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Abstract: Abdominal-wall metastasis following laparoscopic surgery for colorectal cancer is rare. We describe FDG PET/MRI findings in a case of isolated abdominal incisional site metastasis after laparoscopic surgery for colon cancer. The abdominal-wall metastasis showed slight hyperintensity on T2-weighted fat-suppressed image and intense focal FDG uptake on PET. This case demonstrates the usefulness of FDG PET/MRI in detecting the atypical metastasis from colon cancer., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: We present a case of pancreatic ductal adenocarcinoma showing increased 68Ga-DOTATATE uptake mimicking neuroendocrine tumor on PET/CT. Immunohistochemical analyses of the resected tumor showed the tumor cells were negative for somatostatin receptor subtype 2. The nonneoplastic islets scattered throughout the tumor were positive for somatostatin receptor subtype 2, which may be responsible for the increased 68Ga-DOTATATE uptake. This case indicates that pancreatic ductal adenocarcinoma should be included in the differential diagnosis of the pancreatic lesions showing increased 68Ga-DOTATATE uptake., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: This study aimed to investigate the value of 68 Ga-fibroblast activation protein inhibitor (FAPI) PET/MR semiquantitative parameters in the prediction of tumor response and resectability after neoadjuvant therapy in patients with pancreatic cancer., Patients and Methods: This study was performed retrospectively in patients with borderline resectable or locally advanced pancreatic cancer who underwent 68 Ga-FAPI PET/MRI from June 2020 to June 2022. The SUV max , SUV mean , SUV peak , uptake tumor volume (UTV), and total lesion FAP expression (TLF) of the primary tumor were recorded. The target-to-background ratios (TBRs) of the primary tumor to normal tissue muscle (TBR muscle ) and blood (TBR blood ) were also calculated. In addition, the minimum apparent diffusion coefficient value of the tumor was measured. After 3-4 cycles of gemcitabine + nab-paclitaxel chemotherapy, patients were divided into responders and nonresponders groups according to RECIST criteria (v.1.1). They were also divided into resectable and unresectable groups according to the surgical outcome. The variables were compared separately between groups., Results: A total of 18 patients who met the criteria were included in this study. The UTV and TLF were significantly higher in nonresponders than in responders ( P < 0.05). The SUV max , SUV mean , and TBR muscle were significantly higher in unresectable patients than in resectable ones ( P < 0.05). Receiver operating characteristic curve analysis identified UTV (area under the curve [AUC] = 0.840, P = 0.015) and TLF (AUC = 0.877, P = 0.007) as significant predictors for the response to gemcitabine + nab-paclitaxel chemotherapy, with cutoff values of 25.05 and 167.38, respectively. In addition, SUV max (AUC = 0.838, P = 0.016), SUV mean (AUC = 0.812, P = 0.026), and TBR muscle (AUC = 0.787, P = 0.041) were significant predictors of the resectability post-NCT, with cutoff values of 14.0, 6.0, and 13.9, respectively. According to logistic regression analysis, TLF was found to be significantly associated with tumor response ( P = 0.032) and was an independent predictor of tumor response ( P = 0.032). In addition, apparent diffusion coefficient value was an independent predictor of tumor resectability ( P = 0.043)., Conclusions: This pilot study demonstrates the value of 68 Ga-FAPI PET/MR for the prediction of tumor response and resectability after neoadjuvant therapy. It may aid in individualized patient management by guiding the treatment regimens., Competing Interests: Conflicts of interest and sources of funding: The authors declare that they have no conflict of interest. We gratefully acknowledge the financial supports by the National Natural Science Foundation of China (grant no. 82172712), the “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (grant no. 2019YXK033, 2019YPT002, and 2020YPT002), and Guhai Plan in the 14th Five-Year Plan Period of Changhai Hospital (grant no. GH145-22)., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Inflammatory variant of well-differentiated liposarcoma is a rare subtype of liposarcoma, and its imaging features have been rarely reported. We describe FDG PET/CT findings in a case of well-differentiated inflammatory liposarcoma. The tumor showed no detectable fat and intense FDG uptake and caused diffuse FDG uptake of the bone marrow due to paraneoplastic leukemoid reaction. Microscopically, there were extensive inflammatory infiltrates in the tumor, which may contribute to the intense FDG uptake. This case indicates that although well-differentiated liposarcoma usually shows low-grade FDG uptake, inflammatory variant of well-differentiated liposarcoma can show intense FDG uptake mimicking high-grade liposarcoma., Competing Interests: Conflicts of interest and sources of funding: none declared. Conflicts of interest and sources of funding: none declared. This work was supported by The Most Important Research Center Construction Project of Shanghai (grant 2022ZZ01011)., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 23-year-old woman presenting with gross hematuria was found to have a left renal mass suspicious for renal cell carcinoma on abdominal contrast-enhanced CT. An 18 F-PSMA-1007 PET/CT scan was performed for evaluating the renal mass. 18 F-PSMA-1007 PET/CT showed