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We present a case of metastatic prostate cancer with rare metastases involving the brain and orbit, in addition to liver, skeletal and nodal metastases. The patient had undergone prior hormonal therapy and chemotherapy and had disease progression despite 2 cycles of 177Lu-Prostate specific membrane antigen (177Lu- PSMA) based radioligand therapy. He had a partial response after 2 cycles of 225Ac- PSMA based targeted alpha therapy, as demonstrated on the 68Ga-PSMA PET/CT study. However, the patient had disease progression at the end of 4 cycles of 225Ac- PSMA therapy, evident by rising prostate specific antigen levels and imaging findings. The end of treatment 68Ga-PSMA PET/CT showed additional sites of metastases in the orbit and brain apart from overall disease progression. These are rare sites of distant spread in prostate cancer and require urgent evaluation and local treatment to prevent potential complications. The importance of detection of metastatic sites in closed cavities is because of the requirement for urgent intervention to avoid compression related complications. [ABSTRACT FROM AUTHOR]

We present the case of a 60-year-old man with metastatic neuroendocrine tumor of the ileum following ileal resection, being evaluated for 177Lu-based peptide receptor radionuclide therapy. 68Ga-DOTANOC PET/CT showed focal increased tracer uptake in the scrotal region without any morphologic changes on the corresponding CT images. Similar increased tracer uptake was seen on post-therapy whole-body imaging following 177Lu-DOTATATE therapy. An USG guided FNA revealed no malignant cells on cytopathologic examination. This case illustrates that focal testicular tracer uptake, may not always be pathological and can represent a normal physiologic variant, similar to the diffuse testicular somatostatin receptor expression as previously reported in literature. [ABSTRACT FROM AUTHOR]

Background: Radioiodine therapy (131I) forms a principal cornerstone in the management of differentiated thyroid cancer. Radioiodine-refractory differentiated thyroid cancer (RAIR-DTC) presents a challenge in detection of structural disease in patients with evidence of biochemical disease and in treatment of the disease using alternate therapies. The present study was conducted to compare the diagnostic accuracy (in terms of sensitivity and specificity) of 68Ga-DOTA-RGD2 positron emission tomography (PET)/computed tomography (CT) as a neoangiogenesis imaging modality with 18F-FDG PET/CT, the current standard in diagnostic algorithm of RAIR-DTC, and to evaluate the radiotracer avidity on 68Ga-DOTA-RGD2 PET/CT for potential theranostics. Methods: Forty-four RAIR-DTC patients with negative post-therapy 131I scan were prospectively enrolled. Serum thyroglobulin (sTg) and anti-thyroglobulin (ATg) measurements were performed with levothyroxine withdrawal (thyrotropin-stimulated state), and 18F-FDG PET/CT and 68Ga-DOTA-RGD2 PET/CT studies were performed within 1 week of each other. Follow-up was performed with histopathology/sTg/ATg/conventional imaging. The findings of 18F-FDG PET/CT and 68Ga-DOTA-RGD2 PET/CT were compared with the reference standard to obtain sensitivity, specificity, and overall accuracy. Degree of radiotracer uptake on 68Ga-DOTA-RGD2 PET/CT was described as tumor to background (T/B) and tumor to liver (T/L) ratios of standardized uptake value. Results:68Ga-DOTA-RGD2 PET/CT detected a total of 123 lesions, with an overall sensitivity, specificity, and accuracy of 82.3%, 100%, and 86.4%, respectively. 18F-FDG PET/CT detected a total of 144 lesions, with an overall sensitivity, specificity, and accuracy of 82.3%, 50%, and 75%, respectively. Most commonly identified disease sites were nodal metastases (82.9%), followed by thyroid bed lesions (10.5%). 82.1% of patients positive on 68Ga-DOTA-RGD2 PET/CT showed lesional radiotracer uptake higher than the liver (grade IV and grade V). Conclusions:68Ga-DOTA-RGD2 PET/CT showed a similar sensitivity to, but higher specificity and overall accuracy than 18F-FDG PET/CT in detection of lesions in RAIR-DTC patients. This novel application of the angiogenesis imaging modality can prove useful in RAIR-DTC, especially in patients with negative/suspicious 18F-FDG PET/CT. Furthermore, since the majority of patients (82.1%) positive on 68Ga-DOTA-RGD2 PET/CT showed radiotracer avidity toward the higher end of the spectrum (grade IV and grade V), novel 177Lu-based theranostics can be a potential treatment for these patients. [ABSTRACT FROM AUTHOR]

