantitative imaging parameters was found. However, borderline significant correlation was seen for H-scores of CA-IX with hypoxic tumor volume (HTV) (r = 0.873, P = 0.054) and fractional hypoxic volume (r = 0.824, P = 0.086) derived from F-MISO-PET/CT. At a median follow-up of 43 months, 5-year Kaplan–Meier estimates of locoregional control, disease-free survival, and overall survival were 53%, 43%, and 40%, respectively. Increased expression of HIF-1α or GLUT-1 (dichotomized by median H-scores) was not individually associated with disease-related outcomes. However, a combination of high HTV (>4.89cc) with above median H-scores of either HIF-1α (>130) and/or GLUT-1 (>95) was associated with worse clinical outcomes. None of the three patients with such “adverse hypoxic profile” were long-term survivors. There is no significant correlation of endogenous tissue biomarkers of hypoxia (HIF-1α, CA-IX, and GLUT-1) with quantitative imaging parameters (on F-MISO-PET/CT and FDG-PET/CT) or long-term outcomes in HNSCC. However, a combination of both can identify a subgroup of patients with adverse outcomes.
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Utility of positron emission tomography–computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation p. 237
Sohini Das, Sowmya Sathyendra, Julie Hephzibah, Reka Karuppusami, Karthik Gunasekaran, Nylla Shanthly, Angel Miraclin, Ramya Iyadurai
Positron emission tomography–computed tomography (PET-CT) has been used as an imaging modality in workup of fever of unknown origin (FUO). The aim of our study is to evaluate the diagnostic utility of PET-CT in FUO workup in a resource-limited setting. We also looked at laboratory parameters as predictors of contributory PET-CT scans and propose an algorithm for evaluation of FUO in resource-limited tropical regions. This retrospective observational study included patients admitted for FUO workup under general medicine in a teaching hospital in South India from June 2013 to May 2016. PET-CT was done when the patient remained undiagnosed after a detailed clinical assessment and first- and second-tier investigations. Among 43 patients included in our study, a definite diagnosis was established in 74% (32). Noninfectious inflammatory diseases, infections, malignancies, and miscellaneous diseases were diagnosed in 37.2% (16/43), 23.3% (10/43), 9.3% (4/43), and 4.7% (2/43), respectively. Tuberculosis was the single most common disease seen in 20.9% (9/43). PET-CT scans were contributory toward establishment of final diagnosis in 90.7% (39/43). High C-reactive protein (CRP) and aspartate aminotransferase (AST) levels were associated with contributory PET-CT scans (P = 0.006 and 0.011, respectively). PET-CT delineating organ/tissue for diagnostic biopsy was associated with final diagnosis of infectious disease (P = 0.001). Sensitivity, specificity, and positive and negative predictive value of PET-CT scans were 76.9% (20/26), 33.3% (2/6), 83% (20/24), and 25% (2/8), respectively. High CRP and AST were predictors of contributory PET-CT scans. PET-CT scans have high sensitivity and positive predictive value when used in evaluation of FUO. Although it is a useful tool in FUO workup, especially in the diagnosis of tropical infections, PET-CT should be done after a comprehensive clinical assessment and basic investigations.