focal activity of the renal mass, which was a transcription factor E3-rearranged renal cell carcinoma proved after nephrectomy. Surprisingly, diffuse heterogeneous intense activity of the bilateral breasts and moderate activity of the right accessory breast was observed. There was no morphological abnormality of the bilateral breasts and right accessory breast on CT images, indicating physiological PSMA uptake., Competing Interests: Conflicts of interest and sources of funding: This work was supported by the “Discipline Climbing 234 Plan For Disciplinary Platform Construction” of The First Affiliated Hospital of Naval Medical University (no. 2020YPT002) and The First Affiliated Hospital of Naval Medical University “Guhai Plan in the 14th Five-Year Plan Period” (grant no. GH145-22 and GH145XKQ-03)., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Solitary fibrous tumor arising from the seminal vesicle is very rare. We describe 18 F-PSMA-1007 PET/CT findings in a case of prostate adenocarcinoma with a solitary fibrous tumor of the left seminal vesicle. The solitary fibrous tumor showed intense 18 F-PSMA-1007 uptake mimicking metastatic prostate adenocarcinoma. This case indicates that solitary fibrous tumor may cause false-positive result when using PSMA PET in staging of prostate cancer., Competing Interests: Conflicts of interest and sources of funding: none declared. Conflicts of interest and sources of funding: The authors have no conflicts of interest to declare. This work was supported by “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (grant no. 2019YPT002 and 2020YPT002) and The First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital) “Guhai Plan in the 14th Five-Year Plan Period” (grant no. GH145XKQ-03)., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 64-year-old man was referred for 18 F-PSMA-1007 PET/CT scan for initial staging of biopsy-proved prostate adenocarcinoma. 18 F-PSMA-1007 PET/CT showed focal intense 18 F-PSMA-1007 of the prostate adenocarcinoma and a focal intense activity with SUV max of 10.5 in the left ilium. The 18 F-PSMA-1007-avid iliac bone lesion corresponded to a hemangioma, which was initially detected on pelvic MRI 13 months ago and remained stable in size. This case indicates that hemangioma should be included in the differential diagnosis of PSMA-avid iliac bone lesions., Competing Interests: Conflicts of interest and sources of funding: none declared. This work was supported by “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (grant no. 2019YPT002 and 2020YPT002) and The First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital) “Guhai Plan in the 14th Five-Year Plan period” (grant no. GH145XKQ-03)., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: In this study, we evaluated and compared the diagnostic performances of 68 Ga-FAPI-04 PET/CT and 18 F-FDG PET/CT for primary and metastatic cholangiocarcinoma (CCA) lesions. We also investigated the performance of PET/MR for visualizing and characterizing CCA and liver metastasis lesions., Patients and Methods: Forty-four patients with suspected CCA were recruited and underwent 68 Ga-FAPI-04 and 18 F-FDG PET/CT within 1 week, including 30 patients who underwent simultaneous abdominal 68 Ga-FAPI-04 PET/MR scanning. The findings were confirmed by histopathology or radiographic follow-up., Results: Compared with 18 F-FDG PET/CT, 68 Ga-FAPI-04 PET/CT showed higher sensitivity (94.3% vs 88.6%) and the same accuracy (86.4% vs 86.4%) in evaluating primary tumors. However, its specificity was lower (55.6% vs 77.8%). 68 Ga-FAPI-04 PET was superior to 18 F-FDG PET in both patient-based and lesion-based evaluations except for metastatic lesions in the liver and bone. For intrahepatic CCA, 68 Ga-FAPI-04 PET/CT and 18 F-FDG PET/CT (100% vs 100%) had similar detection rates, with similar uptake levels between tracers ( P > 0.05). However, for extrahepatic CCA, 68 Ga-FAPI-04 PET/CT had a higher detection rate (89.5% vs 78.9%), and 68 Ga-FAPI-04 had a higher uptake ( P < 0.05). PET/MR was more effective than PET/CT in terms of lesion conspicuity and diagnostic confidence for primary tumors and liver metastases. In addition, multisequence MRI identified more liver metastases than 68 Ga-FAPI-04 PET/CT and 18 F-FDG PET/CT., Conclusions: Compared with 18 F-FDG PET/CT, 68 Ga-FAPI-04 PET/CT showed a higher sensitivity in detecting primary CCA tumors, involved lymph nodes, and peritoneal metastases. Compared with 68 Ga-FAPI-04 PET/CT, PET/MR detected primary and liver metastatic lesions more accurately. For extrahepatic CCA, the combination of 68 Ga-FAPI-04 PET/CT and abdominal PET/MRI may replace 18 F-FDG PET/CT., Competing Interests: Conflicts of interest and sources of funding: The authors declare that they have no conflicts of interest. The authors received financial support of the National Natural Science Foundation of China (grant no. 82172712) and the “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (grant no. 2019YXK033, 2019YPT002, and 2020YPT002)., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Hemosiderosis is a chronic condition characterized by abnormal iron accumulation in tissues. In a PET scan of a 37-year-old woman, we observed an irregular distribution of 68 Ga-DOTATATE in the liver and spleen. Specifically, 68 Ga-DOTATATE appeared to be concentrated primarily in the peripheral regions of these organs, creating a distinctive "shell-like" appearance. This peculiar pattern may be attributed to the substantial accumulation of hemosiderin in the liver and spleen., Competing Interests: Conflicts of interest and sources of funding: This work is supported by the “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (grant no. 2019YPT002 and 2020YPT002), the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital) “Guhai Plan in the 14th Five-Year Plan period” (GH145–22). The authors declared no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 77-year-old man was referred for 18 F-PSMA-1007 PET/CT scan for initial staging of biopsy-proved prostate adenocarcinoma. 