We present 18 F-FAPI-74 PET/CT findings before and after proton beam therapy (PBT) in a 71-year-old woman with liver metastasis following pancreatic cancer resection. Before PBT, no uptake was observed on FDG-PET, wherea...We present 18 F-FAPI-74 PET/CT findings before and after proton beam therapy (PBT) in a 71-year-old woman with liver metastasis following pancreatic cancer resection. Before PBT, no uptake was observed on FDG-PET, whereas the lesion was visualized on FAPI-PET, consistent with contrast-enhanced MRI. Follow-up FAPI-PET at 3 and 6 months post-PBT revealed mild, newly developed uptake confined to the high-dose irradiated area. However, contrast-enhanced MRI demonstrated complete tumor disappearance and normalization of serum tumor marker levels. These findings suggest that post-irradiation 18 F-FAPI-74 uptake is more likely attributable to reactive changes, such as radiation-induced hepatic fibrosis, rather than residual or recurrent tumor.
Prostate cancer is the most frequently diagnosed malignancy among men. Biochemical recurrence occurs in ∼20%-40% of patients and poses a significant clinical challenge. PSMA-PET/CT has emerged as a highly sensitive and s...Prostate cancer is the most frequently diagnosed malignancy among men. Biochemical recurrence occurs in ∼20%-40% of patients and poses a significant clinical challenge. PSMA-PET/CT has emerged as a highly sensitive and specific imaging modality for detecting recurrent and metastatic prostate cancer, outperforming conventional imaging, especially at low PSA levels. We report an unusual site of metastatic recurrence detected on [¹⁸F]-Piflufolastat PSMA PET/CT in a patient with rising PSA. This case highlights the crucial role of advanced molecular imaging in accurately identifying atypical metastatic spread, which may have a direct impact on clinical decision-making.
PSMA PET, widely used in prostate cancer, targets a transmembrane glycoprotein overexpressed in tumor cells, and PSMA expression is also seen in some nonprostatic tumors and normal tissues. In this case, a 66-year-old ma...PSMA PET, widely used in prostate cancer, targets a transmembrane glycoprotein overexpressed in tumor cells, and PSMA expression is also seen in some nonprostatic tumors and normal tissues. In this case, a 66-year-old man with biopsy-proven prostate adenocarcinoma and PSA 16 ng/mL underwent 68Ga-PSMA PET/CT for staging. Focal uptake consistent with primary prostate malignancy was detected in the mid-prostate, predominantly left lateral. In addition, a polypoid intraluminal tracheal lesion demonstrated intense PSMA expression. Histopathology confirmed adenoid cystic carcinoma, emphasizing the modality's value beyond prostate cancer.
Approximately 17% of patients with neurosarcoidosis develop peripheral neuropathy, whereas polyradiculopathy is rare, occurring in ∼2% of patients with neurosarcoidosis. Radiculopathy may be associated with dorsal root g...Approximately 17% of patients with neurosarcoidosis develop peripheral neuropathy, whereas polyradiculopathy is rare, occurring in ∼2% of patients with neurosarcoidosis. Radiculopathy may be associated with dorsal root ganglion (DRG) involvement. We report a case of a 28-year-old man who presented with limb weakness and sensory disturbances. 18F-FDG PET/CT showed bilateral symmetric hypermetabolic foci in multiple cervical and lumbar DRGs. 18F-FDG PET/CT was more informative in detecting DRG lesions and mapping their distribution than MRI. Few reports have presented cases of DRG and asymmetric involvement. However, no report has described multilevel and symmetric 18F-FDG-avid DRGs in sarcoidosis.
Clin Nucl Med
· 2026 Jun · PMID 41954944
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A 55-year-old man presented with a 2-week history of cough, expectoration, and transient hemoptysis. Contrast-enhanced CT revealed a mildly heterogeneous soft-tissue nodule in the left upper bronchus, causing distal obst...A 55-year-old man presented with a 2-week history of cough, expectoration, and transient hemoptysis. Contrast-enhanced CT revealed a mildly heterogeneous soft-tissue nodule in the left upper bronchus, causing distal obstructive atelectasis. Bronchoscopy identified an endoluminal tumor at the left upper lobe orifice; initial biopsy suggested adenoid cystic carcinoma. Staging 18 F-FDG PET/CT demonstrated increased FDG activity in the nodule with no evidence of metastatic disease. Following surgical resection, histopathology confirmed a salivary gland-type tumor: intermediate-grade mucoepidermoid carcinoma. The patient recovered well postoperatively.
