Indian Journal of Nuclear Medicine最新文献

Chylous ascites, attributed to various etiologies including malignancy, tuberculosis, ruptured lymphatics, and congenital lymphatic disorders, manifests as abdominal distension. Our patient presented with this condition, and an elevated CA 125 prompted further investigation. Flourine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET-CT) revealed a metabolically inactive omental nodule, while gallium 68 fibroblast activation protein inhibitor (Ga-68-FAPI) PET-CT demonstrated uptake in the same nodule and low-grade uptake in bilateral adnexae. Colloid liver scan ruled out chronic liver disease. Surprisingly, lymphoscintigraphy showed no lymphatic leak. Histological examination of the omental nodule confirmed heterotopic pancreas (HP) in the small bowel mesentery, with normal adnexae. This case report illuminates the diagnostic challenges entailed in HP and signifies a pioneering instance in the literature where evidence of HP was identified for the first time on Ga-68-FAPI PET-CT during the investigative process.

False positive findings in ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸F-FDG PET/CT) scans can present challenges in the accurate diagnosis and staging of various conditions. We report a case of a 52-year-old male with known adenocarcinoma of the stomach who underwent total gastrectomy and chemotherapy and was referred for ¹⁸F-FDG PET/CT to rule out recurrence. ¹⁸F-FDG PET/CT showed a large FDG-avid lesion involving the entire right testicle mimicking testicular cancer or lymphoma. Further evaluation with ultrasonography revealed epididymo-orchitis, possibly of granulomatous etiology. Orchitis, an inflammatory condition of the testicles, can cause misleading results in ¹⁸F-FDG PET/CT imaging for cancer surveillance. Imagers should cautiously interpret PET/CT findings, considering clinical context, patient history, and additional imaging modalities to distinguish true malignancies from false positives.

We present an unusual case of invasive ductal breast carcinoma in a postmenopausal female with a clinically node-negative disease that was incidentally found to have mesenteric metastatic deposits on ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography scan. Mesenteric metastasis from invasive breast carcinoma is rare, with <1% cases reported worldwide and limited availability of diagnostic and therapeutic protocols for carcinoma breast with mesenteric metastasis, this proved to be a challenging and intriguing case. To further accentuate the complexity, the primary tumor of this mesenteric metastasis was found to be invasive ductal carcinoma, which is even more infrequent, and <0.5% of cases have been reported till date.

Bacillus Calmette-Guërin (BCG) has been traditionally used as a vaccine against tuberculosis (TB), which contains live, attenuated strain of Mycobacterium bovis. However, intravesical BCG administration has been used as an immunological treatment of superficial bladder cancer. Complications after bladder instillation of BCG are rare. We report a case of carcinoma urinary bladder with histopathologically proven granulomatous epididymo-orchitis (TB) after treatment with intravesical BCG.

Metastases from squamous cell carcinoma of the lung typically occur in the brain, liver, adrenal glands, bone, and regional lymph nodes. It is exceedingly uncommon to encounter multiple rare sites of metastasis from a single primary neoplasm. Herein, we describe a case of a 44-year-old male diagnosed with squamous cell carcinoma lung with pituitary and renal metastasis detected on ¹⁸F-FDG (Fluorodeoxyglucose) PET/CT. ¹⁸F-FDG PET/CT is the standard of care and is an integral part of the clinical staging of patients with lung cancer. According to published literature, the incidence of symptomatic pituitary and renal metastasis from squamous cell carcinoma lung is rare to find with incidences <1% and 5%, respectively. The revelation of rare sites of metastasis originating from primary squamous cell carcinoma lung, as reported in this case on FDG PET/CT, illuminates the exceptional rarity and intricacies in oncology. The exquisite sensitivity of FDG PET/CT enables the identification of occult metastasis in atypical anatomical locations, presenting a distinct advantage over conventional imaging modalities.

The history of radiation science began with Wilhelm Rontgen's discovery of X-rays in 1895, followed closely by Henri Becquerel's discovery of radioactivity in 1896. Subsequent research focused on developing radioisotope technology and exploring its applications in medical diagnosis and treatment. The first recorded use of radioisotopes for tumor treatment was by William Dune in Marie Curie's laboratory. George D Heawse employed radioisotopes to study plant and animal physiology. Irene and Joliot Curie pioneered the production of artificial radioisotopes using alpha particle bombardment. Ernest O. Lawrence's invention of the cyclotron furthered the development of artificial isotopes. His brother John Lawrence treated the first patient with cyclotron-produced phosphorus-32. Glenn Seaborg's discovery of Tc-99m and I-131 led to the development of radioiodine therapy by Saul Hertz and many diagnostic procedures using Tc-99m. Bendit Casin invented the rectilinear scanner, a pioneering imaging device, while Hal Anger developed the gamma camera. Over time, the contributions of researchers, scientists, engineers, and physicians have advanced the field of nuclear medicine, resulting in state-of-the-art equipment such as positron emission tomography (PET)/magnetic resonance imaging (MRI), positron emission tomography (PET)/computed tomography (CT), single-photon emission computed tomography (SPECT)/computed tomography (CT), and many other innovative technologies.

