Clin Nucl Med
· 2026 Jun · PMID 42275650
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18F-FDG PET scan performed on a 59-year-old man with progressive chorea, cognitive decline, peripheral neuropathy, and elevated creatine kinase revealed marked bilateral caudate and putamen hypometabolism. Huntington dis...18F-FDG PET scan performed on a 59-year-old man with progressive chorea, cognitive decline, peripheral neuropathy, and elevated creatine kinase revealed marked bilateral caudate and putamen hypometabolism. Huntington disease was suspected but HTT testing was negative. Whole-exome sequencing identified a hemizygous XK mutation (c.664C>T, p.(Arg222*)), confirming McLeod syndrome. This case highlights that bilateral striatal hypometabolism with peripheral involvement in addition to extrapyramidal symptoms should raise suspicion for McLeod syndrome.
Clin Nucl Med
· 2026 Jun · PMID 42257570
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Abdominal wall endometriosis is rare. Malignant transformation of abdominal wall endometriosis is extremely rare. We describe FDG PET/CT findings in a case of clear cell carcinoma arising from abdominal wall endometriosi...Abdominal wall endometriosis is rare. Malignant transformation of abdominal wall endometriosis is extremely rare. We describe FDG PET/CT findings in a case of clear cell carcinoma arising from abdominal wall endometriosis with multiple lymph node metastases. The primary tumor was located at the site of the prior cesarean section and showed intense FDG activity with a SUVmax of 26. The metastatic lymph nodes in the bilateral inguinal and pelvic regions showed variable FDG-activity. This case indicates that malignant transformation of abdominal wall endometriosis should be included in the differential diagnosis of FDG-avid lesions in the abdominal incisional site.
Clin Nucl Med
· 2026 Jun · PMID 42257568
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Paraneoplastic pemphigus is a rare and fatal autoimmune mucocutaneous blistering disease associated with underlying tumors. We describe FDG PET/CT findings in a case of paraneoplastic pemphigus associated with pelvic fol...Paraneoplastic pemphigus is a rare and fatal autoimmune mucocutaneous blistering disease associated with underlying tumors. We describe FDG PET/CT findings in a case of paraneoplastic pemphigus associated with pelvic follicular dendritic cell sarcoma transformed from Castleman disease. FDG PET/CT showed intense activity in the oral cavity, diffuse, heterogeneous activity in the skin, linear activity in the upper esophagus, focal activity in the anus, and heterogeneous activity in the pelvic tumor. This case indicates that paraneoplastic pemphigus should be considered as a differential diagnosis in patients with hypermetabolic mucocutaneous lesions.
Werner A, Drescher R, Freesmeyer M
… +2 more, Rohland O, Dondorf F
Clin Nucl Med
· 2026 Jun · PMID 42257567
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Accurate localization of biliary leaks with conventional imaging remains challenging. We report a critically ill patient with a suspected biliothoracic fistula following a perforated gastric ulcer repair. Dynamic hepatob...Accurate localization of biliary leaks with conventional imaging remains challenging. We report a critically ill patient with a suspected biliothoracic fistula following a perforated gastric ulcer repair. Dynamic hepatobiliary PET/CT using the tracer [68Ga]Ga-TEoS-DAZA enabled antegrade, high-temporal-resolution visualization of bile flow, directly demonstrating bile leakage into a drained abscess cavity with cranial extension into the thorax. Compared with scintigraphy and MRI, hepatobiliary PET offers superior dynamic tomographic imaging, robustness against motion artifacts, and precise leak localization, highlighting its potential value in complex biliary complications.
Güzel F, Nacir M, Çetin A
… +2 more, Alakuş MF, Kömek H
Clin Nucl Med
· 2026 Jun · PMID 42257566
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Incidental findings on 18F-FDG PET/CT may mimic pathologic processes, making recognition of imaging pitfalls essential. The eye-black sign, a rare finding characterized by bilateral symmetric FDG uptake in the lower eyel...Incidental findings on 18F-FDG PET/CT may mimic pathologic processes, making recognition of imaging pitfalls essential. The eye-black sign, a rare finding characterized by bilateral symmetric FDG uptake in the lower eyelids, has mainly been reported in patients receiving systemic oncologic therapy. We present a 53-year-old woman with endometrial adenocarcinoma treated surgically and with adjuvant vaginal brachytherapy, without systemic therapy. Follow-up PET/CT 18 months later showed bilateral lower eyelid uptake (SUVmax: 9.7) without recurrence. Biopsy revealed chronic inflammatory changes. This case demonstrates that the eye-black sign can occur without systemic therapy and should be recognized as a benign imaging pitfall.
