Clin Nucl Med
· 2026 May · PMID 42257432
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A 63-year-old woman presented with progressive facial edema. 18F-FDG PET/CT showed a large soft tissue mass with heterogeneous hypermetabolism in the right atrium and superior vena cava, without distant metastases. The p...A 63-year-old woman presented with progressive facial edema. 18F-FDG PET/CT showed a large soft tissue mass with heterogeneous hypermetabolism in the right atrium and superior vena cava, without distant metastases. The patient underwent surgical resection, and postoperative pathology confirmed a primary type B1 thymoma originating from the right atrium. To our knowledge, this case report details the 18F-FDG PET/CT imaging features of primary intracardiac thymoma, which has rarely been described in the literature. It demonstrates the unique advantages of PET/CT in evaluating tumor malignant phenotype and systemic staging, and enriches the differential diagnosis spectrum of intracardiac hypermetabolic lesions.
Molecular theranostics has revolutionized the field of personalized medicine, specifically augmenting "precision oncology" and is now integral in the management of malignancies like differentiated thyroid carcinoma, neur...Molecular theranostics has revolutionized the field of personalized medicine, specifically augmenting "precision oncology" and is now integral in the management of malignancies like differentiated thyroid carcinoma, neuroendocrine tumors, and metastatic carcinoma prostate. The potential of theranostics is huge with possible applications in a variety of tumors, including at their early stages. This article will focus on the advancements in nuclear theranostics-highlighting the expanded indications of already established radionuclide therapies like peptide receptor radionuclide therapy (PRRT), prostate specific membrane antigen radioligand therapy (PRLT), and meta-iodobenzylguanidine therapy (MIBG therapy); and also on novel radiolabeled theranostic agents targeting fibroblast activated protein (FAPI-based radiopharmaceuticals), chemokine receptor targeting agents (pentixfor/pentixather), integrins, cholecystokinin receptors and their potential applications.
A 23-year-old man undergoing systemic therapy for diffuse large B-cell lymphoma presented for a routine interim 18F-FDG PET/CT. PET/CT demonstrated a fully erect penis without internal FDG uptake. The patient was subsequ...A 23-year-old man undergoing systemic therapy for diffuse large B-cell lymphoma presented for a routine interim 18F-FDG PET/CT. PET/CT demonstrated a fully erect penis without internal FDG uptake. The patient was subsequently evaluated at the emergency department for persistent, painful erection. After successful surgical management for ischemic priapism, follow-up 18F-FDG PET/CT showed a non-erect penis with physiological uptake. An erect, internally photopenic penis is a potentially acute finding on 18F-FDG PET that may represent ischemic priapism.
We present a 63-year-old man with a history of prostate adenocarcinoma (mCRPC), widespread skeletal and multiple lymph node metastases, who was referred for 177Lu-PSMA therapy. In second course of therapy, posttreatment...We present a 63-year-old man with a history of prostate adenocarcinoma (mCRPC), widespread skeletal and multiple lymph node metastases, who was referred for 177Lu-PSMA therapy. In second course of therapy, posttreatment scan showed multiple foci of increased activity throughout the liver, compatible with diffuse hepatic metastases, which were not seen in the diagnostic and the first posttreatment scans and SPECT/CT images. This unexpected finding turned the case into a clinical dilemma, leaving the medical team uncertain about how best to proceed to ensure the most appropriate care. Eventually, a liver FNA confirmed the presence of metastatic prostatic adenocarcinoma.
A 79-year-old woman with suspected choroidal lesion underwent 18F-FDG PET/CT, which revealed a non-FDG-avid right thyroid lobe incidentaloma (4.8 cm in largest dimension) that was cold on 99mTc-thyroid scan, showed inten...A 79-year-old woman with suspected choroidal lesion underwent 18F-FDG PET/CT, which revealed a non-FDG-avid right thyroid lobe incidentaloma (4.8 cm in largest dimension) that was cold on 99mTc-thyroid scan, showed intense SSTR expression on 68Ga-DOTATATE PET/CT, and MIBG avidity on 131I-MIBG scan, thereby proving it to be of neural crest origin. Fine needle aspiration biopsy (FNAB) with immunohistochemistry was positive for GATA3 and synaptophysin and negative for CK7, PAX8, TTF1, and calcitonin, establishing the diagnosis of thyroid paraganglioma. Even though rare, the diagnosis of paraganglioma should be considered in SSTR and MIBG-avid thyroid nodules, as seen in this case.
