PURPOSE: This exploratory study investigated alterations in cerebral metabolism and metabolic connectivity using 18F-fluorodeoxyglucose positron emission tomography (F-18 FDG-PET) in patients with multiple myeloma with n...PURPOSE: This exploratory study investigated alterations in cerebral metabolism and metabolic connectivity using 18F-fluorodeoxyglucose positron emission tomography (F-18 FDG-PET) in patients with multiple myeloma with neurotoxicity after B-cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T-cell therapy. PATIENTS AND METHODS: The retrospective study included 20 BCMA CAR T-cell therapy recipients who underwent brain F-18 FDG-PET imaging (15 with baseline PET scans). Brain metabolism was quantified using standardized uptake value ratios (SUVRs), with the cerebellum as the reference region. Metabolic connectivity was assessed using correlation matrices and network topology metrics. Metabolic patterns were age-adjusted and compared between patients with and without neurotoxicity. RESULTS: Neurotoxicity occurred in 7 patients. SUVR analysis involving those with neurotoxicity demonstrated significantly reduced post-treatment FDG uptake in the left precentral gyrus and striatum. Greater declines were observed in FDG uptake within the left inferior occipital cortex and striatum in patients with neurotoxicity than in those without. Metabolic connectivity analysis identified 508 significantly altered regional pairs, primarily with reduced frontotemporal correlations. Hub node analysis demonstrated a redistribution of network centrality from higher-order cortical regions to temporal and occipital areas, with reduced centrality in the insular and limbic regions among patients with neurotoxicity. CONCLUSIONS: Patients with neurotoxicity after BCMA CAR T-cell therapy demonstrated distinct metabolic-level and network-level differences on F-18 FDG-PET, highlighting the potential of brain PET imaging to elucidate the underlying mechanisms and warranting further investigation in larger cohorts.
A 59-year-old woman with a history of recurrent pheochromocytoma underwent 18F-FDG and 18F-octreotide PET/CT to evaluate metastatic disease following progression on targeted therapy. FDG PET/CT showed intense uptake in a...A 59-year-old woman with a history of recurrent pheochromocytoma underwent 18F-FDG and 18F-octreotide PET/CT to evaluate metastatic disease following progression on targeted therapy. FDG PET/CT showed intense uptake in a mass in the right adrenal bed, bones, lung nodules, and lymph nodes. Octreotide PET/CT confirmed concordant high uptake in the corresponding lesions. Germline testing revealed a VHL p.Asp126Asn mutation. This "dual-tracer" strategy provided complementary information on glucose metabolism and somatostatin receptor expression, facilitating prognostic stratification and therapeutic decision-making in VHL-mutated pheochromocytoma.
A 24-year-old woman was referred for chronic right foot pain, with suspicion of stress fracture. 99mTc-HDP bone scintigraphy using new 3D-ring CZT system (StarGuide) was performed. Bloodpool and late-phase SPECT/CT demon...A 24-year-old woman was referred for chronic right foot pain, with suspicion of stress fracture. 99mTc-HDP bone scintigraphy using new 3D-ring CZT system (StarGuide) was performed. Bloodpool and late-phase SPECT/CT demonstrated intense increased uptake in the right second metatarsal head, while the CT part of SPECT/CT showed subchondral sclerosis, suggestive of Freiberg disease, which was confirmed by MRI. Our case highlights the importance of including Freiberg disease in the differential diagnosis of uptake in the metatarsal head, especially in its early stages. The CT part of SPECT/CT and/or MRI may be needed to distinguish Freiberg disease from a stress fracture, as both have different therapeutic approaches.
Here, we present a precision oncologic approach for localized prostate cancer (PCa) in a 66-year-old man. Overcoming the limitations of conventional MRI in delineating tumor extent and multifocality, preoperative 68Ga-PS...Here, we present a precision oncologic approach for localized prostate cancer (PCa) in a 66-year-old man. Overcoming the limitations of conventional MRI in delineating tumor extent and multifocality, preoperative 68Ga-PSMA PET/MRI precisely defined the index lesion and excluded metastases. This diagnostic workflow was directly translated into therapy through PET/MRI-US fusion-guided irreversible electroporation (IRE). The procedure targeted the tumor accurately while sparing surrounding functional anatomy. Significant PSA and phi decline post-IRE confirmed therapeutic efficacy. This case demonstrates that integrating molecularly targeted diagnostics with advanced image-guided focal therapy enables maximal precision in oncologic control.