Background: Cancer is a prime cause of death globally and accounted for about 10 million deaths in 2020. The accurate determination of the extent of disease is crucial for treatment conceptualization and planning. The aim of the present study was to assess the role of teleradiology in the oncological interpretation of positron emission tomography-computed tomography (PET-CT) scans.

Materials and methods: In this retrospective study, a total of 1137 PET-CT scans of a cohort of 1057 patients from hospitals in India, the US and Nepal were uploaded to the teleradiology cloud server and interpreted by board certified radiologists empanelled by a teleradiology service provider.

Results: The telehealth model proposed in the study was seen to provide timely and quality reporting of all PET- CT studies with a mean turnaround time of 20.06 h 95% confidence interval (19.35-20.78).

Conclusion: The early-stage diagnosis of cancer before it has progressed or metastasized is crucial for the immediate treatment conceptualization and plan and improves the prognosis for long-term survival of the patient. Teleradiology is an important tool in the field of oncology, providing rapid and accurate interpretation of imaging findings, essential for appropriate treatment planning.

Posttransplant lymphoproliferative disorders (PTLDs) represent a spectrum of malignancies occurring in transplant recipients under immunosuppression, often linked with Epstein-Barr Virus infection. PTLD has a varied presentation, and isolated muscular involvement is infrequent. Here, we present the case of a 47-year-old female renal transplant recipient presenting with acute left knee joint swelling, initially suggestive of an infective or inflammatory etiology. Biopsy revealed high-grade non-Hodgkin lymphoma of natural killer/T-cell lymphoma. F-18 Fluorodeoxyglucose positron emission tomography-computed tomography scan revealed metabolically active soft tissue mass lesions isolated to thigh muscles. The patient was on a modified chemotherapy regimen tailored to accommodate renal function. This case underscores the necessity for heightened vigilance in diagnosing PTLD, particularly considering its atypical presentations.

Obsessive-compulsive disorder is among the most extensively researched mental health disorder. Various metabolic neuroimaging research findings are consistent but still nonconclusive. The major limitation is a homogeneous sample. There are research findings which have established the impact of treatment in changing brain metabolism. Therefore, it is important to highlight differential metabolic changes with respect to treatment staging and its outcome. It will also help to individualized neuromodulation protocol based on differential metabolic findings. This study highlights the distinct differential fluorodeoxyglucose metabolic changes among two distinct cases: drug-naïve and treatment-refractory.

Purpose of the study: The 2015 American Thyroid Association pediatric differentiated thyroid cancer (DTC) guidelines recommend posttherapy whole body scan (PTS) 4-7 days after (Iodine-131) I-131 activity administration. There is no recommendation of timing of performing a diagnostic whole-body scan (Dx-WBS). However, this 4-7 day time frame for PTS lacks a solid basis and is essentially arbitrary. This is especially crucial as it has the potential to significantly impact patient management. Our primary goal in this study was to establish the optimal timing for both Dx-WBS and PTS in pediatric and young adult patients with DTC.

Methods: The DTC patients aged ≤21 years underwent serial whole-body scan (WBS) at 24 h, 48 h, and/or 72 h or more after the administration of diagnostic and therapeutic activities of I-131. The utility of Dx-WBS and PTS was assessed based on the identification of new lesions that could potentially influence the prescribed therapeutic activity of I-131. The optimal timing for acquiring Dx-WBS and PTS was determined based on when the first lesion appeared in the I-131 WBS.

Results: Ninety-five patients (27 males and 68 females) with an average age of 17.9 ± 3 years received a 74 MBq I-131 for Dx-WBS. Ten patients (10.5%) showed no uptake in Dx-WBS, thus, no I-131 therapy was given. The remaining 85 patients received a therapeutic activity of 1.11-5.55 GBq I-131 based on the extent of their disease. The serial Dx-WBS or PTS showed no additional lesions in patients with thyroid remnants. However, additional nodes were detected in 2/32 patients in the ≥48 h Dx-WBS, and 1/32 patients in the known nodal disease patients, which were not clinically relevant. Importantly, 72 h PTS picked up pulmonary metastases in 17.6% (3 out of 17) of patients, which were missed in serial Dx-WBS. However, >72 h PTS did not have additional value.

Conclusion: I-131 Dx-WBS is best to be performed at 48 h, and PTS at 72 h in pediatric and young adult patients with DTC.