A 52-year-old man with multiple scalp nodules for more than 30 years and a right occipital mass that had been progressively enlarging for the past 2 years and rupturing and draining for more than 6 months was pathologica...A 52-year-old man with multiple scalp nodules for more than 30 years and a right occipital mass that had been progressively enlarging for the past 2 years and rupturing and draining for more than 6 months was pathologically confirmed to be secondary malignant proliferating trichilemmal cyst (MPTC). 18F-FDG PET/CT showed active glucose metabolism in the scalp lesion and similar hypermetabolism in the dorsal and right iliac spine skin nodules. This case demonstrates the significant advantages of 18F-FDG PET/CT whole-body imaging in evaluating malignant proliferating trichilemmal cyst, a rare disease.
Yamane T, Iimori H, Akamatsu G
… +9 more, Ikari Y, Hoda Y, Shimizu K, Matsumoto K, Senda M, Werner RA, Nose N, Chen X, Higuchi T
Clin Nucl Med
· 2026 Jul · PMID 42247617
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BACKGROUND: Current norepinephrine transporter (NET) tracers used for cardiac sympathetic imaging and oncology are limited by radiosynthesis complexity, suboptimal image quality, or operational constraints. [18F]fluproxa...BACKGROUND: Current norepinephrine transporter (NET) tracers used for cardiac sympathetic imaging and oncology are limited by radiosynthesis complexity, suboptimal image quality, or operational constraints. [18F]fluproxadine (formerly [18F]AF78) was developed to address these limitations by providing high NET affinity, favorable biodistribution, and an operationally straightforward radiosynthesis. We therefore conducted the first-in-human evaluation of this new class of [18F] labeled NET PET tracer to assess its safety, biodistribution, radiation dosimetry, and imaging characteristics. PATIENTS AND METHODS: In a prospective study, 4 healthy adult volunteers received [18F]fluproxadine (101.8-204.0 MBq). Dynamic whole-body PET/CT acquisitions were obtained 10 times from 1 to 232 minutes postinjection, and vital signs, laboratory tests, and adverse events were monitored. Time-activity curves were generated for major organs, including myocardium from the whole-body scans, and organ-absorbed doses and effective dose were estimated using OLINDA/EXM v2.0 from time-integrated activities. Myocardial uptake and target-to-background behavior were assessed using semiquantitative methods. Radiosynthesis performance and key operational steps were documented to assess practical scalability. RESULTS: Radiosynthesis of [18F]fluproxadine was operationally straightforward with encouraging yields and fewer specialized steps than some legacy tracers. Imaging was completed without serious adverse events. Biodistribution showed predominant renal clearance; biliary excretion was not observed within the imaging window. Highest organ doses were to the urinary bladder wall and kidneys, with additional uptake in liver, thyroid, salivary glands, and myocardium. The effective dose was 21.6±1.5 µSv/MBq. Myocardial uptake was clearly visualized on whole-body images with favorable target-to-background characteristics at delayed time points, consistent with NET biology and supporting practical cardiac imaging windows. CONCLUSIONS: [18F]fluproxadine demonstrated clear myocardial uptake, acceptable radiation dosimetry comparable to typical 18F PET agents, and an early safety profile without serious adverse events.
