Clinical Nuclear Medicine最新文献

Testicular adrenal rest tumors (TARTs) are benign lesions believed to arise from pluripotent steroidogenic cells within the testes, typically developing under chronic stimulation by adrenocorticotropic hormone. We present the case of a male with congenital adrenal hyperplasia (CAH) who underwent FDG PET/CT due to bilateral testicular masses, demonstrating false-positive FDG avidity suggestive of malignancy. Following appropriate corticosteroid therapy, repeat imaging revealed complete metabolic resolution of the lesions. This case illustrates a rare false-positive finding on FDG PET/CT and to our knowledge, it is the first reported case demonstrating complete metabolic response on FDG PET/CT following an appropriate therapy in a patient with CAH-associated TARTs.

This case illustrates an atypical clinical presentation of a nasopharyngeal invasive process in a 56-year-old woman, which corresponded to a chordoma, a rare malignant primary bone tumor with unfavorable prognosis, derived from remnants of the notochord.

Objective: This preliminary study aimed to evaluate the safety and efficacy of 225Ac-DOTA-IBA in the treatment of bone metastases.

Materials and methods: Fourteen patients with bone metastases were enrolled and received at least one cycle of 225Ac-DOTA-IBA at a fixed dose of 3.7 MBq per cycle. Treatment-related adverse events (AEs) were graded according to the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0). Efficacy assessments included Eastern Cooperative Oncology Group (ECOG) performance status, Karnofsky Performance Status (KPS), and pain Numeric Rating Scale (NRS) scores at baseline and 2-4 weeks post-treatment, as well as 68Ga-DOTA-IBA PET/CT scans within 1 week before treatment and 4-8 weeks post-treatment. Imaging responses were categorized as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD).

Results: 225Ac-DOTA-IBA was well tolerated, with no grade 3/4 AEs. On the basis of NRS scores, the pain relief rate was 92.9% (13/14) after the first cycle and was maintained at this level after subsequent cycles. ECOG performance status remained stable in the majority of patients, with improvement (from grade 2 to 1) observed in 2 cases (14.3%). KPS improved in 71.4% (10/14) of all patients after treatment. 68Ga-DOTA-IBA PET/CT analysis showed PR in 50.0% (7/14), SD in 35.7% (5/14), and PD in 14.2% (2/14). Among 7 patients who had previously received 177Lu-DOTA-IBA, 57.1% (4/7) improved in KPS, and 85.7% (6/7) in NRS. Regarding imaging response in these 7 patients, 42.9% (3/7) achieved PR, 42.9% (3/7) had SD, and 14.3% (1/7) showed PD. Subgroup analysis revealed that patients with bone-only metastases (n=9) had a significantly higher rate of KPS improvement (77.8% vs. 60.0%, P=0.012) and achieved a greater median reduction in pain scores (3.0 vs. 2.0 points, P=0.008).

Conclusions: This study indicated that 225Ac-DOTA-IBA was a promising and well-tolerated therapeutic for bone metastases, demonstrating acceptable toxicity and notable efficacy, including 177Lu-DOTA-IBA-refractory cases. Subgroup analyses indicated that patients with bone-only metastases derived particular clinical benefit.

Background: Effective surgical management of persistent air leaks (PAL) after thoracic surgery depends on their quick and reliable localization, which has been hitherto limited to the intraoperative water submersion test (iWST). We present a case series of 20 patients examined for PAL using technetium-99m Technegas ventilation SPECT/CT (vSPECT).

Patients and methods: Technegas was prepared and administered according to the manufacturer's instructions using a Cyclomedica TechnegasPlus generator. SPECT projections were acquired on a Siemens Symbia Intevo Bold gamma camera equipped with a low-energy high-resolution (LEHR) collimator. We reviewed patient records, correlating imaging with intraoperative assessment and the subsequent clinical course.

