A 77-year-old man with a remote history of renal cell carcinoma (RCC) presented with gait disturbance and underwent delayed [ 18 F]FP-CIT PET/CT to evaluate Parkinsonism. The scan showed focal uptake in the temporopariet...A 77-year-old man with a remote history of renal cell carcinoma (RCC) presented with gait disturbance and underwent delayed [ 18 F]FP-CIT PET/CT to evaluate Parkinsonism. The scan showed focal uptake in the temporoparietal and insular cortices with a focal striatal photopenic defect. Brain MRI confirmed enhancing metastases corresponding to the cortical foci and attributed the striatal abnormality to chronic infarction. Hypervascular metastases such as RCC may exhibit cortical [ 18 F]FP-CIT uptake, possibly from increased perfusion and/or altered blood-brain barrier permeability, reflecting nonspecific tracer retention. Therefore, cortical uptake warrants cautious interpretation and appropriate correlation with clinical history and anatomic imaging for differential diagnosis.
Chen KC, Chang YM, Su HH
… +2 more, Shen DH, Chan HP
Clin Nucl Med
· 2026 Mar · PMID 41949412
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A 54-year-old man with papillary thyroid carcinoma after thyroidectomy underwent a 99mTc thyroid scan showing no thyroid remnants but a 3.5-cm left lung lesion with faint 99mTc uptake on SPECT/CT, suggesting metastasis....A 54-year-old man with papillary thyroid carcinoma after thyroidectomy underwent a 99mTc thyroid scan showing no thyroid remnants but a 3.5-cm left lung lesion with faint 99mTc uptake on SPECT/CT, suggesting metastasis. Post-I-131 therapy scans on days 3 and 7 revealed intense I-131 avidity in the lung lesion. Surgical excision confirmed a benign bronchogenic cyst, negative for thyroglobulin, TTF-1, BRAF V600E, and PAX-8. I-131 uptake was likely NIS-mediated, but independent of PAX-8 or due to mucinous content. This case underscores that bronchogenic cysts should be considered in the differential diagnosis of I-131-avid lesions, with tissue confirmation essential to avoid misdiagnosis.
A 76-year-old woman presented with progressive left-sided motor incoordination, dystonia, and instability, clinically concerning for atypical parkinsonism. MRI showed Fazekas grade 1 chronic microvascular changes. ¹⁸F-FD...A 76-year-old woman presented with progressive left-sided motor incoordination, dystonia, and instability, clinically concerning for atypical parkinsonism. MRI showed Fazekas grade 1 chronic microvascular changes. ¹⁸F-FDG brain PET revealed asymmetric right cerebral hemisphere, sensorimotor cortex, and basal ganglia hypometabolism, suggestive of corticobasal degeneration. ¹⁸F-Florbetapir PET was negative. ¹⁸F-Flortaucipir PET demonstrated asymmetric right basal ganglia uptake, corresponding to hypometabolic regions and contralateral to left-sided symptoms. Although ¹⁸F-Flortaucipir demonstrates limited affinity for pure 4R tau and known off-target subcortical binding, the pronounced asymmetry in this Aβ-negative case of atypical parkinsonism supports a 4R tauopathy phenotype, illustrating potential utility beyond the current FDA-approved indication.
Clin Nucl Med
· 2026 Mar · PMID 41949403
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A 7-year-old girl diagnosed with neuroblastoma underwent 123I-MIBG scintigraphy for disease staging following surgery. The scan revealed diffuse uptake of MIBG throughout nearly all skeletal regions, with absence of radi...A 7-year-old girl diagnosed with neuroblastoma underwent 123I-MIBG scintigraphy for disease staging following surgery. The scan revealed diffuse uptake of MIBG throughout nearly all skeletal regions, with absence of radiotracer accumulation in the salivary glands, liver, and bladder-findings consistent with a superscan pattern. Following multiple treatment cycles, the patient completed 3 subsequent MIBG scans, all demonstrating a similar distribution of radiotracer, persistently indicative of MIBG superscan.