Elahifard H, Samadi MH, Saberifar M
… +2 more, Makhdoumi Y, Aghaee A
Clin Nucl Med
· 2026 May · PMID 42149939
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A 47-year-old man with advanced laryngeal squamous cell carcinoma had received chemotherapy but subsequently developed widespread skeletal metastases identified on bone scintigraphy. He underwent 99mTc-FAPI-46 SPECT/CT,...A 47-year-old man with advanced laryngeal squamous cell carcinoma had received chemotherapy but subsequently developed widespread skeletal metastases identified on bone scintigraphy. He underwent 99mTc-FAPI-46 SPECT/CT, which demonstrated FAPI uptake in primary laryngeal tumor, cervical soft tissue involvement, and extensive skeletal metastases, accurately reflecting the overall disease burden. Due to disease progression despite chemotherapy and for palliative management of bone pain, he was enrolled in a clinical trial and received 177Lu-FAPI-2286 radioligand therapy. Post-treatment imaging confirmed tracer accumulation in all known disease sites, highlighting the clinical utility of FAPI-based imaging and its theranostic potential in advanced laryngeal carcinoma.
Clin Nucl Med
· 2026 May · PMID 42149926
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A 27-year-old woman with ovarian immature teratoma underwent 18F-FDG PET/CT for preoperative staging, which revealed intense FDG uptake in 2 distinct pelvic structures, mimicking primary endometrial cancer or metastasis....A 27-year-old woman with ovarian immature teratoma underwent 18F-FDG PET/CT for preoperative staging, which revealed intense FDG uptake in 2 distinct pelvic structures, mimicking primary endometrial cancer or metastasis. Although MRI showed no anatomic lesions in either uterus, it confirmed uterine didelphys-a rare Müllerian duct anomaly. This case illustrates that physiological menstrual uptake within a duplicated uterus can simulate malignancy. Clinicians must recognize such anatomic variants to avoid diagnostic pitfalls and accurately stage pelvic malignancies on PET/CT.
Clin Nucl Med
· 2026 May · PMID 42149922
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A 60-year-old woman with cervical squamous cell carcinoma received 18F-FDG PET/CT for tumor surveillance because of increased serum CA-125. PET/CT images showed multiple left pleural foci and nodular thickening of the pl...A 60-year-old woman with cervical squamous cell carcinoma received 18F-FDG PET/CT for tumor surveillance because of increased serum CA-125. PET/CT images showed multiple left pleural foci and nodular thickening of the pleura at the corresponding sites. Then, the pathology after CT-guided biopsy confirmed that the pleural foci were metastases from the cervical carcinoma.
Al Riyami K, Jain A, Al Busaidi A
… +2 more, Ismaila A, Usmani S
Clin Nucl Med
· 2026 May · PMID 42149908
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68Ga-FAPI PET/CT has demonstrated higher sensitivity than 18F-FDG PET/CT in breast cancer, particularly in invasive lobular carcinoma. However, its role in treatment response assessment remains limited. We report a case...68Ga-FAPI PET/CT has demonstrated higher sensitivity than 18F-FDG PET/CT in breast cancer, particularly in invasive lobular carcinoma. However, its role in treatment response assessment remains limited. We report a case of recurrent metastatic pleomorphic lobular breast cancer in which baseline 68Ga-FAPI PET/CT revealed extensive regional and distant disease underestimated by 18F-FDG PET/CT. Serial follow-up FAPI PET/CT after initiation of olaparib demonstrated marked response with near complete resolution of disease, highlighting the potential utility of FAPI PET/CT for response assessment in lobular breast cancer.
Clin Nucl Med
· 2026 May · PMID 42149894
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Acrometastasis is an uncommon presentation of lung cancer with poor prognosis. We describe bone scintigraphy and FDG PET/CT findings in a case of pulmonary nuclear protein in testis (NUT) carcinoma with only initial pres...Acrometastasis is an uncommon presentation of lung cancer with poor prognosis. We describe bone scintigraphy and FDG PET/CT findings in a case of pulmonary nuclear protein in testis (NUT) carcinoma with only initial presentation of bony metastasis to the distal phalanx of the right little finger after traumatic injury. FDG PET/CT showed intense activity of the primary lung tumor with multiple FDG-avid lymph node, adrenal, bone, and cartilage metastases including unusual and unexpected metastases at the finger, mandibular condyle, and thyroid cartilage. Bone scintigraphy significantly underestimated the extent of osseous involvement because the osseous metastases appeared as non-osteoblastic lesions.