Clin Nucl Med
· 2026 Jun · PMID 42257564
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Variations in hepatic vascular anatomy are commonly observed. There is limited evidence regarding Y-90 radioembolization (RE) via nonhepatic arterial feeders. In tumors with aberrant vascularization, RE is sometimes repl...Variations in hepatic vascular anatomy are commonly observed. There is limited evidence regarding Y-90 radioembolization (RE) via nonhepatic arterial feeders. In tumors with aberrant vascularization, RE is sometimes replaced by TACE or abandoned due to potential complications. Liver lesions may also receive blood supply from extrahepatic arteries depending on their location, and failure to recognize these vessels may result in suboptimal therapy. This case series shows that in selected patients, and with careful prevention of extrahepatic leakage, RE can be safely and effectively performed using aberrant feeders.
Clin Nucl Med
· 2026 Jun · PMID 42257561
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PET/CT with 18F-Piflufolastat (18F-DCFPyL, trade name Pylarify) is performed to identify areas of metastatic prostate cancer. However, activity is seen in many additional organs and benign conditions. This case illustrat...PET/CT with 18F-Piflufolastat (18F-DCFPyL, trade name Pylarify) is performed to identify areas of metastatic prostate cancer. However, activity is seen in many additional organs and benign conditions. This case illustrates PSMA activity associated with lipomatous hypertrophy of the interatrial septum (LHIS), a benign, usually incidental and asymptomatic lesion with well-known uptake on FDG PET/CT. This is a potential pitfall in the interpretation of PSMA PET/CT, which should not be confused with a malignant cardiac mass. Awareness of this source of activity avoids unnecessary intervention or additional imaging.
Sharma A, Thakur P, Kumar V
… +2 more, Singh H, Gupta M
Clin Nucl Med
· 2026 Jun · PMID 42257558
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A 71-year-old man presented with weight loss and abdominal bloating for 3 months. He was a known case of clear cell renal cell carcinoma (ccRCC) in remission. Investigations discovered an enhancing lesion in the pancreat...A 71-year-old man presented with weight loss and abdominal bloating for 3 months. He was a known case of clear cell renal cell carcinoma (ccRCC) in remission. Investigations discovered an enhancing lesion in the pancreatic head and neck region, which on 68Ga-DOTATATE PET imaging showed intense tracer-avidity along with tracer-avid lung nodules and a muscular soft tissue lesion mimicking a metastatic pancreatic neuroendocrine tumor. However, the histopathology of the pancreatic mass revealed metastatic ccRCC. This case highlights that RCC can cause extremely late recurrences and rarely mimics neuroendocrine tumors (NETs) due to SSTR expression.
Clin Nucl Med
· 2026 Jun · PMID 42257555
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Chordoma is a rare malignant bone tumor derived from notochordal remnants, typically occurring in the axial skeleton. Herein, we report a case of an 81-year-old woman with a cervical chordoma involving the C1-C5 vertebra...Chordoma is a rare malignant bone tumor derived from notochordal remnants, typically occurring in the axial skeleton. Herein, we report a case of an 81-year-old woman with a cervical chordoma involving the C1-C5 vertebrae. The lesion demonstrated intense 18F-FDG uptake but minimal 68Ga-DOTA-FAPI-04 accumulation. This discordant imaging pattern highlights that while FAPI-targeted PET/CT is a promising pan-cancer imaging modality, its uptake in chordoma may be heterogeneous, potentially influenced by the tumor microenvironment or specific histologic subtypes.
Gregersen T, Rose HK, Bærentzen S
… +2 more, Baad-Hansen T, Vendelbo MH
Clin Nucl Med
· 2026 Jun · PMID 42257554
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A patient with alveolar soft part sarcoma (ASPS) underwent FDG-PET/CT followed by a DOTATOC PET due to a suspicion of a pancreatic neuroendocrine tumor. DOTATOC PET showed no uptake in the pancreatic lesion but revealed...A patient with alveolar soft part sarcoma (ASPS) underwent FDG-PET/CT followed by a DOTATOC PET due to a suspicion of a pancreatic neuroendocrine tumor. DOTATOC PET showed no uptake in the pancreatic lesion but revealed high uptake in the primary ASPS in scapula and previously unrecognized metastases in the breast and skull, indicating high somatostatin receptor (SSTR) expression. To our knowledge, this is the first report of DOTATOC uptake in ASPS, which raises the prospect of SSTR-targeted treatment with 177Lu-DOTATATE.