Clin Nucl Med
· 2026 Jun · PMID 41945622
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A 49-year-old woman with chronic total occlusion of the proximal left anterior descending (LAD) artery underwent a baseline 18 F-FAPI PET/CT, and showed no abnormal uptake in the coronary artery. New focal 18 F-FAPI acti...A 49-year-old woman with chronic total occlusion of the proximal left anterior descending (LAD) artery underwent a baseline 18 F-FAPI PET/CT, and showed no abnormal uptake in the coronary artery. New focal 18 F-FAPI activity appeared at the LAD stent ostium at 6 months and progressed by 1 year, preceding angiographically confirmed in-stent restenosis. This case demonstrates that 18 F-FAPI imaging may detect early fibro-inflammatory activity predictive of restenosis.
We present the 18 F-FDG PET/CT findings of pancreatic metastasis in a 60-year-old man with a history of rectal cancer, who presented with abdominal discomfort and elevated carcinoembryonic antigen (CEA). 18 F-FDG PET/CT...We present the 18 F-FDG PET/CT findings of pancreatic metastasis in a 60-year-old man with a history of rectal cancer, who presented with abdominal discomfort and elevated carcinoembryonic antigen (CEA). 18 F-FDG PET/CT revealed a hypermetabolic pancreatic nodule with ductal dilation. Histopathology confirmed metastatic intestinal-origin adenocarcinoma. This case highlights the diagnostic challenge in differentiating metastasis from primary pancreatic cancer, particularly given the uncommon presentation of solitary pancreatic metastasis and its atypical imaging features. A comprehensive evaluation is essential for accurate diagnosis.
Clin Nucl Med
· 2026 Jun · PMID 41945372
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68 Ga-NY104 is a novel tracer targeting carbonic anhydrase IX (CAIX) with promising diagnostic efficacy for clear cell renal cell cancer. We present a 55-year-old woman with a suspected left renal mass who underwent 68 G...68 Ga-NY104 is a novel tracer targeting carbonic anhydrase IX (CAIX) with promising diagnostic efficacy for clear cell renal cell cancer. We present a 55-year-old woman with a suspected left renal mass who underwent 68 Ga-NY104, showing no significant uptake in the renal mass but incidentally revealing an intense uptake nodule in the left breast. Subsequent 18 F-FDG PET/CT revealed mild renal mass and intense breast nodule uptake. Postoperative pathology confirmed the renal mass as benign angiomyolipoma and the breast nodule as invasive ductal carcinoma. This case highlights the inclusion of primary breast cancer in the differential diagnosis of extra-renal CAIX-avid lesions.
Clin Nucl Med
· 2026 Jun · PMID 41945370
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PURPOSE: Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) tracers have reshaped prostate cancer (PC) imaging, supplementing non-PSMA options such as choline-based agents. However, dir...PURPOSE: Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) tracers have reshaped prostate cancer (PC) imaging, supplementing non-PSMA options such as choline-based agents. However, direct comparative performance data across tracers remain scarce, leaving the optimal choice uncertain. We therefore conducted a systematic review and network meta-analysis (NMA) to assess detection rates (DRs) among PET tracers used for primary and biochemically recurrent PC. METHODS: Following PRISMA-NMA guidelines, we systematically searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov through March 2025 for studies comparing 2 PET tracers for prostate cancer. The primary outcome was DR, defined as the proportion of PET-positive patients or lesions. Two reviewers independently extracted data on study design, patient demographics, and imaging parameters, and evaluated quality with QUADAS-2. We performed frequentist random-effects NMA to calculate relative risks (RRs) with 95% CIs, using 68 Ga-PSMA-11 as reference. RESULTS: Nineteen studies (1681 patients) addressed biochemical recurrence, and 6 (271 patients) targeted primary PC, with 2 overlapping. Risk of bias was low for most domains, though some uncertainty remained for reference standards and timing. In biochemically recurrent PC, PSMA-directed tracers achieved higher DRs than non-PSMA probes. Within the PSMA tracers, 64 Cu-PSMA-617 achieved the highest estimated DR, followed by 18 F-DCFPyL, 18 F-PSMA-1007, and 68 Ga-PSMA-11. Both 18 F-PSMA-1007 and 18 F-DCFPyL showed higher DRs than 68 Ga-PSMA-11 in primary and recurrent PC. CONCLUSIONS: PSMA tracers outperform non-PSMA alternatives for detecting biochemical recurrence. Among PSMA tracers, 18 F-labeled agents consistently surpass 68 Ga-PSMA-11 in both biochemically recurrent and primary PC. When available, 18 F-labeled PSMA tracers should be preferred.