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The effect of body mass index on high versus low administered activity protocol myocardial perfusion imaging scan time and effective dose using a cadmium zinc telluride camera in clinical practice p. 247
Kalpna Prasad, Chad C Adams, Eiping Quang, Justin Taylor, Derek J Stocker
Cadmium Zinc Telluride (CZT) crystal-based myocardial perfusion imaging (MPI) cameras have increased count sensitivity compared to Anger cameras and can be used to lower either the injected activity or the image acquisition time. Institutions adopting CZT cameras need to decide whether to lower the injected activity or imaging time or attempt to lower both with a compromise. The aim of our study was to compare the scan time required to obtain similar count images using high activity protocol (HAP) versus low activity protocol (LAP) stratified by body mass index (BMI) and assess the impact on effective dose and our clinic workflow. Using a CZT camera, a cohort of 100 consecutive clinical patients imaged with LAP rest-stress MPI with approximately 185 MBq and 555 MBq activity was retrospectively compared to a similar cohort of 100 consecutive clinical patients imaged with HAP rest-stress MPI using approximately 370 MBq and 1110 MBq. Administered activity and BMI both had a statistically significant effect on scan time and radiation effective dose. LAP scans took an average of 9 min longer than HAP scans overall, P < 0.0001 and larger BMIs took longer than smaller BMIs, P < 0.0001. In addition, scan times were longer in men than women, P = 0.007. Effective dose was inversely proportional to BMI with an overall decrease of approximately 50% comparing LAP to HAP. For the same CZT camera, the LAP increased scan time while lowering the radiation effective dose when compared to HAP. The increase in scan time increased proportionally to BMI. The effective dose was inversely proportional to BMI. This increase in time did not have a significant impact on our local workflow, but its implications should be considered in the setting of LAP implementation, especially in obese or high patient volume practices.
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Clinical predictors of I-131 therapy failure in differentiated thyroid cancer by machine learning: A single-center experience p. 253
David J Lubin, Caleb Tsetse, Mohammad S Khorasani, Massoud Allahyari, Mary McGrath
Well-differentiated thyroid carcinoma is predominantly a slow-growing malignancy, amendable to treatment, and has an excellent prognosis following thyroidectomy and radioiodine (RAI) therapy. However, patients who fail the initial RAI treatment attempt may require repeated RAI or other treatments and with this, comes an associated impact on patient quality of life. Therefore, the anticipation of patients in whom there is a higher risk of RAI failure may help in patient risk stratification and subsequent management. We conducted a retrospective review to determine the factors associated with initial RAI therapy failure in well-differentiated thyroid cancer patients. Using scikit-learn from Python, we implemented a machine-learning algorithm to determine the clinical patient factors associated with a higher likelihood of treatment resistance. We found that clinical factors such as tumor focality (P = 0.026) and lymph node invasion at surgical resection (P = 0.0135) were significantly associated with initial treatment failure following RAI. Elevated serum thyroglobulin (Tg) and Tg antibody levels following surgery but before RAI were also associated with treatment resistance (P < 0.0001 and P = 0.011 respectively). Less expected factors such as decreased time from surgery to RAI were also associated with treatment failure, however not to a statistically significant degree (P > 0.064). Clinical outcomes following RAI can be stratified by identifying factors that are associated with initial treatment failure. These findings can help restratify patients for RAI treatment and change patient management in certain cases. Such stratification will ultimately help to optimize successful treatment outcomes and improve patient quality of life.
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Is abnormal gallbladder ejection fraction hokum? Retrospective chart review of gallbladder ejection fraction and subsequent postoperative symptom relief, surgical pathology, and current literature review p. 260
Youngmin Chu, Mary A McGrath
The purpose of this report is to investigate the clinical importance of increased or decreased gallbladder ejection fraction (GBEF) and ultrasound findings for biliary dyskinesia by evaluating postsurgical symptom relief and surgical pathology. Single institution electronic medical record review was prepared for patients who underwent hepatobiliary iminodiacetic acid (HIDA) scan with GBEF and cholecystectomy between January 2013 and March 2020. Relevant data included patient demographics, ultrasound results, surgical pathology, HIDA with GBEF results, and postoperative symptom relief at the time of follow-up. Student's t-test was also utilized for additional statistical analysis. A total of 67 patients underwent cholecystectomy within a 1-month period of time after HIDA with GBEF. Of these patients, 97% had findings consistent with chronic cholecystitis and 3% of the patients demonstrated both acute and chronic cholecystitis surgical pathology. Fifty-seven percent of the patients demonstrated a GBEF <38%, 30% had a GBEF >80%, and 13% had a GBEF 38%–80% with a postoperative symptom resolution around 82%, 77%, and 100%, respectively. GBEF alone may not be determinative regarding gallbladder pathology or postoperative symptom relief in patients that present with typical symptoms. Regarding dyskinetic gallbladders, elevated and decreased GBEF groups were not significantly different in terms of surgical pathology or symptom relief. These patients may benefit from being treated as a single group rather than as separate entities. Elevated and decreased GBEF groups demonstrated mostly normal ultrasound results that raised concern for the utility of ultrasound as a rule out test for gallbladder inflammation.