Results: The median age at the time of surgery was 68.5 years. Surgical indications were pulmonary neoplasm (n = 16, lobectomy/segmentectomy), chronic obstructive pulmonary disease (n = 2, lung volume reduction surgery), solitary fibrous tumor of the pleura (n = 1, fissural pleurectomy), and thymoma (n = 1, thymectomy/pericardectomy). In 10/20 cases, vSPECT successfully located PAL subsequently confirmed by iWST. In 4/20 cases, vSPECT located PAL without confirmation by iWST, however, surgical intervention at the site indicated on vSPECT curbed the leak. In 4/20 cases, PALs identified on vSPECT were managed conservatively as thoracic drainage volumes decreased. In 2/20 cases, vSPECT did not display a PAL; in 1 case, a trocar hernia was found responsible, in another case, revision surgery was deferred, and fistulation resolved without intervention.

Conclusions: Technegas ventilation SPECT/CT appears to be a useful and remarkably accurate modality for the assessment of patients with clinical suspicion of PAL.

We describe MRI and FDG PET/CT findings of vaginal epithelioid malignant peripheral nerve sheath tumor in a 60-year-old woman. The patient presented with irregular vaginal bleeding. On MRI, the mass appeared hypointense on T1WI and hyperintense on T2WI, demonstrating diffusion restriction and enhancement. 18F-FDG PET/CT revealed a solitary vaginal mass with intense FDG uptake. Surgical pathology confirmed the diagnosis of epithelioid malignant peripheral nerve sheath tumor.

We present a case of a 3-year-old girl with intractable epilepsia partialis continua (EPC) for 6 months, in whom Ictal FDG-PET was able to accurately localize the seizure onsets while standalone ictal SPECT was noncontributory.

We present the 18F-AlF-NOTA-pentixather PET/CT findings in a 53-year-old man with papillary thyroid carcinoma and cervical lymph node metastases. The patient underwent 18F-AlF-NOTA-pentixather PET/CT for evaluation of primary aldosteronism, which incidentally revealed a thyroid neoplasm. PET/CT demonstrated increased radiotracer uptake in a thyroid mass and bilateral cervical lymph nodes, suggesting neoplastic involvement. Postoperative histopathology confirmed anaplastic thyroid carcinoma with lymph node metastases.

A 14-year-old girl underwent bilateral living-donor lobar lung transplants (LDLLT) from each parent for bronchiolitis obliterans following hematopoietic stem cell transplantation (HSCT). Pulmonary perfusion scintigraphy demonstrated a marked reduction in blood flow in the father-derived graft, which subsequently collapsed and was diagnosed as chronic lung allograft dysfunction (CLAD), whereas the mother-derived graft remained stable and functional. The HSCT was performed with the mother's stem cells, theoretically preventing rejection of the mother's graft. This case highlights the unique immunologic dynamics arising from donor selection in HSCT and LDLLT, and underscores the usefulness of scintigraphy in the early detection of CLAD.

We present a 69-year-old man with a history of renal cell carcinoma who previously underwent nephrectomy. He was referred to our department for 99m Tc-FAPI and 99m Tc-PSMA scans (under an investigational protocol) due to a newly diagnosed rising prostate-specific antigen (PSA) level and a suspected retroperitoneal mass of unknown origin. Notably, the patient had a known history of malignant ascites, and his 99m Tc-FAPI scan demonstrated increased radiotracer uptake within the abdominal cavity.

A 64-year-old man presented with severe anemia (hemoglobin 56 g/L; RBC 2.60×10 12 /L) on a background of hypertension, diabetes, coronary heart disease, and cerebral thrombosis. Contrast-enhanced abdominal CT and initial endoscopy were unremarkable. Initial 99m Tc-RBC SPECT/CT scintigraphy localized active bleeding to the descending colon. However, repeat endoscopy revealed brown stool in the terminal ileum. Subsequent 99m Tc-RBC SPECT/CT scintigraphy identified a small-bowel soft-tissue mass whose position shifted confirmed epithelioid angiosarcoma of the small intestine. This case highlights the utility of 99m Tc-RBC SPECT/CT in diagnosing challenging small intestinal angiosarcoma.