Clin Nucl Med
· 2026 Mar · PMID 41945369
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Prostate carcinoma metastasizing to the spinal cord is an extremely rare entity. We present a 70-year-old man with prostate carcinoma with a Gleason's score of 10 and an elevated serum prostate-specific antigen (PSA) of...Prostate carcinoma metastasizing to the spinal cord is an extremely rare entity. We present a 70-year-old man with prostate carcinoma with a Gleason's score of 10 and an elevated serum prostate-specific antigen (PSA) of 25.99 ng/mL. He underwent [68Ga] Ga-prostate-specific membrane antigen (PSMA)-11 positron emission tomography (PET)/computed tomography (CT) imaging for initial staging. The PET/CT revealed a high-grade [68Ga] Ga-PSMA-11 expressing primary prostatic lesion and metastatic abdomino-pelvic lymph nodes and skeletal lesions. Focal moderate grade [68Ga] Ga-PSMA-11 uptake was noted in the spinal cord at the cervical region, suggestive of spinal cord metastasis (SCM). Thus, in the present case, the rare occurrence of SCM in prostate carcinoma in a recently detected, untreated patient is underscored, indicating the high diagnostic performance of [68Ga] Ga-PSMA-11 PET/CT for accurate disease staging.
Dharmashaktu Y, Sanjith, Damle NA
… +3 more, Wakankar R, Ganapathy C, Venugopal A
Clin Nucl Med
· 2026 Mar · PMID 41945367
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Pancreatic neuroendocrine tumors (PNETs) are uncommon neoplasms comprising approximately 1%-2% of all pancreatic malignancies. They display a wide clinical spectrum ranging from indolent, well-differentiated Grade 1 lesi...Pancreatic neuroendocrine tumors (PNETs) are uncommon neoplasms comprising approximately 1%-2% of all pancreatic malignancies. They display a wide clinical spectrum ranging from indolent, well-differentiated Grade 1 lesions to aggressive, poorly differentiated tumors. While metastatic spread to the liver is relatively common, vascular invasion and tumor thrombus formation are exceedingly rare in low-grade NETs. Here, we present an unusual postoperative case of a Grade 1 PNET with tumor recurrence, kidney infiltration, and tumor thrombus involving the left renal vein and extending into the gonadal vein.
We report the case of a 52-year-old man who presented with a diffuse, nonenhancig right frontotemporal lesion on MRI, without a solid component. Neither FDG nor FDOPA PET/MR was able to identify a hypermetabolic focus to...We report the case of a 52-year-old man who presented with a diffuse, nonenhancig right frontotemporal lesion on MRI, without a solid component. Neither FDG nor FDOPA PET/MR was able to identify a hypermetabolic focus to guide the biopsy, but photopenic defect. Stereotactic biopsy performed at the temporal region revealed a IDH wild-type glioblastoma with a Ki-67 index below 1%. Seven months after biopsy, aggressive tumor growth was observed around the biopsy tract, with a solid enhancing mass and very high FDOPA and FDG uptake, typical for a glioblastoma. The patient died 28 months after diagnosis.