Miralai A, Ghaedian T, Sadra H
… +2 more, Yazdani B, Firuzyar T
Clin Nucl Med
· 2026 May · PMID 42149626
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This case is a 54-year-old woman with systemic lupus erythematosus (SLE) and distal esophageal squamous cell carcinoma (SCC) who showed inconsistent uptake patterns on 18F-FDG and 68Ga-FAPI PET/CT. 18F-FDG PET/CT reveale...This case is a 54-year-old woman with systemic lupus erythematosus (SLE) and distal esophageal squamous cell carcinoma (SCC) who showed inconsistent uptake patterns on 18F-FDG and 68Ga-FAPI PET/CT. 18F-FDG PET/CT revealed diffuse uptake in the enlarged axillary lymph nodes as well as mild increased uptake in the bilateral inguinal and cervical, and mediastinal uptake, beyond the uptake in the esophageal tumor (SUVmax 19.85). A week later, FAPI PET/CT showed negligible uptake in the axillary nodes but strong uptake in the main tumor. These lymph nodes' histopathology showed reactive hyperplasia. This pattern of 18F-FDG PET/CT has been previously described in a few cases of SLE patients mimicking lymphoma; however, this case also underscores the potential high specificity of FAPI in distinguishing inflammatory from metastatic lymph node disease.
Clin Nucl Med
· 2026 May · PMID 42149625
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A 67-year-old woman with coexisting papillary thyroid carcinoma (PTC) and anaplastic thyroid carcinoma (ATC) harbored an ALK rearrangement on FISH. Despite surgery and 2 courses of 131I treatments, 18F-FDG PET/CT showed...A 67-year-old woman with coexisting papillary thyroid carcinoma (PTC) and anaplastic thyroid carcinoma (ATC) harbored an ALK rearrangement on FISH. Despite surgery and 2 courses of 131I treatments, 18F-FDG PET/CT showed an intensely avid right lower-neck mass extending into the superior mediastinum. The patient was considered radioiodine-refractory (RAIR) and started ensartinib (225 mg once daily). CT at 3 months showed marked regression, with sustained disease control at 12 months. This case illustrates an objective imaging response to ALK-directed therapy in RAIR thyroid carcinoma.
Usmani S, Elshafie O, Jain A
… +4 more, Al Rawahi A, Bou Khalil A, Farah M, Bichuriya S
Clin Nucl Med
· 2026 May · PMID 42149622
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Carney triad is a rare syndrome characterized by the synchronous or metachronous occurrence of gastric gastrointestinal stromal tumors (GISTs), pulmonary chondromas, and extra-adrenal paragangliomas. We report a case of...Carney triad is a rare syndrome characterized by the synchronous or metachronous occurrence of gastric gastrointestinal stromal tumors (GISTs), pulmonary chondromas, and extra-adrenal paragangliomas. We report a case of a 40-year-old woman with a suspected Carney triad who underwent 68Ga-DOTATOC PET/CT for comprehensive disease characterization. Imaging revealed multiple well-circumscribed pulmonary masses with chondroid matrix calcifications and minimal tracer uptake, consistent with pulmonary chondromas. An intensely DOTATOC-avid nodular soft-tissue lesion was identified between the left atrium and the superior vena cava, and in the left para-aortic region, suspicious for paraganglioma. Multiple intensely 68Ga-DOTATOC-avid exophytic gastric wall masses were noted, compatible with gastric GISTs. A mild to moderate tracer-avid left adrenal lesion was subsequently characterized as an adrenal adenoma on MRI. This case highlights the pivotal role of somatostatin receptor PET/CT in the evaluation of multisystem tumors suggestive of Carney triad.