18 F-PSMA-1007 PET/CT showed focal intense 18 F-PSMA-1007 of the prostate adenocarcinoma and a focal intense activity (SUV max , 27) in the spleen. The 18 F-PSMA-1007-avid splenic lesion corresponded to a splenic hemangioma, which was initially detected on contrast-enhanced CT 7 months ago and unchanged in size and enhancement pattern on follow-up contrast-enhanced CT. This case indicates that splenic hemangioma should be included in the differential diagnosis of PSMA-avid splenic lesions., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 37-year-old man was admitted to our hospital after experiencing syncope. An MRI of his head revealed multiple foci of abnormal signal, which could potentially be metastases. The patient then underwent a 68 Ga-FAPI-04 PET/MRI examination, which revealed multiple FAPI-avid foci in the brain. Upon analyzing the cerebrospinal fluid, it was found that the patient had a Staphylococcus aureus infection. The results suggest that 68 Ga-FAPI-04 PET has the potential to be a valuable tool in the visualization of intracranial infectious lesions., Competing Interests: Conflicts of interest and sources of funding: This work is supported by the “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (grants 2019YPT002 and 2020YPT002). None declared to all authors., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 51-year-old woman with a history of IgA nephropathy was found to have a mass in the right lobe of the liver by abdominal ultrasound. The PET/CT scan revealed elevated 68 Ga-FAPI-04 uptake in the aforementioned lesion, indicating the potential presence of liver cancer. However, subsequent histopathological analysis confirmed it to be an arteriovenous malformation. This case illustrates that 68 Ga-FAPI-04 uptake can occur in arteriovenous malformation and is a benign cause of 68 Ga-FAPI-04 uptake., Competing Interests: Conflicts of interest and sources of funding: All the authors declared no conflicts of interest. This work is supported by the “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (grant no. 2019YPT002 and 2020YPT002)., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: We describe 18 F-PSMA-1007 PET/CT findings in case of von Hippel-Lindau syndrome with a cerebellar hemangioblastoma, 6 renal cell carcinomas in the bilateral kidneys, cystic lesions in the pancreas and left adrenal gland, and solid lesions in the bilateral epididymides. 18 F-PSMA-1007 PET/CT showed intense activity with SUV max of 111.3 of the cerebellar hemangioblastoma, variable activity with SUV max range of 6.4-37.6 of the renal cell carcinomas, and increased activity of the bilateral epididymal lesions (SUV max of 5.1 and 8.2 for the left and right epididymal lesions, respectively)., Competing Interests: Conflicts of interest and sources of funding: The authors declare no conflicts of interest. This work was supported by The First Affiliated Hospital of Naval Medical University “Guhai Plan in the 14th Five-Year Plan Period” (no. GH145XKQ-03) and Shanghai Hospital Development Center (no. SHDC12023103)., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: We describe FDG PET/CT findings in a case of isolated skull metastasis with spiculated periosteal reaction from rectal mucinous adenocarcinoma 8 years after proctectomy. The skull metastasis showed heterogeneous FDG uptake and multiple short spicules of bone producing the sunburst appearance resembling primary osteosarcoma or Ewing sarcoma. Familiarity with this atypical imaging appearance of the bone metastasis from rectal cancer may be helpful for the diagnosis and differential diagnosis., Competing Interests: Conflicts of interest and sources of funding: This work was supported by a grant from the General Program of Shanghai Municipal Health Commission (grant 202040414)., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Malacoplakia is a rare chronic granulomatous disease and frequently associated with Escherichia coli infection. We describe the contrast-enhanced CT and FDG PET/CT findings in a case of bladder and ureteral malakoplakia with E. coli urinary tract infection. Contrast-enhanced CT showed multiple enhancing mural nodules in the bladder and left ureter, ranging from several millimeters to 3.1 cm. The ureteral nodules showed significantly increased FDG uptake with SUVmax of 20.4, due to histiocyte, lymphocyte, and plasma cell infiltrates revealed by histopathology., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Isolated peritoneal metastasis of prostate cancer is extremely rare. We present 68Ga-PSMA-11 PET/CT findings in a case of isolated parietal peritoneal metastasis from prostate adenocarcinoma 35 months after radical prostatectomy. The peritoneal metastases showed multifocal intense PSMA uptake, but subtle structural abnormalities on 68Ga-PSMA-11 PET/CT. The patient was subsequently treated with androgen deprivation therapy. The peritoneal metastases progressed 25 months after the initiation of androgen deprivation therapy and were