Indian Journal of Nuclear Medicine最新文献

We would like to present a 49-year-old female patient who was presented with a vulva lesion and palpable inguinal lymph nodes who were diagnosed with disseminated multiorgan involvement of high grade diffuse large B-cell lymphoma. The ¹⁸F-fluorodeoxyglucose positron emission tomography computerized tomography imaging showed multiple cervical, axillary, and abdominal lymph nodes, pulmonary nodules as well as gross hypermetabolic vulvar lesion.

Sarcoidosis is a systemic disease characterized by noncaseating granulomas involving any organ. Concurrent carcinoma breast with sarcoidosis is a rare occurrence. A 51-year-old female presented with right breast lump and was diagnosed with infiltrating ductal carcinoma with lymph nodal (LN) metastases (estrogen receptor, progesterone receptor positive, and HER2neu negative). Baseline fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan revealed breast mass with multiple LNs. Biopsy of iliac and internal mammary LNs indicated granulomatous lymphadenitis. A possible diagnosis of sarcoidosis was considered. End of chemotherapy (4 EC, 12 paclitaxel), FDG PET/CT revealed a complete metabolic response in breast mass. Most lymph nodes were resolved. Modified radical mastectomy specimen was negative for breast malignancy with granulomatous lymphadenitis in LNs.

Lithium is used in the treatment of bipolar disorder to manage and stabilize mood, proving effective in addressing both manic and depressive phases. In these patients, the use of lithium is associated with various thyroid disorders, such as goiter and hypothyroidism; thyrotoxicosis is a rare presentation. In this case report, we demonstrated lithium-induced thyroiditis on thyroid scintigraphy.

Necrotizing fasciitis is a deadly yet rare soft tissue and skin infection that is usually diagnosed clinically. At times, clinical signs may betray the underlying etiology and masquerade as cellulitis in the early course of the disease. We report four cases with clinical suspicion of necrotizing fasciitis, some after the failure of therapy for cellulitis who underwent 18-F fluorodeoxyglucose positron emission tomography-computed tomography (18-F FDG PET/CT) showing the extent of the disease, showing subclinical sites of involvement in patients with necrotizing fasciitis on baseline scan as well as its role in assessing response to treatment using 18-F FDG PET/CT.

Conventional imaging techniques, while essential, occasionally fall short in identifying elusive metastatic lesions, leading to delayed diagnoses and compromised patient outcomes. Gallium-68 fibroblast activating protein inhibitor (⁶⁸Ga-FAPI) positron emission tomography/computed tomography (PET/CT), leveraging the distinct affinity of fibroblast activation protein for cancer-associated fibroblasts, emerges as a promising solution to bridge this diagnostic gap. Parotid gland adenocarcinoma is a relatively rare malignancy with metastasis typically occurring in regional lymph nodes and distant sites such as the lungs and bones. However, there have been limited reported cases of rare metastatic sites such as the adrenal gland. This exceptional case report details the clinical presentation, diagnostic workup, and management steps of a rare case of a 47-year-old female patient diagnosed with parotid gland adenocarcinoma with confusing metastasis to the ipsilateral adrenal gland which was confirmed later with a follow-up ⁶⁸Ga-FAPI PET/CT scan. We aim to highlight FAPI unique ability to illuminate metastatic foci in challenging anatomical locations.

Background: Fluorine-18 (¹⁸F) flumazenil (FMZ) has been synthesized using various precursors, and its role has been explored in imaging Gamma-aminobutyric acid-A receptors.

Aim and objective: The main objective was to synthesize (¹⁸F) FMZ using isotopic substitution.

Materials and methods: Around 18 ± 2 GBq was added to the module, dried, and radiolabeling was standardized with 3.0 mg of the FMZ precursor at various temperatures (110°C -160°C) for 10-30 min. The product was finally eluted with 20% ethanol (in phosphate buffer). The final product was characterized by high-performance liquid chromatography (HPLC). The stability was evaluated in water, saline, and phosphate-buffered saline for 4 h.