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Evaluation of 68Ga-DOTA-Ubiquicidin (29–41) for imaging Staphylococcus aureus (Staph A) infection and turpentine-induced inflammation in a preclinical setting p. 266
Dilip Kumar Boddeti, Vijay Kumar
Synthetic antimicrobial peptide fragment, 99mTc-Ubiquicidin 29–41, is shown to be sensitive and also specific for imaging bacterial infections. We undertook this study to explore the advantage of using a positron emission agent, 68Ga-DOTA-Ubiquicidin 29–41 (68Ga-DOTA-UBI), for detecting Staph-A infection in an animal model, and also evaluated its ability to distinguish a turpentine-induced sterile inflammation in an animal model. Pure Ga-68 was freshly eluted from a 68Ge/68Ga generator (IGG-100). DOTA-UBI (50 μg) was ra diolabeled with pure Ga-68 (500MBq) by incubating the reaction mixture at pH 4.5 for 10 min, 95°C. Rats were infected with Staph-A at the hind leg joint of rats to form bacterial abscess. Sterile inflammation was induced in the right thigh muscle by injecting 200 μl of 100% turpentine oil. Rats were injected intravenously with 10–15 MBq of tracer, and images were acquired at different time intervals with Siemens (Biograph mCT) positron emission tomography computed tomography scanner. The early images at 6 min postinjection clearly indicated mild uptake of the agent corresponding to the infection site, which increased dramatically at 20, 30, and 60 min postinjection. The target to background ratio (T/B) increased significantly over the same time period of study (1.6, 4.2, and 6.1, respectively). There was a mild uptake of 68Ga-DOTA-UBI at the site corresponding to sterile inflammation at 6 min postinjection, which was rapidly washed off as seen at 25 and 45 min images. The images indicated fast clearance of the agent from liver and soft tissues within 6 min. Control rats showed similar biodistribution of activity. The mild uptake of 68Ga-DOTA-UBI at the corresponding Staph-A infection lesion and very fast kinetics of clearance from the blood pool and soft tissues suggested a very high clinical potential for this agent. The absence of uptake of the agent at sterile inflammation site suggests that the agent may be useful in distinguishing infection from inflammation.
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Alterations of regional cerebral glucose metabolism using18F-fluorodeoxyglucose positron-emission tomography/computed tomography and electroencephalography analysis during mindfulness breathing in Anapanasati meditation: A preliminary analysis p. 273
Chanisa Chotipanich, Supatporn Tepmongkol, Yodchanan Wongsawat, Attapon Jantarato
Anapanasati is a core meditation of a breath-centered practice in the Buddhist Theravada tradition, which may have some neurological mechanism effects on the brain. To gain insight into the neurological mechanisms involved in Anapanasati meditation, we measured the alterations of regional cerebral glucose metabolism during Anapanasati meditation using positron-emission tomography/computed tomography (PET/CT) and electroencephalography (EEG) analysis. This prospective study was conducted in six right-handed volunteer participants (two men, four women; aged: 32–67 years) who underwent18F-fluorodeoxyglucose (18F-FDG) PET/CT scans to compare the alterations of regional cerebral glucose metabolism during normal consciousness and Anapanasati meditation states. Spectral EEG analysis was performed throughout the investigations. Statistical parametric mapping was used for the18F-FDG PET/CT image analyses. The visual analysis demonstrated moderate-to-marked increased metabolism in posterior cingulate cortex in all six patients, while mild-to-moderate increased uptake in the whole frontal lobe was also observed in four patients and precuneus in four patients. Meanwhile, the semiquantitative analysis yielded an increase of regional cerebral glucose metabolism in the right mid-to-posterior cingulate gyrus (P < 0.000), with visible alpha waves on the frontal of the EEG findings. Our semiquantitative analysis showed a significantly increased metabolism only in the posterior cingulate cortex, but visually, there was also an increased metabolism in the whole frontal lobe in most of the patients correlating with EEG findings.