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive malignancy characterized by skin involvement and frequent systemic dissemination. We report a case of a 32-year-old man with multiple violaceous...Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive malignancy characterized by skin involvement and frequent systemic dissemination. We report a case of a 32-year-old man with multiple violaceous cutaneous nodules who underwent F-18 FDG PET/CT for staging. PET/CT demonstrated extensive metabolic activity in cutaneous sites and revealed previously unsuspected inguinal and cervical lymph-node involvement. Histopathology confirmed BPDCN. This case highlights the crucial role of FDG PET/CT in detecting subclinical nodal disease, delineating total disease burden, and improving staging accuracy in BPDCN, thereby supporting its value in guiding management and future response assessment.
A 62-year-old man with an 18-month history of nephrotic syndrome secondary to focal segmental glomerulosclerosis presented with bilateral perirenal masses. Contrast-enhanced CT scan revealed the large perirenal lesions e...A 62-year-old man with an 18-month history of nephrotic syndrome secondary to focal segmental glomerulosclerosis presented with bilateral perirenal masses. Contrast-enhanced CT scan revealed the large perirenal lesions encasing both kidneys and extending into the renal sinuses, with mild progressive enhancement and no cortical invasion. PET/CT showed a mild to moderate 18F-FDG avidity. Core needle biopsy of the lesion confirmed the diagnosis of perinephric myxoid pseudotumor of fat.
A 4-year-old girl presented with persistent fever and an abdominal mass detected on ultrasound. 18F-FDG PET/CT revealed peripheral hypermetabolism with central photopenia in the abdominal lesion, diffuse hepatic 18F-FDG...A 4-year-old girl presented with persistent fever and an abdominal mass detected on ultrasound. 18F-FDG PET/CT revealed peripheral hypermetabolism with central photopenia in the abdominal lesion, diffuse hepatic 18F-FDG uptake, and hepatomegaly, consistent with a hepatic superscan. Biopsy confirmed neuroblastoma metastases to the liver and bone marrow (stage IV). Postchemotherapy 123I-MIBG SPECT/CT demonstrated absent lesion uptake but marked diffuse hepatic tracer accumulation with heterogeneous parenchymal density, fulfilling criteria for a hepatic superscan on MIBG imaging. This case illustrates dual-tracer hepatic superscans in neuroblastoma, which represents an uncommon clinical presentation.
We report a 69-year-old man with de novo high-volume metastatic hormone-sensitive prostate cancer (mHSPC) presenting with PSA 433.75 ng/mL and widespread skeletal and nodal metastases. Androgen-deprivation therapy with g...We report a 69-year-old man with de novo high-volume metastatic hormone-sensitive prostate cancer (mHSPC) presenting with PSA 433.75 ng/mL and widespread skeletal and nodal metastases. Androgen-deprivation therapy with goserelin, abiraterone, and cyproterone acetate reduced PSA to 44.29 ng/mL. He subsequently received 3 cycles of 177Lu-PSMA radioligand therapy, achieving a near-complete biochemical response (PSA 0.15 ng/mL) and resolution of bone pain. Nine-month follow-up 99mTc-PSMA demonstrated complete regression of metastatic lesions. This case highlights the potential efficacy and safety of early 177Lu-PSMA therapy in high-volume mHSPC, suggesting a role for optimizing hormonal therapy outcomes.
Papillary renal neoplasm with reverse polarity (PRNRP) is very rare. Herein, we report a case of imaging findings of PRNRP in a 75-year-old woman. On the 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT image, it presented as a so...Papillary renal neoplasm with reverse polarity (PRNRP) is very rare. Herein, we report a case of imaging findings of PRNRP in a 75-year-old woman. On the 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT image, it presented as a soft-tissue nodule in the left renal pelvis with intense FDG uptake (SUVmax: 20.8) but no FAPI uptake. Postsurgical pathology supported a diagnosis of PRNRP.
OBJECTIVE: DOTA-ibandronic acid (DOTA-IBA) is a recently developed prodrug targeting bone metastases. Labeling with 68 Ga/ 177 Lu ( 68 Ga/ 177 Lu-DOTA-IBA) induces good curative effects and safety in these patients. Howe...OBJECTIVE: DOTA-ibandronic acid (DOTA-IBA) is a recently developed prodrug targeting bone metastases. Labeling with 68 Ga/ 177 Lu ( 68 Ga/ 177 Lu-DOTA-IBA) induces good curative effects and safety in these patients. However, there has been no evaluation of the safety and effectiveness of 177 Lu-DOTA-IBA in cases of multiple bone metastases. Here, the hematological toxicity and efficacy of 177 Lu-DOTA-IBA in cases of multiple bone metastases were investigated. PARTICIPANTS AND METHODS: Twenty-eight cases of multiple bone metastases were enrolled in the analysis. Following 177 Lu-DOTA-IBA treatment, blood biomarkers were monitored to evaluate the safety of treatment. Karnofsky Performance Status assessments (KPS), Visual Analogue Scale (VAS) pain scores, and 68 Ga-DOTA-IBA PET/CT follow-up were utilized for evaluation of the curative effect. RESULTS: The 28 enrolled patients with multiple bone metastases had a median treatment cycle of 3. The baseline hematological parameters of 25 patients (89%) were abnormal. Post-treatment follow-up showed that blood counts remained essentially unchanged from baseline, with only one patient (4%) developed new grade 3 anemia. A 79% (22/28) rate of bone pain remission was observed and follow-up 68 Ga-DOTA-IBA PET/CT images showed that 15 cases (54%, 15/28) had partial remission. CONCLUSIONS: No serious adverse events were observed in patients with multiple bone metastases who received 177 Lu-DOTA-IBA. The therapeutic agent demonstrated promising efficacy, particularly for pain control and improved quality of life, suggesting that 177 Lu-DOTA-IBA is a safe, effective therapeutic option for this population.