Ahmadi M, Tanha AS, Elahifard H
… +2 more, Bahonar M, Askari E
Clin Nucl Med
· 2026 Mar · PMID 41950268
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We report the case of a 75-year-old man with prostate adenocarcinoma, referred for initial staging using 99mTc-PSMA scan. The whole body PSMA scan revealed a zone of increased uptake in the skull. Subsequent 99mTc-PSMA S...We report the case of a 75-year-old man with prostate adenocarcinoma, referred for initial staging using 99mTc-PSMA scan. The whole body PSMA scan revealed a zone of increased uptake in the skull. Subsequent 99mTc-PSMA SPECT/CT imaging demonstrated a hypodense lesion in the brain parenchyma. Notably, the patient recently presented with left-sided hemiparesis. The subsequent MRI and surgical pathology confirmed the diagnosis of glioblastoma multiforme for the incidentally detected PSMA-avid lesion in the brain. This case highlights the importance of recognizing atypical PSMA-avid lesions to avoid misclassification as metastatic disease, thereby enhancing diagnostic accuracy. Furthermore, PSMA uptake in glioblastoma may serve as a potential target for theranostic approaches.
A 40-year-old man was admitted with acute diarrhoea, 3 kg weight loss, and mild fever (up to 38 °C). His medical history included acute necrotising pancreatitis and an axial hiatal hernia. Laboratory tests showed elevate...A 40-year-old man was admitted with acute diarrhoea, 3 kg weight loss, and mild fever (up to 38 °C). His medical history included acute necrotising pancreatitis and an axial hiatal hernia. Laboratory tests showed elevated inflammation parameters (C-reactive protein of 188 mg/L). A 18 F-FDG-PET/CT scan revealed infected abdominal pancreatic pseudocysts extending to the thoracic region due to the hiatal hernia. Endosonography and transgastric drainage removed 200 mL of pus. Klebsiella pneumoniae was identified, and antibiotic therapy with ampicillin and sulbactam was started. A follow-up ultrasound showed significant cyst regression. The patient was discharged in a satisfactory condition with reduced inflammation.
Clin Nucl Med
· 2026 Mar · PMID 41950255
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FET-CREB fusion-positive intracranial mesenchymal tumor is a newly recognized provisional tumor type. Usefulness of FDG PET/CT in the management of this tumor is rarely reported. We describe FDG PET/CT findings in a case...FET-CREB fusion-positive intracranial mesenchymal tumor is a newly recognized provisional tumor type. Usefulness of FDG PET/CT in the management of this tumor is rarely reported. We describe FDG PET/CT findings in a case of FET-CREB fusion-positive intracranial mesenchymal tumor with metachronous extracranial metastases to the mediastinum, mesentery, and left Leg. The metastatic tumors showed mild to moderate FDG uptake. This case indicates that FET-CREB fusion-positive intracranial mesenchymal tumors can develop extracranial metastasis, and FDG PET/CT may be useful for detecting extracranial metastasis of this rare tumor.
Viohl N, Seifert P, Drescher R
… +2 more, Freesmeyer M, Leder T
Clin Nucl Med
· 2026 Mar · PMID 41950253
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A 57-year-old woman was referred to our department for a whole-body F-18-DOPA PET/CT scan after surgical treatment of medullary thyroid cancer to exclude metastases as the reason for persistent low-level calcitonin. The...A 57-year-old woman was referred to our department for a whole-body F-18-DOPA PET/CT scan after surgical treatment of medullary thyroid cancer to exclude metastases as the reason for persistent low-level calcitonin. The PET/CT showed an area of increased tracer uptake in the frontal right skull, being otherwise unremarkable. Subsequent MRI performed to exclude an intracranial metastasis displayed a lesion consistent with a meningioma. No metastases of thyroid cancer were found, and the patient underwent surveillance.
Clin Nucl Med
· 2026 Jun · PMID 41950247
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A 58-year-old man with a history of lithotripsy for urolithiasis presented with persistent fever and pollakisuria. As empirical anti-infective therapy was ineffective, 18 F-FDG PET/CT was performed to detect potential ma...A 58-year-old man with a history of lithotripsy for urolithiasis presented with persistent fever and pollakisuria. As empirical anti-infective therapy was ineffective, 18 F-FDG PET/CT was performed to detect potential malignancy, revealing bilateral renal enlargement with multiple nodular cortex uptakes and an enlarged left axillary lymph node, suggestive of pyelonephritis. However, biopsies of the axillary lymph node and right kidney confirmed high-grade diffuse large B-cell lymphoma (DLBCL). Following R-DA-EPOCH chemotherapy, the patient achieved sustained remission. This case highlights that renal DLBCL can mimic pyelonephritis on 18 F-FDG PET/CT, and PET/CT is instrumental in guiding biopsy for accurate diagnosis.