We present the case of a 60-year-old man with metastatic neuroendocrine tumor of the ileum following ileal resection, being evaluated for 177Lu-based peptide receptor radionuclide therapy. 68Ga-DOTANOC PET/CT showed focal increased tracer uptake in the scrotal region without any morphologic changes on the corresponding CT images. Similar increased tracer uptake was seen on post-therapy whole-body imaging following 177Lu-DOTATATE therapy. An USG guided FNA revealed no malignant cells on cytopathologic examination. This case illustrates that focal testicular tracer uptake, may not always be pathological and can represent a normal physiologic variant, similar to the diffuse testicular somatostatin receptor expression as previously reported in literature. [ABSTRACT FROM AUTHOR]

Lymphomatoid granulomatosis (LYG) is a rare, extranodal B-cell lymphoproliferative disorder. The disease commonly presents with nonspecific symptoms and imaging features, making the diagnosis and therapeutic response assessment difficult. While histopathology is the mainstay of diagnosis, different imaging modalities such as computed tomography (CT), magnetic resonance imaging, or F18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) can help in identifying the different organs involved. We present a case of LYG, post chemotherapy in remission for the past 5 years, presenting with symptoms of disease recurrence. [ABSTRACT FROM AUTHOR]

18F fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) is a standard imaging tool in staging as well as response evaluation for lymphoma. Here, we present a young male with extensive extranodal lymphoma with cardiac involvement which presented as diffuse myocardial lesion mimicking hypertrophic obstructive cardiomyopathy. 18F-FDG PET/CT helped in the staging by revealing multiple systemic involvements. Interim PET after three cycles of chemotherapy showed a complete metabolic response to therapy in all the extranodal sites including the cardiac involvement, thus retrospectively confirming the lymphomatous involvement. Previous literature also conforms to the superior role of 18F-FDG PET/CT in the clinical management of extensive extranodal lymphoma. [ABSTRACT FROM AUTHOR]

Adenoid cystic carcinoma of the buccal mucosa has an increased propensity for recurrence and distant metastases. Due to the poor prognosis at late detection of distant metastases, it is advisable to keep a close follow-up. In the present case, 18F-fluorodeoxyglucose positron emission tomography/computed tomography proved invaluable in the comprehensive workup of the patient, including detection of local recurrence, distant metastases, and in assessing treatment response. [ABSTRACT FROM AUTHOR]

Extrathyroidal manifestations of autoimmune thyroid disorders include thyroid-associated ophthalmopathy, thyroid dermopathy, and thyroid acropachy. Thyroid acropachy is an extreme manifestation of autoimmune thyroid disorder characterized by clubbing and swelling of fingers and toes, with or without periosteal reaction of the distal bones. We present a 50-year-old woman, posttreatment for carcinoma breast (6 years back) and referred for bone scan for generalized body ache. Bone scan findings resulting in detailed clinical evaluation prompted toward the suspicion of a thyroidal disease with ultimate diagnosis of Graves' disease. [ABSTRACT FROM AUTHOR]

The complementary anatomical and functional information provided by hybrid imaging with single-photon emission computed tomography-CT (SPECT-CT) is a very useful imaging tool in selected cases where anatomical information is lacking as in the scenario of dynamic renal scintigraphy. The authors present a case of a 5-year-old male child with symptoms suggestive of cutis laxa with urinary tract infection. The child underwent dynamic renal scintigraphy with Tc99m ethylene dicysteine for cortical function and drainage assessment. Hybrid SPECT/CT proved valuable in the child in identification of the bilateral gross urinary bladder diverticulae. [ABSTRACT FROM AUTHOR]