Saber Tanha A, Aryana K, Zahed Anaraki S
… +3 more, Askari E, Elahifard H, Raeisi N
Clin Nucl Med
· 2026 May · PMID 42149621
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We report a 58-year-old woman with recurrent mucoepidermoid carcinoma (MEC) of the right parotid gland who developed progressive, refractory bone pain following surgery and adjuvant radiotherapy. A 99mTc-MDP bone scintig...We report a 58-year-old woman with recurrent mucoepidermoid carcinoma (MEC) of the right parotid gland who developed progressive, refractory bone pain following surgery and adjuvant radiotherapy. A 99mTc-MDP bone scintigraphy demonstrated limited skeletal metastases, and palliative radiotherapy failed to alleviate symptoms. Amid worsening and more widespread bone pain accompanied by cough and hemoptysis, a 99mTc-FAPI-46 scintigraphy revealed multiple skeletal metastases, pulmonary involvement and metastatic lymph nodes, showing a markedly greater disease burden. This case highlights the potential added value of FAP-targeted imaging in detecting metastatic disease extent in MEC and suggests that 99mTc-FAPI-46 may provide comprehensive information beyond conventional imaging, particularly in patients with discordant symptoms and imaging findings.
Clin Nucl Med
· 2026 May · PMID 42149612
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A 48-year-old woman with a history of colon cancer presented with abdominal pain and elevated tumor markers. She underwent 68Ga-FAPI and 18F-FDG PET/MR examinations. FAPI imaging revealed focal uptake in both adnexal reg...A 48-year-old woman with a history of colon cancer presented with abdominal pain and elevated tumor markers. She underwent 68Ga-FAPI and 18F-FDG PET/MR examinations. FAPI imaging revealed focal uptake in both adnexal regions, while no abnormal FDG metabolism was observed. Combined with a known history of uterine malformation, this uptake was confirmed to be physiological FAPI avidity in the benign myometrium of a bicornuate uterus, rather than ovarian metastasis. This case highlights the value of FDG-PET in ruling out malignancy and the importance of multi-tracer imaging in differential diagnosis.
Clin Nucl Med
· 2026 May · PMID 42149608
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A 56-year-old man presented with hyperglycemia and weight loss. Imaging revealed a pancreatic head mass with features suggestive of primary pancreatic carcinoma. 18F-FDG PET/CT confirmed a hypermetabolic lesion without e...A 56-year-old man presented with hyperglycemia and weight loss. Imaging revealed a pancreatic head mass with features suggestive of primary pancreatic carcinoma. 18F-FDG PET/CT confirmed a hypermetabolic lesion without evidence of distant metastasis. Following the Whipple procedure, histopathology and immunohistochemistry (CD34+, Vimentin+), together with a history of resected ankle sarcoma, established the diagnosis of a solitary pancreatic metastasis from dermatofibrosarcoma protuberans (DFSP). This case highlights the diagnostic difficulty posed by solitary pancreatic metastases, which can closely mimic primary pancreatic cancer. A comprehensive approach integrating clinical history, tumor markers, and multimodality imaging is essential for accurate differentiation.
Clin Nucl Med
· 2026 May · PMID 42149606
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A 10-year-old boy was enrolled in our clinical trial. He underwent 18F-MFBG PET/CT imaging for the differential diagnosis of a right adrenal lesion, which revealed moderate 18F-MFBG uptake in the lesion with a central ph...A 10-year-old boy was enrolled in our clinical trial. He underwent 18F-MFBG PET/CT imaging for the differential diagnosis of a right adrenal lesion, which revealed moderate 18F-MFBG uptake in the lesion with a central photopenic defect. Concurrently, focal increased 18F-MFBG uptake was observed in the lower pole of the right kidney. Retrospective review of prior abdominal contrast-enhanced CT demonstrated imaging features consistent with renal infarction. Surgical pathology confirmed a right adrenal pheochromocytoma. This case illustrates that focal renal 18F-MFBG uptake may arise secondary to renal infarction, which should be considered in the differential diagnosis of atypical 18F-MFBG accumulation.