removed surgically. Histologic and immunohistochemical evaluation revealed metastatic prostate adenocarcinoma with treatment-related neuroendocrine differentiation. This case demonstrates the usefulness of 68Ga-PSMA-11 PET/CT in identifying atypical metastasis from prostate adenocarcinoma., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Renal oncocytosis is a very rare oncologically indolent form of renal neoplasia characterized by diffuse involvement of renal parenchyma by numerous oncocytic nodules. We describe contrast-enhanced CT and 99m Tc-MIBI SPECT/CT findings in a patient with renal oncocytosis presenting with metachronous bilateral renal tumors. Contrast-enhanced CT showed numerous tumors ranging from several millimeters up to 3.9 cm in the left kidney. The tumors showed hypervascularity in the corticomedullary phase and washout in the excretory phase mimicking renal cell carcinoma. The larger tumors showed higher 99m Tc-MIBI uptake than the adjacent renal parenchyma, suggesting renal oncocytoma confirmed by biopsy., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Prostate-specific membrane antigen (PSMA) PET findings of mixed ductal-acinar adenocarcinoma of the prostate are rarely reported. We describe 18 F-PSMA-1007 PET/CT and delayed pelvic 18 F-PSMA-1007 PET/MRI findings in a case of prostatic mixed ductal-acinar adenocarcinoma with multiple lymph node and bone metastases. The primary tumor showed heterogeneous PSMA uptake. The metastases in the right ilium and acetabulum showed intense PSMA uptake, but the pelvic lymph node and left iliac bone metastases showed no significant PSMA uptake. Knowledge of the intraprimary and intermetastatic heterogeneity of PSMA uptake in mixed ductal-acinar adenocarcinoma of the prostate may be helpful for accurate interpretation., Competing Interests: Conflicts of interest and sources of funding: This work was supported by “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (grants 2019YPT002 and 2020YPT002). The authors have no conflicts to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 46-year-old man underwent PET/CT for metastatic survey 6 years after radical resection of pancreatic cancer. In addition to the increased uptake observed in the operative area, increased FDG uptake was also observed in the left external abdominal oblique muscle and the left frontal scalp. Both intramuscular and subcutaneous lesions were surgically excised and diagnosed as metastases from pancreatic cancer., Competing Interests: Conflicts of interest and sources of funding: This work is supported by the “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (grant no. 2019YPT002 and 2020YPT002). The authors have no conflicts to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Extrarenal retroperitoneal angiomyolipomas are rare benign tumors that may mimic other benign or malignant retroperitoneal tumors. We describe 68 Ga-FAPI-04 PET/MRI findings in a case of tuberous sclerosis complex with an extrarenal retroperitoneal angiomyolipoma and multiple angiomyolipomas involving bilateral kidneys. The extrarenal retroperitoneal angiomyolipoma and most of the renal angiomyolipomas were 68 Ga-FAPI-04-avid. One left renal angiomyolipoma with extensive hemorrhage and fibrosis had no significant 68 Ga-FAPI-04 uptake. Angiomyolipoma should be included in the differential diagnosis of FAPI-avid renal or extrarenal retroperitoneal lesions., Competing Interests: Conflicts of interest and sources of funding: This work was supported by the 234 Discipline Climbing Plan of the First Affiliated Hospital of Naval Medical University (grants 2019YPT002 and 2020YPT002). The authors have no conflicts to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 75-year-old woman presented with right lower abdominal pain. Pelvic ultrasound showed a cystic solid mass in the right adnexa. Painless enlarged lymph nodes on the left supraclavicular side with biopsy were suggestive of metastatic cancer. 18F-FDG PET/CT performed to evaluate the primary tumor showed intense uptake in both regions of the right adnexa and the gastric sinus, but 68Ga-FAPI PET/MRI showed uptake only in the right adnexal region. A subsequent gastroscopic biopsy confirmed atrophic inflammation. Finally, surgery histopathology revealed ovarian cancer. This case demonstrated that 68Ga-FAPI PET/MRI may help exclude suspected primary gastric carcinoma with false-positive 18F-FDG uptake., Competing Interests: Conflicts of interest and sources of funding: This work was financially supported by Discipline Construction Climbing 234 Plan of First Affiliated Hospital of Naval Medical University (grants 2019YPT002 and 2020YPT002). The authors have no conflicts to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Sarcomatoid renal cell carcinoma is an uncommon high-grade malignancy with poor prognosis. We describe 68 Ga-FAPI-04 PET/CT findings in a patient with a small (1.8 cm in the maximum diameter) sarcomatoid clear cell renal cell carcinoma with widespread metastatic disease. Both the primary renal tumor and its metastases in bones, lymph nodes, adrenals, and liver showed increased 68 Ga-FAPI-04 uptake. The primary renal tumor showed hypovascularity on contrast-enhanced CT, mimicking papillary renal cell carcinoma. This case indicates FAPI PET/CT may be useful for detecting and staging of this unusual malignancy., Competing Interests: Conflicts of interest and sources of funding: The authors have no conflicts of interest to report. This work was supported by 234 Discipline Climbing