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Appropriate use criteria in myocardial perfusion imaging in a tertiary care hospital in South India: An audit p. 281
Madhur Kumar Srivastava, Ram Manohar Pagala, Vinodh Kendarla, Kavitha Nallapareddy
Myocardial perfusion imaging (MPI) is an important investigative tool in the diagnosis and management of coronary artery disease. This investigation has seen a manifold increase in number in past decades as compared to other investigations such as cardiac magnetic resonance imaging/positron emission tomography or computed tomography. In 2005, “Appropriate use criteria (AUC) in cardiac radionuclide imaging” was formulated by the American College of Cardiology Foundation and the American Society of Nuclear Cardiology for effective use of this investigation, later revised in 2009. We assessed the appropriateness of indications for MPI in patients presenting to the nuclear medicine department of a tertiary care hospital according to the latest AUC for cardiac radionuclide imaging. This is a retrospective analysis of all cardiac perfusion scans performed from June 2019 to January 2020 in a tertiary care teaching hospital in South India. All patients' indications for MPI were assessed for appropriateness using AUC 2009 as appropriate, inappropriate, and uncertain indications by two experienced nuclear medicine physicians blinded for results of the test and hospital stay of the patients. A total of 1015 cardiac scans were performed in the given period, which were analyzed. This included 613 males and 402 females, with most of the patients aged above 60 years (n = 640; males = 385, females = 255). Most of the patients had diabetes mellitus or hypertension or both except in 161 patients (15.8%) which did not have either of the comorbidities. Chest pain and/or shortness of breath were the most common presenting complaints. The appropriate indication for imaging was found in 784 patients (77.2%), inappropriate in 121 patients (12%), and uncertain in 110 patients (10.8%). Our results showed appropriate indication to be 77.2% and inappropriate indications as 12% for MPI referrals in a tertiary care teaching hospital, similar to Western literature but can be improved further by continued teaching and awareness campaigns.
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18F-fallypride and 11C-methionine positron emission tomography/computed tomography for the study of prolactinomas and nonfunctioning pituitary adenomas: A case series p. 286
Andres Damian, Maria M Pineyro, Adriana Quagliata, Mariana Risso, Paula Montiglia, Ramiro Lima, Omar Alonso
Some studies have assessed the expression of dopaminergic dopamine 2 (D2)/3 receptors in prolactinomas and nonfunctioning pituitary adenomas (NFPA) by positron emission tomography/computed tomography (PET/CT) with 11C-raclopride, proving that this modality can be useful to predict the response to treatment with dopamine agonists. However, the use of 11C-labeled radiotracers is limited, as it requires a cyclotron in the PET center. 18F-fallypride is a radiotracer that has proven useful in assessing the expression of D2/3 receptors. As it is labeled with 18F, it can be produced and transported to distant PET centers. There are no studies on the usefulness of 18F-fallypride for the evaluation of patients with prolactinomas and NFPA. The aim of this study was to describe the first case series of patients with prolactinomas and NFPA studied with 18F-fallypride and 11C-methionine PET/CT to reveal D2/3 expression and amino acid (AA) metabolism. 18F-fallypride and 11C-methionine uptake were assessed in a case series of six patients, five with prolactinomas and one with a NFPA, and compared with clinical presentation and follow-up at 6–18 months. All patients presented with macroadenomas, with a wide range of AA metabolism, as revealed by 11C-methionine PET/CT. 18F-fallypride PET/CT identified low to moderate/high D2/3 expression in the tumors. The patient that presented low expression of D2/3 in the tumor and high AA metabolism showed a poor response to DA therapy. 18F-fallypride was able to reveal D2/3 receptor expression in prolactinomas and NFPA, with the advantage of been a more accessible radiotracer in comparison with previous 11C labeled analogs.