Results: The radiolabelling efficiency of cartridge-based purification was 16 ± 4% (n = 10) with a radiochemical purity of 96.5 ± 1.8%, whereas in HPLC-based purification, the yield was 10 ± 4% (n = 5) with a radiochemical purity of 97.3 ± 1.4%. The specific activity was 120 ± 20 GBq/μmol.

Conclusions: (¹⁸F) FMZ was successfully synthesized using an isotopic approach and could be used as an alternative cheaper option for the synthesis.

Background: Distribution and quantification of extra-pulmonary tuberculosis and elicitation of response antitubercular therapy via F18-Fluorodeoxyglucose Positron Emission-based Tomography/ Computed Tomography(F18-FDG PET/CT).

Materials and methods: This was a prospective Pilot study. In this study 30 patients of age between 15 to 36 years(mean 26.8±6.13years) were included. PET/CT scan was performed at the time of presentation(baseline) and after 2 months of anti-tubercular therapy to evaluate bacterial activity in different levels of cervical lymph nodes and changes in various parameters of lymph nodes such as size, conglomeration and abscess formation were included in the evaluation.

Result: In this study, 18 patients were of 18 to 30 years(60.0%), 3 patients were below 18 years(10.0%) and 9 patients above 30 years(30%). The female proportion was higher in our study population(53.3%). Node-positive status, conglomeration, and abscess were evaluated clinically. Maximum percentages were found in level II and level V groups. While minimum percentage was found in level I and level VI. We also found that in all patients of tubercular cervical lymphadenopathy, tubercular bacterial activity was found at some distant sites also the common sites were the lung(56.7%), mediastinum(53.3%), abdomen(36.7%) and bone(23.3%). The response of antitubercular therapy by F18 - FDG PET/CT scan after 2 months of treatment was checked. There was a significant change in standardized uptake value(SUV-max) pre-treatment and post-treatment at all distant sites except the bony site.

Conclusion: F18-FDG PET/CT scan is a non-invasive tool in monitoring the response of antitubercular chemotherapy in patients of extrapulmonary and multiorgan lymphadenopathy.

Adenosine is extensively utilized in myocardial stress perfusion imaging for the detection and risk stratification of coronary artery disease. It has a well-established safety profile. The majority of the undesirable effects experienced during adenosine infusion are transient (owing to its brief half-life of ~10 s) and arise from the stimulation of receptors in the atrio-ventricular (AV) node (AV block) and bronchial smooth muscles (bronchospasm). We hereby report an unusual electrocardiographic finding during adenosine stress perfusion imaging, in a patient who had previously undergone single chamber pacemaker insertion and was referred for the assessment of atypical chest pain.

Paraneoplastic neurological syndrome (PNS) represents a rare group of central nervous system disorders that are unrelated to direct tumor invasion or metastasis but may be triggered by an immune system reaction to a neoplasm or malignant tumor. In many patients, PNS is diagnosed before identifying the primary cancer. In such instances, positron emission tomography/computed tomography scan can assess individuals with suspected PNS enabling the detection of hidden malignancies. We share an interesting image of paraneoplastic cerebellar degeneration in a case of invasive ductal carcinoma breast.

Role of FDG PET/CT in evaluation of biliary tract diseases remains relatively unexplored. PET/CT with FDG helps in evaluation of both infective / inflammatory as well as neoplastic diseases as increased glucose utilization is observed in both the conditions. In this article, we describe the spectrum of FDG PET/CT findings in various diseases affecting the biliary tract. Role of FDG PET/CT in neoplastic diseases involving the biliary duct has been described at the time of staging and response evaluation; in characterization of the intrahepatic mass (abscess v/s cholangiocarcinoma). In addition, we have discussed about the false positive FDG uptake along the biliary duct stent, which interfere with scan interpretation. Few of the benign conditions described are Langerhans cell histiocytosis and IgG4 related disease involving the biliary duct and adenomyomatosis and Xanthogranulomatous cholecystitis involving the gall bladder.