A 78-year-old woman with medullary thyroid carcinoma (MTC) demonstrated persistently elevated serum calcitonin despite prior surgery and radiotherapy. 99mTc-octreotide imaging failed to detect skeletal metastases, while...A 78-year-old woman with medullary thyroid carcinoma (MTC) demonstrated persistently elevated serum calcitonin despite prior surgery and radiotherapy. 99mTc-octreotide imaging failed to detect skeletal metastases, while 68Ga-FAPI PET/CT revealed extensive skeletal involvement. Biochemical markers were disproportionately low relative to disease burden, consistent with a low-secretory MTC. This case highlights the limitations of SSTR-targeted imaging in MTC and underscores the diagnostic superiority of FAP-targeted imaging.
Marulanda-Corzo V, Kakkar P, Sharbatdaran A
… +2 more, Sternberg CN, Huicochea-Castellanos S
Clin Nucl Med
· 2026 Mar · PMID 41950234
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A 65-year-old man with oligometastatic prostate cancer underwent radical prostatectomy and stereotactic body radiation therapy (SBRT) to a right pubic bone metastasis. Four weeks after SBRT, PSMA PET showed increased ext...A 65-year-old man with oligometastatic prostate cancer underwent radical prostatectomy and stereotactic body radiation therapy (SBRT) to a right pubic bone metastasis. Four weeks after SBRT, PSMA PET showed increased extent and intensity of uptake at the treated site, despite a 92% PSA decline (8.5 to 0.7 ng/mL) and no new lesions. Later imaging confirmed resolution of uptake, consistent with bone flare, but revealed multiple new osseous metastases and rising PSA (2.8 ng/mL), indicating progression. To our knowledge, this is the first reported case of SBRT-induced bone flare, highlighting the need for cautious interpretation of early posttreatment PSMA PET.
A 10-year-old child presented with episodic headache, diaphoresis, and dizziness during micturition straining, raising clinical suspicion for paraganglioma. 123 I-MIBG SPECT/CT revealed no abnormal radiotracer uptake in...A 10-year-old child presented with episodic headache, diaphoresis, and dizziness during micturition straining, raising clinical suspicion for paraganglioma. 123 I-MIBG SPECT/CT revealed no abnormal radiotracer uptake in the bladder mass or enlarged lesions. In contrast, 18 F-FDG PET/CT demonstrated increased metabolic activity with marked 18 F-FDG uptake in these same regions. Histopathological examination following surgical resection confirmed the diagnosis of malignant paraganglioma with multiple metastases. This case illustrates that bladder paragangliomas may exhibit positive 18 F-FDG PET/CT findings despite negative 123 I-MIBG SPECT/CT results, highlighting the complementary role of functional imaging modalities in the diagnostic evaluation of bladder paragangliomas.
Cardiac metastases from neuroendocrine tumors (NETs) are rare and usually occur in advanced metastatic disease. We present a 58-year-old man with a well-differentiated terminal ileum NET (grade 1, Ki-67 1%) who underwent...Cardiac metastases from neuroendocrine tumors (NETs) are rare and usually occur in advanced metastatic disease. We present a 58-year-old man with a well-differentiated terminal ileum NET (grade 1, Ki-67 1%) who underwent 68Ga-DOTATATE PET/CT for staging. The scan demonstrated intense uptake in the primary tumor and 2 incidental myocardial foci. Subsequent cardiac magnetic resonance imaging (CMR) revealed myocardial signal heterogeneity at corresponding locations, supporting the diagnosis of myocardial metastases. This case illustrates isolated myocardial involvement detected at initial staging of a well-differentiated NET and highlights the complementary role of somatostatin receptor-based PET/CT and CMR in detecting cardiac metastases.
A 50-year-old man presented with a rapidly growing neck mass. Initial cytology suggested anaplastic thyroid carcinoma (ATC), necessitating urgent surgery. Preoperative imaging revealed a thyroid lesion with a "moth-eaten...A 50-year-old man presented with a rapidly growing neck mass. Initial cytology suggested anaplastic thyroid carcinoma (ATC), necessitating urgent surgery. Preoperative imaging revealed a thyroid lesion with a "moth-eaten" appearance; FDG-PET/CT revealed unexpected uptake around the sternocleidomastoid muscle and at the maxilla, with an osteolytic lesion preserving tooth roots. During surgery, atypical infiltration for ATC prompted reevaluation, preventing unnecessary radical procedures. Pathologic examination revealed Langerhans cell histiocytosis (LCH), confirmed by CD1a staining. LCH of adult thyroid is rare, mimicking ATC clinically and cytologically. This case highlights that identifying systemic clues with FDG-PET may enable accurate diagnosis, preventing unnecessary radical surgery.