Plan of the First Affiliated Hospital of Naval Medical University (grants 2019YPT002 and 2020YPT002)., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Somatostatin receptor imaging findings of pancreatic neuroendocrine tumor with diffuse involvement of the pancreas are rarely reported. We present somatostatin receptor PET imaging findings in 3 cases of diffuse pancreatic neuroendocrine tumor. One case showed diffuse swelling and diffusely intense activity of the pancreas with multiple metastases in the peripancreatic lymph nodes and liver. The other 2 cases showed diffusely intense activity of the pancreas without metastasis. The pancreatic tumor extended into the duodenum in all the 3 cases. Familiarity with this rare pattern of radiotracer uptake in pancreatic neuroendocrine tumor may be helpful for the diagnosis., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Primary angiosarcoma of the kidney is a rare aggressive malignancy. We describe MRI and FDG PET/CT findings in a case of primary renal angiosarcoma with hepatic, pulmonary, and bony metastases. The large primary tumor showed extensive necrosis and increased FDG uptake in the nonnecrotic components. Multiple metastatic lesions in the liver, lung, and bones were detected by FDG PET/CT. Most of the hepatic metastases seen on MRI were missed on FDG PET/CT due to low FDG avidity., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Primary or secondary rectal linitis plastica is rare. We describe MRI, 68 Ga-PSMA-11 PET/CT, and PET/MRI findings in a case of rectal linitis plastica secondary to prostate adenocarcinoma. In this case, the rectal linitis plastica was the first manifestation of the prostatic adenocarcinoma, and the rectum was the only metastatic site of the prostate adenocarcinoma. The rectal wall showed circumferential thickening with a concentric ring pattern on MRI, and diffuse intense 68 Ga-PSMA-11 uptake on PET/CT and PET/MRI. Familiarity with the imaging findings of rectal linitis plastica secondary to prostate adenocarcinoma may be helpful for recognition of this rare entity., Competing Interests: Conflicts of interest and sources of funding: The authors declare that they have no conflict of interest. This work was supported by the “Discipline Climbing 234 Plan for Disciplinary Platform Construction” of Changhai Hospital of Navy Medical University (no. 2020YPT002) and Advanced Appropriate Technology Promotion Project of Shanghai Health System (no. 2019SY029)., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 65-year-old man presented with abdominal bloating for approximately 4 weeks. After CT imaging, it was diagnosed as gastric carcinoma with hepatic metastasis. 68Ga-FAPI-04 PET/CT revealed much higher tumor-to-background contrast and more metastatic lesions compared with 18F-FDG PET/CT in this case. Following gastroscopy and pathological examination, the final diagnosis was malignant gastrointestinal stromal tumor. This case demonstrated that 68Ga-FAPI-04 PET/CT was more sensitive than 18F-FDG PET/CT for detecting primary and metastatic lesions in malignant gastrointestinal stromal tumor., Competing Interests: Conflicts of interest and sources of funding: The authors declare that they have no conflicts of interest. This work was supported by the “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (grant 2019YPT002, and 2020YPT002)., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Two hepatic masses were discovered through ultrasonography in a 50-year-old man with increased CA19-9, which is highly suspicious for malignancy. PET/CT images revealed intense 18 F-FDG and 68 Ga-FAPI-04 uptake in intrahepatic lesions. Histopathology with biopsy confirmed the diagnosis of immunoglobulin G4 (IgG4)-related disease. Here, we reported a case of IgG4-related primary localized pseudotumor without any other organ involvement. We concluded that in clinical work, if intrahepatic masses show high uptake of 18 F-FDG or 68 Ga-FAPI-04, intrahepatic IgG4-related disease should be considered for differential diagnosis., Competing Interests: Conflicts of interest and sources of funding: The authors declare that they have no conflicts of interest. This work is supported by the “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (grant no. 2019YPT002 and 2020YPT002). None declared to all authors., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: We describe 68 Ga-FAPI (fibroblast activation protein inhibitor)-04 and 18 F-FDG PET/CT findings in a case with epithelioid malignant pleural mesothelioma. Compared with 18 F-FDG PET/CT, 68 Ga-FAPI-04 PET/CT more clearly showed the pleural tumors and lymph node metastases and detected more pleural lesions because the tumors showed higher 68 Ga-FAPI-04 activity. This case indicates that 68 Ga-FAPI-04 PET/CT may be a promising new tool in evaluation of malignant pleural mesothelioma, which needs further investigation., Competing Interests: Conflicts of interest and sources of funding: The authors declare that they have no conflicts of interest. This work was supported by “Discipline Climbing 234 Plan for Disciplinary Platform Construction of Changhai Hospital of Navy Medical University” (grants 2019YPT002 and 2020YPT002)., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: FAPI PET/CT findings of renal tumors have been rarely reported. We describe 68 Ga-FAPI-04 PET/CT findings in 1 case with lipid-poor renal angiomyolipoma and 1 case with high-grade clear cell renal cell carcinoma. Both tumors showed intense 68 Ga-FAPI-04 uptake. These 2 