Tumoral calcinosis is a rare entity presenting with periarticular calcium deposits, leading to multiple swellings and biochemical hyperphosphatemia and normocalcemia. Skeletal scintigraphy in these cases is helpful by providing a whole-body survey and delineating the common multifocality of this entity. We present the case of a 16-year-old boy with multiple swellings around the knee and elbow joints, having developed over 4 years and diagnosed as tumor calcinosis. [ABSTRACT FROM AUTHOR]

The article presents the case of a 54-year-old woman with papillary carcinoma thyroid who developed thyroglobulin elevation with negative I scintigraphy (TENIS) syndrome after receiving 500 becquerel (GBq) of integrins in cumulative doses. Topics covered include patient response to sorafenib therapy, and evaluation of disease extent and for pre-therapy assessment by Ga-DOTA-RGD positron emission tomography/computed tomography (PET/CT).

Brown tumors are an uncommon entity associated with hyperparathyroidism. Initially described with primary hyperparathyroidism, with the widespread use of dialysis, they were also seen to be associated with secondary and tertiary hyperparathyroidism. These are lytic, expansile lesions causing bony pains, and depending on the size and extent, skeletal dysmorphism. The present case illustrates the detection of parathyroid adenoma with multiple brown tumors on 99mTc-sestamibi parathyroid scintigraphy in a patient presenting with facial dysmorphism and multiple bony pains. [ABSTRACT FROM AUTHOR]

The article discusses research on the efficacy of daily oral ulipristal acetate in comparison with a monthly intramuscular injection of leuprolide acetate in controlling bleeding along with its side-effect profile before a planned preoperative management of uterine fibroids. The study conducted by J. Donnez, J. Tomaszewski and colleagues is published in a 2012 issue of the "New England Journal of Medicine." The efficacy and safety end points at week 13 are enumerated.

Background/Aims: Esophageal transit scintigraphy (ETS) is a useful tool for evaluating esophageal motility disorders, although conflicting results are seen due to lack of ideal bolus. Semisolid/solid boluses have shown superiority over liquid boluses, and the present study aims to establish the utility of in-house-prepared bolus in normal volunteers and its comparison with liquid bolus. Materials and Methods: Thirty-three healthy volunteers were selected for ETS with in-house-prepared semisolid bolus jelly containing 99mTc-sulfur colloid. Dynamic studies were acquired in anterior projection with single swallow for both supine and sitting positions. T90% esophageal emptying time (EET) was calculated for whole and three equally divided segments of esophagus and also done with liquid bolus on different day. Results: The median value of EET for semisolid bolus for whole esophagus in sitting and supine positions was 11.7 s (interquartile range [IQR]: 8.0-16.7) and 17.7 s (IQR: 12.0-33.0). EET of liquid bolus for whole esophagus in sitting and supine positions was 9.3 s (IQR: 8.0-13.3) and 13.0 s (IQR: 9.7-25.0), respectively. Significantly different EET for whole esophagus and lower one-third esophagus between sitting and supine positions was seen for semisolid (whole esophagus; P = 0.003, lower one-third esophagus; P = 0.025) and liquid boluses (whole esophagus; P = 0.032, lower one-third esophagus; P = 0.016). Comparing EET using semisolid and liquid boluses, only lower one-third esophagus in supine position showed significant difference (P = 0.033). Conclusions: In-house-prepared semisolid radiolabeled jelly is inexpensive, easy to prepare with good radiolabeling. Condensed dynamic images from semisolid bolus were better, sharper, and reproducible in comparison to liquid bolus without fragmentation. This study standardized semisolid bolus and verified its suitability for clinical use. [ABSTRACT FROM AUTHOR]