A 42-year-old man presented with an incidentally discovered, elevated serum carcinoembryonic antigen (CEA) level. Although colonic polyps were identified and removed through polypectomy, his CEA level remained persistent...A 42-year-old man presented with an incidentally discovered, elevated serum carcinoembryonic antigen (CEA) level. Although colonic polyps were identified and removed through polypectomy, his CEA level remained persistently elevated. Subsequent CT revealed a cystic-solid mass in the midline upper pelvis, raising suspicion for malignancy. Staging FDG PET/CT demonstrated increased FDG avidity in the known mass, with no evidence of metastasis. The lesion was surgically resected, and histopathologic analysis confirmed a rare urachal mucinous adenocarcinoma. The patient recovered well postoperatively. Urachal mucinous adenocarcinoma should be considered in the differential diagnosis of hypermetabolic midline pelvic masses on FDG PET/CT imaging.
BACKGROUND: The aim of this study was to assess the prognostic value of 18 F-FDG PET/CT-based features performed at the diagnosis of giant cell arteritis (GCA) for the risk of relapse. PATIENTS AND METHODS: 18 F-FDG PET/...BACKGROUND: The aim of this study was to assess the prognostic value of 18 F-FDG PET/CT-based features performed at the diagnosis of giant cell arteritis (GCA) for the risk of relapse. PATIENTS AND METHODS: 18 F-FDG PET/CT was performed in patients with GCA between 2014 and 2024 before 10 days of corticosteroid therapy. Visual scores were assessed: TVS, PETVAS, "extended" PETVAS with 17 segments (PETVAS51), cephalic score "C-VAS" dedicated to the branches of the external carotid artery, and global score "G-VAS" combining all the previous territories. Maximum standardized uptake values (SUVmax) and target-to-background ratios (TBR) normalized to liver or circulating blood pool were also collected. Relapse was defined by the occurrence of suggestive clinical, biological, or imaging events. Survival analyses (Kaplan-Meier) and Cox models adjusted for age, sex, and camera type (analog or digital) were used to identify prognostic factors for relapse. RESULTS: Seventy-six patients were included, 41% of them relapsed after a median follow-up of 14 months. None of the conventional scores (TVS, PETVAS, PETVAS 51) or semiquantitative parameters predicted relapse. In contrast, the G-VAS >45 and C-VAS >8 were significantly associated with relapse in univariate analysis [HR = 2.64 (95% CI: 1.00; 6.98), P = 0.043 and 3.48 (1.30; 9.29), P = 0.0084, respectively]. Only a C-VAS score >8 was an independent predictor of prompt relapses in multivariate analysis [HR = 3.31 (1.16-9.38)]. CONCLUSIONS: In patients with GCA, increased uptake of the cephalic branches of the external carotid artery on initial 18 F-FDG PET/CT was an independent prognostic factor for relapse.