cases indicate that lipid-poor renal angiomyolipoma should be included in the differential diagnosis of FAPI-avid renal tumors., Competing Interests: Conflicts of interest and sources of funding: The authors declare that they have no conflicts of interest. This work was supported by “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (grants 2019YPT002 and 2020YPT002)., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Prostate-specific membrane antigen (PSMA) PET findings of urothelial carcinoma were rarely reported. We describe 18 F-FDG PET/CT and 68 Ga-PSMA-11 PET/MRI findings in a case of urothelial carcinoma of the bladder with bone metastases in the sternum, ribs, spine, pelvis, and femurs. The bone metastases showed isodensity to hyperdensity and mild to intense FDG uptake on FDG PET/CT and moderate to intense PSMA uptake on PSMA PET/MRI. PSMA PET/MRI more clearly delineated the bone metastases compared with FDG PET/CT., Competing Interests: Conflicts of interest and sources of funding: none declared. C.Z. was supported by Discipline Climbing 234 Plan for Disciplinary Platform Construction of Changhai Hospital of Navy Medical University (grants 2019YPT002 and 2020YPT002)., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: 68 Ga-FAPI-04 has great potential for the detection and staging evaluation of a variety of tumors. We report a case of suspected gallbladder carcinoma that was enrolled in a prospective study of 68 Ga-FAPI-04 imaging at our institution. This case was later histopathologically confirmed as xanthogranulomatous cholecystitis. This demonstrates that xanthogranulomatous cholecystitis might be disguised as gallbladder carcinoma in 68 Ga-FAPI-04 imaging. Thus, we suggest that nuclear clinicians evaluating 68 Ga-FAPI-04 imaging should be aware of this possibility., Competing Interests: Conflicts of interest and sources of funding: none declared. This work is supported by the “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (grants 2019YPT002 and 2020YPT002)., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Intraventricular metastasis from extracranial tumor is rare. We describe MRI and 68Ga-FAPI-04 PET/CT findings in a case of histologically proved solitary choroid plexus metastasis from clear cell renal cell carcinoma. The tumor showed remarkable enhancement on MRI and increased FAPI uptake with high tumor-to-background activity ratio on PET/CT. This case indicates FAPI PET may be useful for detection of intraventricular metastasis from renal cell carcinoma., Competing Interests: Conflicts of interest and sources of funding: none declared. This work was supported by “Discipline Climbing 234 Plan for Disciplinary Platform Construction of Changhai Hospital of Navy Medical University” (grant numbers 2019YPT002 and 2020YPT002)., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 10-year-old girl with a right renal mass underwent 18 F-FDG PET/CT and 68 Ga-FAPI-04 PET/MRI for presurgical assessment of tumor invasion and malignant potential. The mass showed low 18 F-FDG uptake and intense 68 Ga-FAPI-04 uptake. Nephrectomy was performed, and the histopathologic diagnosis was aggressive PEComa (perivascular epithelioid cell tumor). This case showed that 68 Ga-FAPI-04 PET outperformed 18 F-FDG PET in detecting aggressive PEComa., Competing Interests: Conflicts of interest and sources of funding: none declared. This work is supported by the “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (grant 2019YPT002, and 2020YPT002)., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Prostatic ductal adenocarcinoma is an uncommon variant of prostatic carcinoma with aggressive behavior and worse prognosis. We describe 68 Ga-PSMA-11 and FDG PET/CT findings in a case of prostatic ductal adenocarcinoma with pelvic lymph node metastases. The majority of the prostate tumor and all the metastatic lesions showed no significant PSMA uptake but intense FDG uptake. The role of PSMA and FDG PET in the management of prostatic ductal adenocarcinoma needs to be investigated in a large number of patients., Competing Interests: Conflicts of interest and sources of funding: none declared. C.Z. was supported by “Discipline Climbing 234 Plan for Disciplinary Platform Construction of Changhai Hospital of Navy Medical University” (grant numbers 2019YPT002 and 2020YPT002)., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A space-occupying lesion in the left renal pelvis was found in a 56-year-old man. The patient voluntarily participated in a clinical trial of 68 Ga-FAPI in solid tumors. PET/CT images revealed an intense 18 F-FDG and 68 Ga-FAPI uptake in this lesion. Malignant tumor was suspected. The patient subsequently underwent laparoscopic partial nephrectomy. The postoperative pathological examination established the diagnosis of immunoglobulin G4-related disease., Competing Interests: Conflicts of interest and sources of funding: This work is supported by the “234 Discipline Climbing Plan” of the First Affiliated Hospital of Naval Medical University (grant 2019YPT002, and 2020YPT002). The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Intimal sarcoma of the pulmonary artery is a rare entity, mimicking acute or chronic pulmonary thromboembolism. We describe 68 Ga-FAPI-04 and 18 F-FDG PET/CT findings in a case with intimal sarcoma of the pulmonary artery. The intrapulmonary artery tumor showed inhomogeneously increased FDG and FAPI uptake. Compared with FDG PET/CT, FAPI PET/CT more clearly delineated the tumor partially because of a very low