Hellenic journal of nuclear medicine最新文献

A 48-year-old man with an intermittent fever of 39.0^oC for more than three weeks underwent computed tomography (CT) and blood testing, which revealed no clues. Antibiotics wereadministered, but his condition did not improve. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) showed right-lobe-dominant diffuse thyroid uptake. On technetium-99m (^99mTc) pertechnetate scintigraphy, the thyroid gland could not be visualized, and he was diagnosed with subacute thyroiditis (SAT). When asymmetric ¹⁸F-FDG diffuse thyroid uptake on PET/CT is observed in a patient with a fever of unknown origin (FUO), SAT may need to be considered.

Gallium-68 (⁶⁸Ga)-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and fluorine-18-fluorodeoxyglucose(¹⁸F-FDG) PET/CT were performed for staging in a 51-year-old man with renal cell carcinoma. Compared with ¹⁸F-FDG PET/CT, no obvious tracer uptake in right renal mass and less metastatic lesions were found on ⁶⁸Ga-PSMA PET/CT. Postoperative pathology demonstrated the diagnosis of fumarate hydratase-deficient renal cell carcinoma (FHRCC).

Objective: Squamous cell carcinomas (SCC) are a number of different types of cancer that result from squamous cells. These cells form on the surface of the skin, on the lining of the respiratory and digestive tracts etc. To evaluate SCC and frequencies of their localizations based on the findings of fluorine-18-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT).

Subjects and methods: This study included 343 consecutive patients with SCC who were sent for the ¹⁸F-FDG PET/CT. Inclusion criteria were: Pathohistologically verified SCC; absence of malignancy of any other localization, as well as absence of infection; and glycemia ≤11mmol/L.

Results: The pathological findings on ¹⁸F-FDG PET/CT were present in 86% of patients. There was statistically significant difference in the finding of ¹⁸F-FDG PET/CT in relation to gender (P>0.006). The disease was more often present in women. The most common localizations of disease were: lungs (70%), vagina/cervix (18%), gastrointestinal tract (18%), head and neck (5%). Highest maximum standardized uptake value (SUVmax) levels were seen in the lungs 11.78±8.38, vagina/cervix 11.21±8.10, and head and neck area 6.32±3.96.

Conclusion: Fluorine-18-FDG PET/CT can be informative in evaluation of SCC. Disease is present usually in women, although it is the same pathohistological type of disease, different organs accumulate this radioactive contrast differently.

Objective: Transthyretin cardiac amyloidosis (ATTR-CA) is a rare and potentially fatal disease caused by the accumulation of insoluble transthyretin (TTR) amyloid fibrils in the heart. The symptoms of ATTR-CA are often non-specific, often leading to underdiagnosis. Early diagnosis and treatment have a significant impact on disease progression and mortality.

Case presentation: In this case we report a 73-year-old male presented with dyspnea on exertion. The patient had a medical history of peripheral neuropathy, bilateral carpal tunnel syndrome, spinal fusion, and a family history of coronary artery disease. Upon his presentation at the Cardiology department, cardiac echo study revealed left and right ventricular hypertrophy with pulmonary hypertension, diastolic dysfunction and a restrictive pattern. Because of the high probability of amyloidosis, the patient underwent a technetium-99m-3,3-diphosphono-1,2-propanodicarboxylic acid (^99mTc-DPD) bone scintigraphic study, which confirmed the diagnosis of ATTR-CA. Transthyretin gene sequencing analysis revealed the rare p. Pro24Ser pathogenic variant. Final diagnosis was ATTR-CA associated with the proline replaced by serine at position 24 (Pro24Ser) TTR variant, which is rare and only a few cases have been reported worldwide. The patient was treated with tafamidis and inotersen and followed up.

Conclusion: This case highlights the importance of considering amyloidosis as a differential diagnosis for non-specific symptoms and the need for early diagnosis and management of ATTR-CA.

Plasma cell disorders are a heterogeneous group caused by the monoclonal proliferation of lymphoplasmacytic cells in the bone marrow. Multiple Myeloma (MM) is the most serious and prevalent plasma cell dyscrasia, with a median age of onset of 60 years.MM displays significant genetic, biological and clinical heterogeneity with subsequent imaging heterogeneity, evident in contemporary imaging modalities (PET/CT and MRI). Evidence suggests that MM is always preceded by precursor stages of monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma.

Differentiated thyroid cancer is composed of papillary (85%), follicular (13%) with their subtypes and anaplastic (<2%) thyroid cancer, derived from follicular dedifferentiation. In the majority of cases (85%), treatment is succeeded with thyroxine suppression and radioiodine ablation. However, there is a small percentage of patients presenting with local recurrence or metastases during follow up. In such cases, reoperation and radioiodine treatment are the treatments of choice. 10% of the aforementioned patients appear resistance to radioiodine treatment and they are considered refractory to iodide. As refractory to radioiodine is defined a patient who fulfills one of the following criteria: 1. Negative RAI Uptake 2. RAI uptake in some but not all metastases 3. Disease progression 6-12 months after Radioiodine ablation 4. Disease progression after radioiodine treatment more of than 600mCi.

Thyroid's ultrasound examination is the first and main imaging modality for the morphological investigation of the gland following clinical examination. It depicts both the number and texture of both palpable and non-palpable nodules.

Neuroendocrine tumors (NETs), are heterogenic neoplasms that arise from the disseminated endocrine cell system, primarily from gastroenteropancreatic (GEP) organs. Nuclear Medicine has a central role in both diagnosis and treatment of GEP-NETs. Somatostatin receptor scintigraphy (SRS) is still performed with SPECT/CT in case that PET/CT is not available but numerous studies have demonstrated the superior diagnostic accuracy of the latter for GEP-NETs. ⁶⁸Ga -Dota peptide PET/CT (SSA-PET/CT) has high sensitivity, specificity and accuracy (86%-100%) and is recommended for the staging as also for the restaging of GEP-NETs.

Breast cancer treatment is determined by the molecular subtype both in the early stage and the advanced disease. While there is clear benefit from adjuvant systemic treatment for patients with early-stage triple negative and HER2 positive breast cancer, it was unclear in the past which patient with luminal breast cancer needs adjuvant chemotherapy. As a result, we used to overtreat or undertreat patients. In the era of personalized treatment, genomic panels have become as or more important than the anatomic extent of disease to define prognosis in luminal breast cancer. Several gene expression assays are available for consideration of adjuvant systemic therapy categorizing patients according to genomic risk for recurrence (e.g., Oncotype, Mammaprint, etc). Except for the high and low risk signature, more recently Mammaprint announced that patients with ultra-low risk signature have excellent prognosis, distinctive from low risk with 8-year BCSS above 99%, regardless of age, clinical risk or treatment received. Very few patients developed distant metastasis, allowing physicians to de-escalate treatment plans.

Technetium-99m (^99mTc)-pertechnetate can be taken up by both gastric mucosa and thyroid tissue. Ectopic gastric mucosa of upper esophagus found in thyroid scintigraphy is rare. We reported a 31-year-old woman who underwent ^99mTc-pertechnetate thyroid static scintigraphy for abnormal ultrasound findings. A focal uptake lesion was found in her upper chest. Single photon emission computed tomography/computed tomography (SPECT/CT) imaging showed increased uptake in multiple sites of the upper esophagus without significant thickening. Eventually, gastroscopic findings revealed multiple ectopic gastric mucosa of upper esophagus.