Clin Nucl Med
· 2026 Mar · PMID 41949893
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Recurrent lymphoma tends to recur at the initial site of involvement or spread to the lymph nodes, but rarely involves the central nervous system. We present an interesting case of isolated recurrence of primary mediasti...Recurrent lymphoma tends to recur at the initial site of involvement or spread to the lymph nodes, but rarely involves the central nervous system. We present an interesting case of isolated recurrence of primary mediastinal B-cell lymphoma in the brain, confirmed on PET imaging, in a 15-year-old girl previously in remission.
Thyroid MIBG uptake is a quite common, typically benign finding; however, abnormal neck activity must not be reflexively misattributed to the thyroid gland. We present the case of a 10-year-old girl with neuroblastoma un...Thyroid MIBG uptake is a quite common, typically benign finding; however, abnormal neck activity must not be reflexively misattributed to the thyroid gland. We present the case of a 10-year-old girl with neuroblastoma undergoing 123I-MIBG scintigraphy. Initial planar images demonstrated intense tracer uptake in the neck, appearing more prominent on the anterior view and mimicking thyroid accumulation. Subsequent SPECT/CT was instrumental in correctly localizing the activity to the C7 vertebral body, confirming a site of osseous metastatic disease rather than physiological uptake.
Thostrup AH, Bentestuen M, Rasmussen TL
… +2 more, Szejniuk WM, Zacho HD
Clin Nucl Med
· 2026 Mar · PMID 41949416
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A 69-year-old man diagnosed with sarcomatoid pleural mesothelioma received 3 cycles of nivolumab with 2 cycles of ipilimumab. Treatment was terminated after the patient developed colitis-an immune-related adverse event (...A 69-year-old man diagnosed with sarcomatoid pleural mesothelioma received 3 cycles of nivolumab with 2 cycles of ipilimumab. Treatment was terminated after the patient developed colitis-an immune-related adverse event (irAE). High-dose prednisolone was initiated. Between 1 and 2 weeks later, the patient underwent FDG- and FAPI PET/CT, both exhibiting prominent, diffuse uptake in the thyroid gland. Biochemistry just before the scans revealed hypothyroidism with further derangement in the following weeks. The patient was diagnosed with irAE thyroiditis. FAPI uptake in chronic thyroiditis has been previously described, whereas uptake in irAE thyroiditis has only been reported once.
Clin Nucl Med
· 2026 Jun · PMID 41949415
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Intramuscular and subcutaneous tissue metastasis of prostate cancer is a rare and aggressive process. We describe the case of a 61-year-old man with metastatic castration-resistant prostate cancer who presented with grow...Intramuscular and subcutaneous tissue metastasis of prostate cancer is a rare and aggressive process. We describe the case of a 61-year-old man with metastatic castration-resistant prostate cancer who presented with growing left gluteal/proximal thigh masses during ongoing 177 Lu-PSMA-617 (Pluvicto) treatment. While post-Pluvicto imaging demonstrates markedly improved nodal and hepatic metastases, progressive development of multifocal left gluteal/proximal thigh intramuscular and subcutaneous tissue metastases suggests a heterogeneous treatment response to Pluvicto. This case shows rare soft tissue metastasis in a heterogeneous treatment response to Pluvicto.
Calderón E, Späth MS, Maas M
… +2 more, la Fougère C, Trautwein NF
Clin Nucl Med
· 2026 Mar · PMID 41949414
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We report an 81-year-old man with metastatic castration-resistant prostate cancer (mCRPC) after multiple prior therapies, including androgen deprivation therapy (ADT), the androgen receptor pathway inhibitor (ARPI) abira...We report an 81-year-old man with metastatic castration-resistant prostate cancer (mCRPC) after multiple prior therapies, including androgen deprivation therapy (ADT), the androgen receptor pathway inhibitor (ARPI) abiraterone, taxane chemotherapy with docetaxel and cabazitaxel, radiopharmaceutical therapy (RPT) with 4 cycles of [177Lu]PSMA-I&T, and the PARP inhibitor olaparib in combination with abiraterone. Due to biochemical and clinical progression, [18F]PSMA-1007 PET/CT was performed for restaging, revealing diffuse skeletal metastases without significant extraosseous disease. Based on this imaging pattern, treatment with the ARPI enzalutamide combined with 223Ra-dichloride was initiated, resulting in an excellent response with a >90% PSA decline and a progression-free survival of 10 months.