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Metabolic positron-emission tomography/magnetic resonance imaging in primary progressive aphasia and frontotemporal lobar degeneration subtypes: Reassessment of expected [18F]-fluorodeoxyglucose uptake patterns p. 294
Ana M Franceschi, Kiyon Naser-Tavakolian, Michael Clifton, Lev Bangiyev, Giuseppe Cruciata, Sean Clouston, Dinko Franceschi
Clinical assessment of frontotemporal lobar degeneration (FTLD)/primary progressive aphasia (PPA) patients is challenging, given that common cognitive assessments rely extensively on language. Since asymmetry in neuroimaging biomarkers is often described as a central finding in these patients, our study evaluated [18F]-fluorodeoxyglucose (FDG) uptake patterns in patients meeting clinical and imaging criteria for FTLD, with emphasis on PPA. Fifty-one subjects underwent brain [18F]-FDG positron-emission tomography/magnetic resonance imaging (PET/MRI) as part of their routine clinical workup for dementia and neurodegenerative disease. Images were obtained using a Siemens Biograph mMR integrated 3T PET/MRI scanner. PET surface maps and fusion fluid-attenuated inversion recovery-PET images were generated utilizing MIMneuro software. Two board-certified neuroradiologists and one nuclear medicine physician blinded to patient history classified each FTLD/PPA subtype and assessed for left- versus right-side dominant hypometabolism. Qualitative and semiquantitative assessment demonstrated 18 cases of PPA, 16 behavioral variant frontotemporal dementia (bvFTD), 12 corticobasal degeneration, and 5 progressive supranuclear palsy. Among the 18 PPA subjects (11 svPPA, 5 lvPPA, and 2 agPPA), 12 (67%) demonstrated left-dominant hypometabolism and 6 (33%) right-dominant hypometabolism. While existing literature stresses left-dominant hypometabolism as a key imaging feature in the PPA subtypes, a third of our cases demonstrated right-dominant hypometabolism, suggesting that emphasis should be placed on the functionality of specific brain regions affected, rather than left versus right sidedness of hypometabolism patterns.
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18F-fluorodeoxyglucose positron emission tomography/computed tomography in the diagnosis of a rare mycotic aneurysm of the thoracic aorta in a patient with fever of unknown origin p. 305
Matthew Q Schmidt, Rola Altoos, Jennifer J Kwak
Fever of unknown origin (FUO) is a condition with high mortality that often presents a diagnostic challenge to clinicians. We present the case of a patient with FUO who was discovered to have a rare mycotic aneurysm of the thoracic aorta by 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging. Mycotic aneurysm, also known as an infected aneurysm, is a highly lethal condition due to the risk of sepsis and aneurysmal rupture. While unusual to present in this manner, it is of utmost importance to promptly recognize a mycotic aneurysm as a potential diagnosis because initiation of treatment is critical in reversing the natural history of the disease.
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Irritated seborrhoeic keratosis masquerading as malignancy on 18F-fluorodeoxyglucose positron emission tomography–computed tomography p. 309
Punit Sharma
Seborrhoeic keratosis is a common benign skin tumor and can have a variable presentation. Irritated seborrhoeic keratosis can clinically mimic cutaneous malignancy and often warrant biopsy. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography–computed tomography (PET-CT) can give false-positive results in many cutaneous pathologies. We present an interesting case of irritated seborrhoeic keratosis masquerading as skin cancer, clinically as well as on18F-FDG PET-CT.
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Follicular thyroid carcinoma metastasizing to rare sites and exhibiting variable inter-lesional heterogeneity on 18F-fluorodeoxyglucose positron emission tomography/computed tomography and 131I p. 312
Rahul V Parghane, Sandip Basu
A patient of differentiated follicular thyroid carcinoma with unusual sites of metastases is illustrated with 131I and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging findings. The described case harbored extremely rare metastasis to the urinary bladder with multi-organ metastatic disease (including unusual sites of right bronchus and hepatic metastases). There was inter-lesional heterogeneity among the metastatic lesions with regard to the 131I and FDG uptake in the aforementioned lesions. The detection of such heterogeneity has important implications for patient management in metastatic differentiated thyroid carcinoma.
