Hellenic journal of nuclear medicine最新文献

Eosinophilic esophagitis (EoE) is a rare immune-mediated chronic inflammatory disease of the esophagus. The main symptoms are dysphagia, retrosternal pain, and repeated food impaction. Esophageal eosinophilic infiltration is seen on histopathological examination. Progressive esophageal stenosis and other complications may occur if not detected and treated. We report a patient with pathologically confirmed EoE whose disease was detected on fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT). This case demonstrates the important role of ¹⁸F-FDG PET/CT in the diagnosis of eosinophilic esophagitis.

Papillary thyroid carcinoma (PTC) originates from the follicular cell of the thyroid gland. PTC is a rare cancer and usually develops in pre-existing thyroid nodules, which are not common in children. PTC is often multifocal and bilateral. Low-risk subtypes such as classic PTC and follicular variant account for the majority of PTC, while high-risk histologic subtypes such as tall cell variant, diffuse sclerosing variant and poorly differentiated thyroid cancer occur more rarely in children. It is worth noting that the size of the thyroid in children is smaller compared to that of adults. Therefore, the size criteria used for tumor staging as well as the diagnosis of papillary microcarcinoma in adults, do not apply to children. Family history of thyroid cancer, exposure to external radiation, iodine deficiency, and autoimmune thyroid diseases as well as some genetic syndromes increase the risk of its occurrence.

Oncologic patients are vulnerable to a broad spectrum of cancer related cardiovascular complications during and/or after antineoplastic treatment. This article is dealing with the main drugs used in real world clinical practice, including conventional chemotherapy, targeted therapy, immunotherapy, radiotherapy and their potential cardiovascular toxicity. Diagnosis of cancer- related cardiovascular events requires thorough clinical evaluation, multimodality imaging techniques and cardiac biomarkers according to established guidelines of cardio-oncology. Multidisciplinary approach and individualized strategies are essential and crucial in confronting oncologic patients.

Objective: To conduct a meta-analysis of the diagnostic efficacy of fluorine-18-fluorodeoxyglucose (¹⁸F-FDG) and gallium-68-labeled fibroblast-activation protein inhibitor (⁶⁸Ga-FAPI) positron emission tomography/computed tomography (PET/CT) for primary liver cancer based on existing clinical evidence.

Materials and methods: Meta-analysis was carried out according to PRISMA reporting specification. The clinical studies in PubMed/Medline, Embase and the Cochrane Library database were retrieved from the establishment to September 2022. Two researchers independently conducted literature screening and data extraction, evaluated the risk of bias according to QUADAS-2, conducted meta-analysis using Meta Disc 1.4 and Stata15.1 software, and calculated the summarized sensitivity (SEN), specificity (SPE), positive likelihood ratio (+LR), negative likelihood ratio (-LR), and diagnostic odds ratio (DOR). The diagnostic performance of ¹⁸F-FDG PET/CT and ⁶⁸Ga-FAPI PET/CT for primary liver cancer was compared using summarized receiver operating characteristic (SROC) curve and area under curve (AUC).

Results: Four original studies on ¹⁸F-FDG PET/CT and ⁶⁸Ga-FAPI PET/CT in the diagnosis of primary liver cancer were included, including 159 intrahepatic lesions in 106 patients. Taking lesions as a unit, in four original studies, the pooled results of ¹⁸F-FDG PET/CT diagnosis of primary liver cancer were Sen=0.5 (95% CI:95% CI: 0.41-0.59), Spe=0.87 (95% CI: 0.52-0.98), AUC=0.58 (95% CI:0.53-0.62); The pooled results of ⁶⁸Ga-FAPI PET/CT in the diagnosis of primary liver cancer, Sen=0.5 (95% CI: 0.41-0.59), Spe=0.87 (95%CI:0.52-0.98), AUC=0.58 (95% CI:0.53-0.62). Besides, the Sen of ⁶⁸Ga-FAPI PET/CT in the diagnosis of primary liver cancer was higher than that of ¹⁸F-FDG PET/CT (Z=2.323, P=0.02), the difference was statistically significant.

Conclusion: Gallium-68-FAPI PET/CT is a promising tool. Compared with ¹⁸F-FDG, ⁶⁸Ga-FAPI has higher sensitivity to detect more lesions in primary liver cancer and metastatic lesions, and has high performance in the diagnosis of primary liver cancer.

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.