Clinical Nuclear Medicine最新文献

Abstract: We report a case of a 33-year-old man with epilepsy and equivocal EEG, MRI signs of mesiotemporal sclerosis, and nondiagnostic standard FDG-PET imaging. The patient underwent repeat FDG-PET/MRI to clarify the sidedness of the epileptogenic focus and to confirm the suspected MTS. The standard PET reconstruction using block sequential regularized expectation maximization failed to provide evidence of a clear epileptogenic focus. However, using MR-guided PET reconstruction, circumscribed hypometabolism was observed in the right-sided entorhinal cortex, compatible with the epileptogenic focus. The MR-guided PET reconstruction provided significantly improved gray/white matter differentiation, enhancing confidence in imaging interpretation.

Abstract: A 38-year-old woman received a 68 Ga-FAPI-04 PET/CT scan for the evaluation of systemic lupus erythematosus. Diffuse uptake in both kidney parenchyma indicated the presence of lupus nephritis. In addition, an incidental carotid body tumor with increased FAPI uptake was also observed. Our case described the imaging features of lupus nephritis coexistent with a carotid body tumor on FAPI PET/CT.

Abstract: The diagnostic workup of primary lymphedema includes lymphoscintigraphy, a diagnostic test that provides objective data derived from the characteristics of the lymphatic flow and the lymphatic nodes. Several empirical scoring systems have been proposed with the aim of harmonizing the procedure. Here we comment the latest one, reflecting on the relevance of these tools to make possible multicenter research, based on intraobserver and interobserver reliability with the aim to, in the long run, improve patient outcomes.

Abstract: Breast cancer presents a significant global health challenge, necessitating continued innovation in diagnostic and therapeutic approaches. Recent advances have led to the identification of cancer-associated fibroblasts, which are highly prevalent in breast cancers and express fibroblast activation proteins (FAPs), as critical targets. FAP-specific radiotracers, when used with PET/CT and SPECT/CT, have significant potential for improving early breast cancer detection, staging, treatment response monitoring, and therapeutic intervention. This review provides insight into FAP-targeted molecular imaging, exploring advanced techniques for protein status assessment, development of early-phase targeted therapies, and other emerging applications. The advent of FAP-targeted imaging stands to significantly enhance personalized oncologic care, leading to improved breast cancer management and overall patient outcomes.

Abstract: The development of radiolabeled small-molecule prostate-specific membrane antigen (PSMA) inhibitors has advanced molecular imaging in prostate cancer. The use of 177 Lu-PSMA is especially beneficial because its therapeutic β-emission combined with γ-radiation enables precise treatment and comprehensive imaging in patients with prostate cancer. We present a case of a prostate cancer patient who developed lower extremity lymphedema and hydrocele secondary to prior radiotherapy. Posttherapy whole-body imaging following 177 Lu-PSMA treatment revealed dermal backflow with a notable accumulation of soft tissue in the lower extremities and hydrocele.

Abstract: A 66-year-old man presented with persistent dull pain in the lower back for over 7 months. An expansile lytic lesion in the L4 vertebral body showed a characteristic "mini brain" appearance on MRI, which is highly suggestive of plasmacytoma. 18 F-FDG PET/CT scan revealed increased FDG uptake in the L4 lesion, with an additional finding of a mass in the anterior mediastinum that showed mild FDG uptake. Lumbar surgery and complete resection of the anterior mediastinum tumor confirmed spinal metastatic type A thymoma, which was classified as p-T1aN0M1b, stage IVb. The patient's condition improved postsurgery and chemotherapy, with long-term follow-up necessary due to recurrence risk.

Abstract: 68 Ga-Trivehexin is a novel radiotracer binding to "cancer-specific integrin αvβ6." 68 Ga-Trivehexin has high specificity for tumor cells and, thus, has the potential to replace 18 F-FDG PET/CT due to its limited specificity in the head and neck cancer. Here, we present one case of papillary thyroid carcinoma, where 68 Ga-Trivehexin PET CT demonstrated accurate staging compared with 18 F-FDG PET/CT.

Abstract: Metastatic or recurrent adrenocortical carcinoma is a potentially lethal malignancy, presenting significant challenges in disease management owing to absence of effective systemic treatments. Significantly diminished survival rates necessitate rapid identification of specific molecules for the development of targeted therapeutics. Fibroblast activation protein (FAP)-expressing cancer-associated fibroblasts have been a major breakthrough causing a paradigm shift in targeted theranostics focusing on the tumor microenvironment. The effectiveness of various FAP inhibitors (FAPis) and FAP targeting peptide has been extensively documented in diverse clinical investigations. We have evaluated 3 molecules, that is, DOTA.SA.FAPi (SA.FAPi), FAPi46, and FAP2286, as potential theranostic probes for adrenocortical carcinoma.

Abstract: Castleman disease is a rare lymphoproliferative disorder primarily affecting lymph nodes, including unicentric and multicentric types. The multicentric form is rarer and can often be misdiagnosed as lymphoma. Here, we report 18 F-FDG and 68 Ga-pentixafor PET/CT findings in a case of Castleman disease involving the nasopharynx and multiple lymph nodes.

Purpose: Autoimmune encephalitis (AIE) is a group of conditions that are insufficiently understood and difficult to diagnose. Several publications indicate that FDG PET has superior sensitivity compared with MRI. This study aimed to perform a systematic review of publications to assess the characteristics and frequency of brain FDG PET compared with MRI findings at the individual level in AIE, including case reports and case series. The resulting meta-analysis is complementary to previous publications with large or medium-sized cohorts.

Patients and methods: The review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and aimed to identify all studies with at least 1 case of AIE in which brain FDG PET was performed. Results from MRI and FDG PET were extracted on a patient-by-patient basis.

Results: The literature search yielded 1303 results, of which 234 studies were included, containing 498 cases. Abnormal FDG PET findings are reported in 93% compared with 55% with MRI. The affected brain regions, rates of unilateral versus bilateral findings, and hypermetabolism versus hypometabolism are descriptively presented in tables categorized according to the associated antibody.

Conclusions: FDG PET detected abnormalities more frequently than MRI, particularly in cases with anti-NMDAR and anti-GABA-B antibodies. Findings include a high prevalence of hypermetabolism in the medial temporal lobes, but also a high prevalence of parietal and occipital hypometabolism. Results differed depending on the associated antibody. Overall, the findings strengthen the importance of FDG PET in patients with suspected AIE, and the antibody-related patterns of regional metabolic abnormalities indicate a high potential for further development as a diagnostic and prognostic tool.