A 28-year-old woman runner was referred for bilateral lower limb pain, associated with diffuse pelvic pain. 18F-NaF PET/CT was performed. It revealed diffuse longitudinal uptake along the posteromedial cortical bone of b...A 28-year-old woman runner was referred for bilateral lower limb pain, associated with diffuse pelvic pain. 18F-NaF PET/CT was performed. It revealed diffuse longitudinal uptake along the posteromedial cortical bone of both tibias, without abnormality on CT, highly suggestive of "shin splint" syndrome, also known as medial tibial stress syndrome (MTSS). The patient reported a significant reduction in pain following a decrease in training intensity. Our case suggests that 18F-NaF PET/CT may be a relevant alternative to SPECT/CT in diagnosing "shin splint" syndrome, especially in times of molybdenum shortage.
A 67-year-old man with newly diagnosed prostate adenocarcinoma underwent 68Ga-PSMA PET/CT for initial staging. In addition to intense focal uptake in the prostate gland consistent with the primary tumor, the scan demonst...A 67-year-old man with newly diagnosed prostate adenocarcinoma underwent 68Ga-PSMA PET/CT for initial staging. In addition to intense focal uptake in the prostate gland consistent with the primary tumor, the scan demonstrated heterogeneous PSMA uptake in the inferior-anterior region of the left temporal lobe adjacent to the left cavernous sinus. Further evaluation of this intracranial lesion with brain MRI raised a differential diagnosis between prostate cancer metastasis and cavernous sinus meningioma. Ultimately, surgical resection and histopathologic analysis established the diagnosis of schwannoma.
A 60-year-old woman with synchronous papillary and medullary thyroid carcinomas (MTC) underwent total thyroidectomy and adjuvant therapy. In later course of her MTC disease, an elevation of serum calcitonin prompted 68Ga...A 60-year-old woman with synchronous papillary and medullary thyroid carcinomas (MTC) underwent total thyroidectomy and adjuvant therapy. In later course of her MTC disease, an elevation of serum calcitonin prompted 68Ga-DOTATATE imaging, revealing mildly avid loco-regional and osseous metastases as well as non-avid nodal and hepatic metastases. 68Ga-FAPI PET/CT demonstrated superior detection compared with 68Ga-DOTATATE PET/CT, particularly in hepatic lesions. 177Lu-FAPI-2286 radioligand therapy (RLT) was administered but failed to achieve biochemical response, though it was well tolerated. This case highlights the diagnostic advantage of FAP-targeted imaging in advanced MTC and underscores the need for standardized RLT protocols and exploration of combination therapeutic strategies.
A 32-year-old man presenting with limb weakness was diagnosed with Guillain-Barré syndrome. Abdominal distension was noted, and imaging revealed a large, heterogeneously enhancing abdominopelvic mass with bilateral crypt...A 32-year-old man presenting with limb weakness was diagnosed with Guillain-Barré syndrome. Abdominal distension was noted, and imaging revealed a large, heterogeneously enhancing abdominopelvic mass with bilateral cryptorchidism and uterine-like tissue. The mass showed high FDG uptake on 18F-FDG PET/CT, while the uterine-like tissue did not. Following surgical biopsy, histopathologic examination demonstrated seminoma and rudimentary uterine tissue, confirming persistent Müllerian duct syndrome (PMDS). PMDS is a rare autosomal recessive disorder characterized by male phenotype with cryptorchidism and persistent Müllerian structures. Imaging for cryptorchidism in children can help establish the diagnosis, allowing timely surgical intervention to prevent malignant transformation.