Xu T, Cheng K, Wang P
… +4 more, Zhang X, Zhang C, Wang W, Chen Y
Clin Nucl Med
· 2026 Jun · PMID 42257553
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PURPOSE: To evaluate the long-term efficacy, safety, and survival outcomes of at least 4 treatment cycles of 177Lu-DOTA-IBA therapy in patients with bone metastases. PATIENTS AND METHODS: This single-center retrospective...PURPOSE: To evaluate the long-term efficacy, safety, and survival outcomes of at least 4 treatment cycles of 177Lu-DOTA-IBA therapy in patients with bone metastases. PATIENTS AND METHODS: This single-center retrospective cohort study enrolled patients with bone metastases who initiated therapy between November 2021 and May 2024 and completed ≥4 cycles of 177Lu-DOTA-IBA. The primary endpoints were symptom improvement [Numerical Rating Scale (NRS) and Karnofsky Performance Status (KPS)], safety (Common Terminology Criteria for Adverse Events v5.0), and overall survival. Longitudinal efficacy changes were analyzed using linear mixed-effects models. RESULTS: Fifty-six patients were included: 31 completed 4-5 cycles and 25 completed 6-10 cycles. Pharmacokinetic analysis (n=20) demonstrated a longer effective half-life in lesions than in the whole body, with progressively increasing target-to-nontarget uptake ratios over time. Treatment-related myelosuppression of any grade occurred in 8 patients (14.3%), renal toxicity in 4 (7.1%), and grade 3 thrombocytopenia in 1 (1.8%); no other grade 3-4 adverse events were observed. Increasing treatment cycles were not associated with increased hematological or renal toxicity. The best overall pain response rate (NRS reduction ≥50%) was 88.5%, and KPS improvement was observed in 79.6% of patients. Longitudinal analysis demonstrated cumulative therapeutic benefit, with continuous NRS reduction and KPS improvement across cycles. Disease progression during treatment independently predicted shorter survival. CONCLUSIONS: For patients with bone metastases who can tolerate multicycle therapy, long-term 177Lu-DOTA-IBA treatment yields cumulative symptom improvement with no significant increase in cumulative toxicity risk, supporting its use as a long-term therapeutic strategy.
Göller S, Kaufmann J, Spektor AM
… +2 more, Stockinger M, Röhrich M
Clin Nucl Med
· 2026 May · PMID 42257455
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Unlike FDG, FAPI tracers target fibroblast activation protein inhibitor (FAPI), highly expressed in the tumor microenvironment. This allows better differentiation between viable tumor and post-therapeutic changes, that i...Unlike FDG, FAPI tracers target fibroblast activation protein inhibitor (FAPI), highly expressed in the tumor microenvironment. This allows better differentiation between viable tumor and post-therapeutic changes, that is, fibrosis or inflammation. Here, a 39-year-old man with a malignant peripheral nerve sheath tumor (MPNST) of the thoracic wall underwent surgery and adjuvant radiotherapy. FAPI-PET/CT 3 months after treatment showed paravertebral and diffuse pleural uptake. Biopsy verified tumor recurrence and pleural sarcomatosis. Among others, a FAPI-radioligand-therapy was initiated. This case demonstrates the efficacy of FAPI imaging in the staging and potential treatment of MPNST and pleural sarcomatosis.
Dubois J, Delcroix O, Gallego C
… +2 more, Abgral R, Dzuko Kamga J
Clin Nucl Med
· 2026 May · PMID 42257453
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Antisynthetase syndrome (ASyS) is a rare idiopathic inflammatory myopathy with systemic manifestations, defined by the presence of anti-tRNA synthetase antibodies. Interstitial lung disease, particularly pulmonary fibros...Antisynthetase syndrome (ASyS) is a rare idiopathic inflammatory myopathy with systemic manifestations, defined by the presence of anti-tRNA synthetase antibodies. Interstitial lung disease, particularly pulmonary fibrosis, is associated with a poorer prognosis. Here, we report a case of anti-Jo-1 positive antisynthetase syndrome assessed by 18F-FDG PET/CT, demonstrating muscular, articular, cutaneous, and pulmonary involvement, with a favorable outcome and complete resolution of abnormalities at 4-year follow-up, without evidence of associated malignancy. This case highlights the potential value of 18F-FDG PET/CT in the initial assessment and treatment monitoring of ASyS, offering a comprehensive approach to exclude underlying neoplastic disease and assess therapeutic response.
Clin Nucl Med
· 2026 May · PMID 42257452
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A 65-year-old woman with treated small cell lung cancer presenting with recurrent stroke-like symptoms and seizures underwent FDG PET/CT and MRI. Brain MRI revealed diffusion restriction. Subsequent 18F-FDG PET/CT demons...A 65-year-old woman with treated small cell lung cancer presenting with recurrent stroke-like symptoms and seizures underwent FDG PET/CT and MRI. Brain MRI revealed diffusion restriction. Subsequent 18F-FDG PET/CT demonstrated an unusual metabolic signature: intense left frontoparietal cortical uptake ("cortex on fire") with discordant ipsilateral thalamic and contralateral cerebellar decreased uptake ("ice in thalamus and cerebellum"). We term this pattern triaxial metabolic diaschisis (TMDS), representing discordant diaschisis, distinct from concordant hypometabolism of ischemic stroke or hypermetabolic cortical and subcortical propagation typical of ictal seizures. The pattern suggests left frontal uptake is not secondary to neuronal activity.