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Everolimus-induced somatostatin receptor overexpression in a rectal neuroendocrine tumor patient may promote somatostatin receptor-guided radionuclide therapy (peptide receptor radiotherapy) as an additional treatment option p. 316
Magdalena Mileva, Zéna Wimana, Patrick Flamen, Ioannis Karfis
We present a case of Grade II, well-differentiated rectal neuroendocrine tumor in a 39-year-old patient. Following different sequential treatment modalities, the disease progressed both on metabolic (18F-fluorodeoxyglucose positron emission tomography-computed tomography [18F-FDG PET/CT]) and somatostatin receptor (SSTR)-imaging (68Ga-DOTA-Tyr3-octreotate [68Ga-DOTATATE] PET/CT), and the patient received three cycles of peptide receptor radiotherapy (PRRT). Two years later, upon new progression due to the appearance of metabolically active, 68Ga-DOTATATE PET/CT-negative liver lesions, targeted treatment with everolimus was introduced. Further morphologic and metabolic progression occurred 4 months after everolimus initiation, however, this time liver lesions demonstrated increased SSTR-expression on68Ga-DOTATATE PET/CT. Thus, the patient became eligible for a second PRRT course.
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Incidental lung findings in a COVID-19 patient on 18F-FDG PET/CT done for preoperative evaluation of Marjolin's ulcer-first report from Chhattisgarh p. 319
Mudalsha Ravina, Tridip Dutta Baruah, Tinu Lukose, Ranganath T Ganga, Amal Moideen
The aim of this case is to illustrate the18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography findings of a patient who was admitted in AIIMS, Raipur, for the preoperative evaluation of Marjolin ulcer and was later diagnosed with COVID-19 infection. Apart from the primary lesion in the right foot and pelvic lymph nodes, the scan revealed mild FDG-avid basal ground-glass opacities in bilateral lung fields with mediastinal and hilar lymph nodal involvement, in an otherwise asymptomatic patient.
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18F-fluorodeoxyglucose positron emission tomography-computed tomography imaging of leiomyomatosis peritonealis disseminata p. 322
Alex Cheen Hoe Khoo, Shyang Yee Lim
Leiomyomatosis peritonealis disseminata (LPD) is a rare benign condition characterized by multiple smooth muscle implants in the peritoneal cavity. The clinical presentation is usually nonspecific abdominal discomfort and nontender abdominal mass. Preoperative imaging usually points to suggests malignancy due to its unusual location, but the diagnosis can only be confirmed by histopathological examination. We share 18F-Fluorodeoxyglucose positron emission tomography-computed tomography images of a 43-year-old woman diagnosed with LPD and briefly discuss the clinical aspects of this disease.
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Somatostatin-receptor avidity of pancreatic neuroendocrine tumor thrombus in porto-caval venous systems on 99mTc-Octreotide and posttherapeutic 177Lu-DOTA-TATE scans p. 324
Mahasti Amoui, Reyhane Ahmadi, Mohsen Qutbi, Isa Neshandar Asli
A 62-year-old woman with a history of abdominal pain presented with multiple hepatic lesions and dilatation of portal, splenic and superior mesenteric veins on the magnetic resonance imaging referred for a 99mTc-octreotide scan. Accordingly, similar octreotide-avid lesions were found as well as an uptake in the epigastric region conforming to the anatomy of the portocaval venous system, compatible with a tumor thrombosis. Then, the patient underwent two cycles of therapy with 177Lu-DOTA-TATE, on that the same appearance was observed. The uptake in the tumor thrombus remained somewhat unchanged, but clinically, a significant improvement of the intractable ascites was achieved.
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Prostate-specific antigen for prediction of skeletal metastases on bone scintigraphy in prostate cancer p. 327
Emmanuel Nii Boye Hammond, Yaw Ampem Amoako, Dennis Odai Laryea, George Amoah
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