background FAPI activity in the walls of the main pulmonary artery and right ventricle, which showed diffuse FDG uptake., Competing Interests: Conflicts of interest and sources of funding: This work was supported by “Discipline Climbing 234 Plan For Disciplinary Platform Construction of Changhai Hospital of Navy Medical University” (grant numbers: 2019YPT002 and 2020YPT002). The authors have no conflicts of interest to declare., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Primary urothelial-type adenocarcinoma of the prostate is extremely rare. We describe FDG PET/CT findings in a case with primary poorly differentiated urothelial-type adenocarcinoma of the prostate with pelvic lymph node metastases. Both the prostate tumor and its metastatic lesions showed intense FDG uptake. The patient had normal serum prostate-specific antigen and elevated carcinoembryonic antigen levels, which may be helpful for the differential diagnosis., Competing Interests: Conflicts of interest and sources of funding: C.Z. was supported by “Discipline Climbing 234 Plan for Disciplinary Platform Construction of Changhai Hospital of Navy Medical University” (grant numbers 2019YPT002 and 2020YPT002). Y.Z. was supported by “Discipline Climbing 234 Plan for Disciplinary Platform Construction of Changhai Hospital of Navy Medical University” (grant number 2019YPT003). A.D. has no conflicts of interest and sources of funding to declare., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Peutz-Jeghers syndrome is a rare inherited hamartomatous polyposis syndrome. We describe 68 Ga-FAPI-04 and 18 F-FDG PET/CT findings in a case of Peutz-Jeghers syndrome with primary duodenal clear cell sarcoma, peritoneal metastases, and multiple intestinal polyps varying in size. The duodenal tumor and its metastases showed increased FDG and FAPI uptake. The peritoneal metastases were delineated more clearly on FAPI PET/CT compared with FDG PET/CT. More interestingly, the intestinal polyps showed increased FDG uptake and no FAPI uptake., Competing Interests: Conflicts of interest: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Primary mucinous tumors involving the prostate gland are rare. We describe MRI and 18F-PSMA-11 PET/MRI findings in a case of prostate adenocarcinoma with mucinous features. The prostate tumor showed inhomogeneous hyperintensity on T2-weighted images due to high extracellular mucin content and inhomogeneous 18F-PSMA-11 uptake with SUVmax of 12.5. This case indicates PSMA PET imaging may be helpful for detection of this uncommon variant of prostate adenocarcinoma., Competing Interests: Conflicts of interest and sources of funding: This work was supported by the “Discipline Climbing 234 Plan for Disciplinary Platform Construction” of Changhai Hospital of Navy Medical University (no. 2020YPT002) and Advanced Appropriate Technology Promotion Project of Shanghai Health System (no. 2019SY029). None declared to all authors., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Renal metastasis from adenoid cystic carcinoma of the head and neck is uncommon. We present 99mTc-MIBI SPECT/CT and FDG PET/CT findings in a case with isolated bilateral renal metastases from adenoid cystic carcinoma of the left maxilla. The metastatic adenoid cystic carcinomas of the kidneys showed photopenia on 99mTc-MIBI SPECT/CT and increased FDG uptake on FDG PET/CT mimicking primary renal cell carcinoma., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Isolated osseous Rosai-Dorfman disease is rare. We describe FDG PET/CT findings of solitary thoracic vertebral Rosai-Dorfman disease without extraosseous involvement. The vertebral lesion caused osteolytic destruction of the vertebral body and showed intense FDG uptake., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 65-year-old man with treated prostate adenocarcinoma underwent 68Ga-PSMA-11 PET/CT scan for restaging due to significantly increased serum PSA levels. PET/CT showed bilateral adrenal masses with high 68Ga-PSMA-11 uptake. There was no other lesion suspicious for metastasis. The laboratory and imaging findings were consisted with isolated bilateral adrenal metastases from prostate adenocarcinoma. The patient received docetaxel chemotherapy in combination with androgen deprivation therapy. PSA levels gradually decreased during chemotherapy. Follow-up MRI showed the bilateral adrenal masses significantly decreased in size. This case demonstrates the usefulness of 68Ga-PSMA-11 PET/CT in identifying atypical metastasis from prostate adenocarcinoma., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Significant 68Ga-PSMA-11 activity is commonly observed in the lacrimal and salivary glands on PSMA PET/CT. An 80-year-old man after radical prostatectomy was evaluated with 68Ga-PSMA-11 PET/CT. There was no obvious PSMA uptake in the bilateral lacrimal, parotid, and submandibular glands. Subsequently, based on laboratory examination results and 99mTcO4 salivary gland scintigraphy, this patient was diagnosed with Sjögren syndrome, which accounted for the absence of uptake by the glands. This case showed the potential of 68Ga-PSMA-11 PET/CT in the evaluation of the lacrimal glands and major salivary glands., Competing Interests: Conflicts of interest and sources of funding: This work was supported by the “Discipline Construction Climbing 234 Plan” of Changhai Hospital of Naval Medical University (Second Military Medical University) (no. 2019YPT002) and Shanghai Advanced Appropriate Technology Promotion Projects (no. 2019SY029). None declared