Clinical Nuclear Medicine最新文献

Purpose: Kidney transplantation is the treatment of choice for end-stage kidney disease, but predicting short-term and long-term outcomes remains challenging. Noninvasive, widely available tools for early risk stratification are lacking. This study evaluated whether the tubular extraction rate (TER) of Tc-99m-MAG3 measured by renal scintigraphy can predict transplant outcomes.

Methods: In this prospective observational study, 488 kidney transplant recipients (2012-2022) underwent standardized Tc-99m-MAG3 scintigraphy on postoperative day 6 to quantify TER. Patients were stratified into quartiles. Primary short-term endpoints were delayed graft function (DGF) and length of hospital stay; the primary long-term endpoint was a composite of graft loss or death. Associations were assessed using multivariable logistic regression, generalized linear models, and Cox regression.

Results: Lower TER was significantly associated with older donor and recipient age, longer ischemia times, and higher DGF risk [adjusted OR 9.45 (95% CI: 4.31-20.72), lowest vs. highest quartile]. Low TER was linked to more dialysis sessions and longer hospitalization. During a median follow-up of 8.4 years, low TER was independently associated with increased risk of biopsy-proven rejection (HR: 4.23; 95% CI: 1.05-17.13), graft failure or death (HR: 3.87; 95% CI: 1.67-8.97). eGFR values over time were consistently higher in patients with higher TER values.

Conclusions: The tubular extraction rate derived from MAG3 scintigraphy is a strong and independent predictor of both short-term and long-term outcomes after kidney transplantation. As a noninvasive and widely available diagnostic tool, it may facilitate early identification of high-risk transplant recipients and support personalized post-transplant care strategies.

A 74-year-old man with a history of monoclonal gammopathy of undetermined significance (MGUS) underwent surveillance whole-body 18 F-FDG PET 2 weeks before MRI-guided high-intensity focused ultrasound (MRgHIFU) of the left dentato-rubro-thalamic tract (DRTT) for his right-hand dominant, debilitating essential tremor. This baseline FDG PET showed normal thalamic metabolism. At 12 months post-treatment, FDG PET scan revealed a small focus of left thalamic hypometabolism, which corresponded to the left DRTT ablation area seen on post-treatment MRI. The patient was tremor-free in his right hand at 1-year follow-up. This case documents the chronic effects of MRgHIFU on cerebral FDG metabolism.

In primary hyperparathyroidism (PHPT), exact preoperative localization of parathyroid adenomas is essential for best surgical planning. While new PET tracers like 18 F-fluorocholine and 68 Ga-Trivehexin show promise, traditional imaging consists of 99m Tc-Sestamibi scintigraphy, SPECT/CT, and 4DCT. Herein, we report the potential new application of another angiogenesis imaging agent, 68 Ga-NODAGA-RGD PET/CT, illustrated in a 12-year-old girl with PHPT. The scan revealed diffuse skeletal tracer uptake (superscan) in addition to localizing right inferior parathyroid adenoma, thereby indicating systemic effects. This case underscores 68 Ga-RGD PET/CT as a possible instrument for parathyroid imaging and systemic evaluation, justifying more research to define its diagnostic value and role in treatment response evaluation.

A 53-year-old man presented with right upper abdominal pain for more than 3 weeks without an apparent cause. Multiple sequences of MR imaging detected multiple liver nodules with irregular peripheral enhancement. 18 F-FDG and 68 Ga-FAPI PET showed multiple elevated tracer uptake, which mimicked multiple liver metastases of unknown primary focus. Finally, the pathology of ultrasound-guided biopsy confirmed the diagnosis of hepatic eosinophilic granuloma (HEG).

Gilal fibrillary acidic protein (GFAP) meningomyelitis is a rare autoimmune inflammatory disorder of the central nervous system, typically presenting with subacute encephalopathy, ataxia, optic neuritis, and cerebrospinal fluid (CSF) pleocytosis. It is characterized by the presence of GFAP-specific autoantibodies, which target astrocytes and cause widespread neuroinflammation. 18 F-FDG PET/CT plays a critical role in the early diagnosis of autoimmune encephalitides, particularly in cases where conventional MRI findings may be subtle or nonspecific. Here, we present a case of 21-year-old woman who presented with early morning occipital headache with fever, followed by progressive drowsiness and acute urinary retention. On clinical examination, meningeal signs were positive. MRI brain was suggestive of leptomeningeal enhancement involving the brain and spinal cord, and 18 F-FDG PET/CT was done for further evaluation.

Technetium-99m Technegas SPECT/CT is a promising tool for the localization of postoperative air leaks in thoracic surgery patients. We report a case of successful leak detection in a mechanically ventilated patient following thoracoscopic surgery and revision. Radioventilation was performed by connecting the TechnegasPlus (Cyclomedica Pty Ltd.) generator's administration set to the patient's endotracheal tube and gently inflating the lungs with a disposable respirator through the generator's assist valve. Intense pleural Technegas accumulation was observed as a correlate of the air leak. Characteristic changes of ventilation distribution secondary to mechanical ventilation are discussed.

[ 18 F]FDG PET/CT is widely used in the diagnosis and treatment monitoring of lung cancer, yet its ability to differentiate histologic heterogeneity remains limited. In this case, a 75-year-old man presented with a large pulmonary mass adjacent to a small satellite lesion. Bronchoscopic biopsy of the main lesion revealed small-cell lung cancer (SCLC). After first-line chemotherapy, the primary lesion showed partial response, while the smaller nodule remained stable. Posttreatment [ 18 F]FDG and [ 68 Ga]Ga-DOTA-3P-TATE-RGD PET/CT demonstrated divergent uptake patterns. Rebiopsy of the nodule with discordant tracer uptake confirmed squamous cell carcinoma, indicating synchronous double primary lung cancers. The dual-targeted tracer PET/CT guided precise biopsy and individualized therapy.

A 72-year-old man underwent 18 F-DCFPyL PSMA PET/CT imaging for the localization of biochemical recurrence (BCR) of prostate cancer. The scan revealed no definite findings, with only a vague uptake of uncertain significance in the bladder neck region. An additional PET/CT scan using a 64 Cu-labeled trimeric PSMA ligand demonstrated astonishing distinct uptake in the former prostate bed, unequivocally confirming the presence of a small local recurrence and allowing for targeted local therapy. This intriguing case highlights the potential of PET/CT using 64 Cu-labeled trimeric PSMA ligands, especially when conventional PSMA PET/CT scans yield ambiguous results.

Epithelioid sarcoma (ES) is an ultra-rare and aggressive soft tissue malignancy, predominantly affecting the extremities. Scalp involvement in ES is exceedingly uncommon. This case report describes a 25-year-old man diagnosed with a scalp mass confirmed to be ES. Despite undergoing surgical resection and adjuvant chemoradiation, the tumor recurred, causing significant pain and erosion of adjacent bony structures. A multidisciplinary team recommended 99m Tc-FAPI-46 scintigraphy, which demonstrated high uptake in the tumor masses. The patient was subsequently treated with 177 Lu-FAPI-2286 in 4 cycles. Initial cycles showed promising treatment responses; however, disease progression was observed in the final cycle.

Primary renal NUT carcinoma is exceptionally rare. Herein, we report 68 Ga-FAPI-04 PET/CT findings in a 10-year-old girl with this malignancy. The 68 Ga-FAPI-04 PET/CT imaging revealed a right renal mass with intense FAPI uptake, accompanied by FAPI-avid retroperitoneal lymphadenopathy and pulmonary metastases. This case highlights the potential of 68 Ga-FAPI-04 PET/CT for precise staging of renal NUT carcinoma.