Nodular fasciitis (NF) is a benign, self-limited soft tissue lesion typically involves the extremities and the head and neck region. We report a rare case of NF arising in the intercostal space of a 74-year-old man. FDG-...Nodular fasciitis (NF) is a benign, self-limited soft tissue lesion typically involves the extremities and the head and neck region. We report a rare case of NF arising in the intercostal space of a 74-year-old man. FDG-PET/CT after the achievement of complete remission after lymphoma treatment revealed intercostal mass and intense FDG uptake (SUVmax 7.3), raising concern for tumor recurrence. Surgical excision was performed and histopathologic examination confirmed NF. This case highlights the diagnostic challenge of NF and the importance of considering it in the differential diagnosis of FDG-avid nodules even in the uncommon site such as chest wall.
Contrast-enhanced abdominal CT of a 57-year-old man presenting with abdominal pain and diarrhea revealed a spiculated, calcified mesenteric mass, initially suggesting a desmoid tumor (DT). The lesion's ametabolic nature...Contrast-enhanced abdominal CT of a 57-year-old man presenting with abdominal pain and diarrhea revealed a spiculated, calcified mesenteric mass, initially suggesting a desmoid tumor (DT). The lesion's ametabolic nature on 18F-FDG PET/CT supported this suspicion. However, ⁶⁸Ga DOTATATE PET/CT demonstrated intense uptake in both the mesenteric mass, which exhibited a "sunburst" calcification pattern, and the primary ileal focus. Histopathology confirmed an ileal neuroendocrine tumor (NET) with mesenteric lymph node metastasis. This case highlights the critical role of ⁶⁸Ga DOTATATE PET/CT in the differential diagnosis, primary site detection, and accurate staging of FDG-negative mesenteric masses associated with a desmoplastic reaction.
Isolated abdominal-wall recurrence in the drainage tube site after surgery for colorectal cancer is extremely rare. We describe contrast-enhanced CT and FDG PET/CT findings in a case of isolated abdominal-wall metastasis...Isolated abdominal-wall recurrence in the drainage tube site after surgery for colorectal cancer is extremely rare. We describe contrast-enhanced CT and FDG PET/CT findings in a case of isolated abdominal-wall metastasis in the drainage tube site after laparotomy surgery for rectal cancer. The abdominal-wall metastasis showed focal hyperenhancement on contrast-enhanced CT and increased activity on FDG PET/CT.
This case report describes an 81-year-old man with primary high-grade urothelial carcinoma of the prostate, which presented with a negative 18 F-PSMA PET/CT. Contrast-enhanced prostate MRI initially suggested a malignant...This case report describes an 81-year-old man with primary high-grade urothelial carcinoma of the prostate, which presented with a negative 18 F-PSMA PET/CT. Contrast-enhanced prostate MRI initially suggested a malignant lesion; however, 18 F-PSMA PET/CT revealed no significant tracer uptake. Postoperative immunohistochemical analysis demonstrated positivity for urothelial markers GATA3 and CK7, while prostate-specific markers PSA and AR were negative, confirming the diagnosis of primary high-grade urothelial carcinoma of the prostate. This case indicates that a negative PSMA PET/CT scan may serve as an important diagnostic clue in distinguishing non-adenocarcinomatous prostate malignancies.
A man in his seventies with an incidentally detected scapular osteochondroma showed progressively increasing FDG uptake on serial 18 F-FDG PET/CT, while the CT component initially revealed no definite signs of malignant...A man in his seventies with an incidentally detected scapular osteochondroma showed progressively increasing FDG uptake on serial 18 F-FDG PET/CT, while the CT component initially revealed no definite signs of malignant transformation. On the final PET/CT, however, CT images showed a periosteal reaction suggestive of extracortical extension, raising strong concern for malignancy. Biopsy was followed by tumor resection, and postoperative pathology confirmed secondary peripheral chondrosarcoma (grade 3). The patient later developed widespread metastases. This case underscores that increased or rising FDG uptake in an osteochondroma may indicate early malignant transformation, emphasizing careful assessment even when CT changes are minimal.
Carotid body tumors (CBTs) are uncommon neuroendocrine neoplasms which typically demonstrate avidity on somatostatin receptor-based imaging rather than radioiodine studies. We report a 50-year-old woman with follicular v...Carotid body tumors (CBTs) are uncommon neuroendocrine neoplasms which typically demonstrate avidity on somatostatin receptor-based imaging rather than radioiodine studies. We report a 50-year-old woman with follicular variant papillary thyroid carcinoma who, eight years post-treatment, developed a CBT incidentally demonstrating mild radioiodine uptake. SPECT/CT localized this unexpected uptake to the CBT, representing a rare false-positive finding. This case underscores the importance of correlating functional imaging with structural imaging to avoid misinterpretation of nonspecific radioiodine uptake as metastatic disease and prevent unnecessary therapeutic interventions.