to all authors., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The aim of this study was to investigate the value of dual-phase Tc-MIBI SPECT/CT in the differential diagnosis between benign and malignant enhancing solid renal tumors., Patients and Methods: Totally, 180 patients were imaged with dual-phase Tc-MIBI SPECT/CT, which was performed 30 minutes and 90 minutes after Tc-MIBI administration. Among them, 147 patients with 148 histologically proved solid renal tumors met the selection criteria and were included for the final analysis. Relative quantification was performed by measuring the radioactive uptake ratio of tumor to the normal renal parenchymal background for both early and delayed images., Results: Benign renal tumors (4 renal oncocytomas and 8 lipid-poor angiomyolipomas) demonstrated a significantly higher early relative uptake value (ERUV) and delayed relative uptake value (DRUV) than malignant renal tumors (n = 136; both P < 0.0001). The ERUV cutoff value of 0.53 helped to differentiate benign from malignant renal tumors, with sensitivity of 100%, specificity of 94.8%, and accuracy of 95.3% for the diagnosis of benign renal tumors. The DRUV cutoff value of 0.50 helped to differentiate benign from malignant renal tumors, with sensitivity of 100%, specificity of 96.3%, and accuracy of 96.6% for the diagnosis of benign renal tumors. There was no statistically significant difference between the efficacy of ERUV and DRUV in the differential diagnosis between benign and malignant renal tumors (P = 0.5). The efficacies of ERUV and DRUV were all significantly higher than the retention index (both P < 0.0001)., Conclusions: Both early and delayed phase Tc-MIBI SPECT/CT are helpful for distinguishing benign renal oncocytoma and lipid-poor angiomyolipoma from malignant renal tumors, and the delayed phase imaging tends to show higher diagnostic accuracy.

We present 2 cases of pancreatic neuroendocrine tumor with diffuse involvement of the entire pancreas. One case with G2 pancreatic neuroendocrine tumor showed nearly normal pancreatic shape and signal intensity on MRI, normal pancreatic FDG uptake, and diffuse pancreatic Ga-DOTATOC uptake. The other case with G3 pancreatic neuroendocrine tumor showed diffusely enlarged pancreas with abnormal MR signal intensity and increased FDG uptake. These 2 cases indicate that neuroendocrine tumor should be included in the differential diagnosis of diffuse pancreatic diseases. Somatostatin receptor imaging may be helpful for the diagnosis of diffuse pancreatic neuroendocrine tumor in equivocal cases.

Cat scratch disease (CSD) is a rare zoonotic infection disease, and the imaging performance for evaluation varies. We present FDG PET/CT images of two cases of CSD. In one case, images showed typical findings of regional lymph node enlargement. In another case, images showed atypical findings of extensive superficial and deep lymph node enlargement.

A 49-year-old woman complained of right upper back pain for 1 month. Serum tests showed increased erythrocyte sedimentation rate. Thoracic spinal MRI showed an epidural lesion at the T1-T4 level with inhomogeneous signal intensity on T2-weighted images, slightly higher signal intensity than spinal cord on T1-weighted images, and remarkable enhancement on enhanced T1-weighted images. Epidural malignant tumor was suspected. FDG PET/CT was performed showing increased FDG uptake of the lesion extending to the right T1-T2 and T2-T3 neural foramina. A decompressive posterior thoracic laminectomy with the lesion resection was performed. Immunoglobulin G4-related spinal hypertrophic pachymeningitis was confirmed by pathology.

Clinically, renal metastasis from esophageal squamous cell carcinoma is uncommon. We present 2 cases of renal metastasis from esophageal squamous cell carcinoma with enhanced CT and FDG PET/CT findings. In the first case, right kidney and right renal hilum were the only known metastatic sites. In the second case, bilateral kidneys were the only known metastatic sites. All the renal metastatic tumors appeared as hypovascular and hypoattenuating masses involving both the renal cortex and medulla on enhanced CT and intense FDG uptake on FDG PET/CT.

Primary splenic angiosarcoma is rare. A 44-year-old man presented with abdominal distension and malaise for 7 months. Laboratory tests showed anemia. Abdominal ultrasound showed enlargement of the spleen with multiple hypoechoic nodules. These nodules showed progressive enhancement on dynamic enhanced CT. Lymphoma was suspected. FDG PET/CT showed increased nonuniform FDG uptake with SUVmax of 11.6 of the entire spleen. Laparoscopic splenectomy was performed. The pathologic findings were consisted with angiosarcoma with replacement of the spleen. Eight months after surgery, multiple hepatic metastases were detected by follow-up abdominal CT.

A 46-year-old man with over a 10-year history of gout complained of progressive bilateral buttock pain with numbness of legs for 4 months. Serum uric acid level was elevated. Lumbar radiographs showed decreased density of the bilateral L4-L5 facet joints. CT showed lytic lesions of the facet joints with hyperdense periarticular lesions. Enhanced MRI showed marked enhancement of these lesions. FDG PET/CT showed avid FDG uptake of the bony and periarticular lesions with SUVmax of 16.8. A decompressive posterior lumbar laminectomy with periarticular lesion resection was performed. Histopathologic findings of the periarticular lesions were consistent with tophaceous gout.