Clin Nucl Med
· 2026 May · PMID 42257449
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Fibrous dysplasia (FD) may demonstrate increased 68Ga-PSMA uptake and mimic skeletal metastases in prostate cancer. We present a 63-year-old man with newly diagnosed prostate cancer who underwent 68Ga-PSMA PET/CT for sta...Fibrous dysplasia (FD) may demonstrate increased 68Ga-PSMA uptake and mimic skeletal metastases in prostate cancer. We present a 63-year-old man with newly diagnosed prostate cancer who underwent 68Ga-PSMA PET/CT for staging. Imaging revealed widespread skeletal uptake involving multiple regions, raising suspicion for diffuse metastatic disease. Bone scintigraphy demonstrated a superscan pattern. However, CT showed characteristic benign features, including ground-glass appearance, bone expansion, and preserved cortical integrity. Histopathologic examination confirmed fibrous dysplasia. This case highlights a potential diagnostic pitfall of 68Ga-PSMA PET/CT and emphasizes the importance of correlating metabolic findings with CT morphology to avoid misinterpretation and overstaging.
Hoberück S, Banek S, Krönke T
… +6 more, Pretze M, Brandt F, Kopka K, Trommer J, Thomas C, Bundschuh RA
Clin Nucl Med
· 2026 May · PMID 42257446
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A 64-year-old man with metachronous metastatic urothelial carcinoma originating from the right renal pelvis underwent nectin-4-targeted [68Ga]Ga-NECT-224 PET/CT prior to initiation of nectin-4-targeted antibody-drug conj...A 64-year-old man with metachronous metastatic urothelial carcinoma originating from the right renal pelvis underwent nectin-4-targeted [68Ga]Ga-NECT-224 PET/CT prior to initiation of nectin-4-targeted antibody-drug conjugate (ADC) therapy with enfortumab-vedotin (PADCEV), in combination with pembrolizumab. A CT follow-up after 3 months of ADC therapy showed a progressive adrenal metastasis. Subsequent [68Ga]Ga-NECT-224 PET/CT restaging revealed multiple new lesions with intense nectin-4 expression. This case illustrates the potential of [68Ga]Ga-NECT-224 PET/CT to visualize heterogeneous nectin-4 expression, its potential in therapy guidance, and highlights the need for theranostic strategies in patients retaining target expression despite cytotoxic therapy resistance.
Clin Nucl Med
· 2026 May · PMID 42257445
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Inflammation-associated coronary artery disease (I-CAD) is a recognized yet underdiagnosed cause of refractory in-stent restenosis. Conventional imaging modalities often lack sensitivity for detecting focal inflammatory...Inflammation-associated coronary artery disease (I-CAD) is a recognized yet underdiagnosed cause of refractory in-stent restenosis. Conventional imaging modalities often lack sensitivity for detecting focal inflammatory activity. A 74-year-old woman with recurrent ISR was admitted to our institution. Dual-tracer ¹⁸F-FAPI and ¹⁸F-FDG PET/CT revealed locally increased radiotracer uptake within the left anterior descending artery (LAD) stent segment, with more intense uptake on 18F-FAPI than on 18F-FDG. We present the dual-tracer PET/CT findings in this patient with recurrent in-stent restenosis, suggesting active peri-stent fibroblast-related remodeling and an inflammation-associated mechanism. The patient was subsequently managed with anti-inflammatory therapy rather than repeated revascularization.
Clin Nucl Med
· 2026 May · PMID 42257441
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A 65-year-old woman underwent 18F-CXCR4 PET/CT for evaluation of a left adrenal lesion, which demonstrated marked radiotracer uptake, suggestive of an aldosterone-producing adenoma. Incidentally, intense focal uptake was...A 65-year-old woman underwent 18F-CXCR4 PET/CT for evaluation of a left adrenal lesion, which demonstrated marked radiotracer uptake, suggestive of an aldosterone-producing adenoma. Incidentally, intense focal uptake was observed in the anterior segment of the right upper lobe on PET imaging; however, no corresponding abnormality was identified on co-registered CT. This finding represents a pulmonary hot-clot artifact, a phenomenon previously documented with other radiotracers, including 18F-FDG, 99mTc-MDP, 99mTc-MIBI, 68Ga-DOTANOC, 68Ga-PSMA, and 177Lu-DOTATATE.