OBJECTIVE: This prospective study evaluated the diagnostic performance of 68 Ga DOTA-Pentixafor PET/CT in characterizing the functional properties and lateralization of aldosterone-producing and cortisol-producing adrena...OBJECTIVE: This prospective study evaluated the diagnostic performance of 68 Ga DOTA-Pentixafor PET/CT in characterizing the functional properties and lateralization of aldosterone-producing and cortisol-producing adrenal cortical lesions. The contribution of Pentixafor PET/CT to diagnosis and treatment planning was assessed in comparison with CT, MRI, and 18 F-FDG PET/CT. PATIENTS AND METHODS: Twenty-five patients with suspected benign functional adrenal cortical masses were included. All patients underwent whole-body imaging at 1 hour and delayed abdominal imaging at 2 hours following intravenous administration of 18 F-FDG and 68 Ga DOTA-Pentixafor. Lesion SUVmax, LCRSUVmax, and LLRSUVmax values were analyzed and correlated with laboratory parameters, other imaging modalities, and postoperative clinical and pathologic outcomes. RESULTS: 68 Ga DOTA-Pentixafor PET/CT demonstrated distinct focal uptake relative to the contralateral adrenal gland and liver parenchyma in 6/6 (100%) patients with suspected PA, 5/18 (27.7%) with suspected CS, and 1/1 (100%) with suspected EAS. Among patients with focal uptake who underwent surgery, all PA (5/5) and all CS (5/5) cases were confirmed as adrenocortical adenomas, resulting in no false-positive findings (PPV 100%). However, due to 2 false-negative CS cases, pentixafor PET/CT demonstrated an overall sensitivity of 83.3%, specificity of 100%, and accuracy of 85.7%. Thresholds of SUVmax >15.11, LCRSUVmax >1.74, and LLRSUVmax >4.36 yielded sensitivities of 33.3%, 41.7%, and 41.7%, respectively, while maintaining 100% specificity. Clinical and biochemical improvement was observed in 100% (5/5) of operated PA patients and 100% (5/5) of operated CS patients. Follow-up of nonoperated patients is ongoing. CONCLUSION: 68 Ga DOTA-Pentixafor PET/CT is a valuable diagnostic and potentially therapeutic tool for benign functional adrenal cortical disorders such as PA, CS, and EAS, with the potential to establish a new standard in minimally invasive patient management.
López-Bermejo García F, Rodríguez Gómez JC, Gatón Ramírez J
… +2 more, Talavera Rubio MDP, Poblete García VM
Clin Nucl Med
· 2026 Mar · PMID 41941245
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An 80-year-old woman, under neurology follow-up for cognitive decline, presented with progressive memory loss, episodes of disconnection and occasional loss of impulse control. Brain CT scan revealed findings consistent...An 80-year-old woman, under neurology follow-up for cognitive decline, presented with progressive memory loss, episodes of disconnection and occasional loss of impulse control. Brain CT scan revealed findings consistent with Fahr syndrome. In addition, an 18F-FDG PET/CT was performed to assess cognitive deterioration. This case illustrates characteristic PET/CT imaging findings of a rare condition.
Clin Nucl Med
· 2026 Jun · PMID 41941244
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A 43-year-old man presented with left hip pain. Contrast-enhanced CT demonstrated lytic destruction of the left ilium and sacrum with associated soft-tissue extension, suggestive of a bone tumor. Subsequent ¹⁸F-FDG PET/C...A 43-year-old man presented with left hip pain. Contrast-enhanced CT demonstrated lytic destruction of the left ilium and sacrum with associated soft-tissue extension, suggestive of a bone tumor. Subsequent ¹⁸F-FDG PET/CT revealed only mild or no FDG avidity in lesions involving the ilium, sacrum, and right fibula. In contrast, these lesions demonstrated intense or elevated uptake on PSMA/FAPI bispecific tracer ¹⁸F-ALF-NOTA-PSFA-1 PET/CT. These observations indicate that ¹⁸F-ALF-NOTA-PSFA-1 PET/CT holds considerable potential for sarcoma detection and may support the development of PSMA/FAPI bispecific targeted receptor radionuclide therapy.
Saber Tanha A, Raeisi N, Sadeghi R
… +3 more, Zahed Anaraki S, Kamali H, Aryana K
Clin Nucl Med
· 2026 Mar · PMID 41941243
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A 49-year-old man diagnosed with well-differentiated adenocarcinoma of the colon, along with liver metastases, underwent several treatments, including chemotherapy, laparoscopic colostomy, and radiofrequency ablation. Af...A 49-year-old man diagnosed with well-differentiated adenocarcinoma of the colon, along with liver metastases, underwent several treatments, including chemotherapy, laparoscopic colostomy, and radiofrequency ablation. After receiving a liver transplant, he achieved 1-year disease-free status. However, rising serum levels of carcinoembryonic antigen (CEA) led to further evaluation, which revealed new metastases in the liver and lungs. As a last resort, he was treated with 177Lu-FAPI-2286 radioligand therapy, but the biochemical response was disappointing, as CEA levels continued to rise. Tragically, the patient experienced respiratory decompensation and passed away 10 weeks after the treatment. This case underscores the potential of FAP-targeted radioligand therapy in managing advanced colon cancer and suggests that earlier intervention might be beneficial.
BACKGROUND: This exploratory study aimed to evaluate the clinical feasibility and added diagnostic value of the heterodimeric agent 68 Ga-NOTA-3P-TATE-RGD, targeting both SSTR2 and integrin α v β 3 , in patients with rad...BACKGROUND: This exploratory study aimed to evaluate the clinical feasibility and added diagnostic value of the heterodimeric agent 68 Ga-NOTA-3P-TATE-RGD, targeting both SSTR2 and integrin α v β 3 , in patients with radioactive-iodine-negative differentiated thyroid cancer (DTC), through a comparison with 18 F-FDG PET/CT. PATIENTS AND METHODS: Twenty-two patients with radioactive-iodine-negative DTC underwent both 68 Ga-NOTA-3P-TATE-RGD and 18 F-FDG PET/CT within 1 week. Diagnostic performance and semiquantitative parameters were compared between the two agents. Based on the collected gene mutation data, a preliminary analysis was conducted on differences in PET uptake among different gene mutation types. RESULTS: A total of 265 and 295 lesions were detected on 68 Ga-NOTA-3P-TATE-RGD and 18 F-FDG PET/CT, respectively. 68 Ga-NOTA-3P-TATE-RGD detected 45 exclusive lesions (12.71%), predominantly in bone (6 lesions) and brain (5 lesions), while 18 F-FDG identified 75 exclusive lesions in lymph nodes (24 lesions) and lungs (51 lesions). The dual-targeted agent exhibited superior total specificity (92.3% vs 70.6%) and significantly higher tumor-background ratio for bone metastases [3.4 (2.6, 4.0) vs 2.3 (1.6, 2.9), P = 0.008]. For PET comparison of different gene mutations, 68 Ga-NOTA-3P-TATE-RGD showed highest uptake in TERT promoter-mutant lesions ( P < 0.01), while 18 F-FDG had maximal uptake in BRAF-mutant lesions ( P < 0.01). CONCLUSIONS: 68 Ga-NOTA-3P-TATE-RGD PET/CT is feasible for radioactive-iodine-negative DTC, providing complementary diagnostic information to 18 F-FDG with enhanced detection of bone and brain metastases. The intense uptake observed in lesions with TERT-associated aggressive subtypes supports potential utility for specific disease identification.
Ichikawa J, Onohara K, Inoue T
… +2 more, Wako M, Kawasaki T
Clin Nucl Med
· 2026 Jun · PMID 41941232
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A 50-year-old man presented with lower abdominal pain. Imaging revealed a pelvic mass extending from the right internal iliac vein into the inferior vena cava. Fluorodeoxyglucose-positron emission tomography revealed int...A 50-year-old man presented with lower abdominal pain. Imaging revealed a pelvic mass extending from the right internal iliac vein into the inferior vena cava. Fluorodeoxyglucose-positron emission tomography revealed intense uptake (SUVmax 13.97) without metastasis. Biopsy revealed a biphasic tumor with cartilaginous matrix and staghorn vasculature. Immunohistochemistry indicated positive for SMA, desmin, MyoD1, and NKX3.1. Moreover, genomic analysis identified a HEY1::NCOA2 fusion, confirming mesenchymal chondrosarcoma (MCS). Given the extent of the tumor, chemoradiotherapy was initiated. MCS is a rare, high-grade sarcoma with limited treatment options. Targeted therapies against HEY1::NCOA2-associated pathways are promising and are currently under investigation.