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A 65-year-old male patient with a one year history of liver transplantation was referred for an 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) to rule out post transplant lymphoproliferative disease. Multiple foci of intense abnormal 18F-FDG uptake were seen in the transplanted liver which were concerning for malignancy. Explantation of the liver approximately 1 month following the PET/CT revealed multiple inflammatory and ischemic changes including large bile duct necrosis, acute cholangitis, bile duct obstruction changes and periportal fibrosis, with no evidence of malignancy. We present the 18F-FDG PET/CT image findings of this case.

A 74-year-old man recently diagnosed with high-risk prostate cancer with high serum prostate specific antigen was referred to nuclear medicine for a technetium-99m-methylene diphosphonate (Tc-99m MDP) bone scan. On delayed three-hour anterior planar image, an unexpected round focus of intense uptake was found overlying the right orbit. Single-photon emission computed tomography/computed tomography localized the uptake to an ocular prosthesis. The hydroxyapatite composition of the ocular implant can be recognized by its bone-like density and its intense accumulation of Tc-99m MDP. Review of the patient’s history revealed remote right eye evisceration secondary to a complication of cataract surgery, consistent with the findings.Yakın zamanda yüksek riskli prostat kanseri tanısı almış, serum prostat spesifik antijen seviyesi yüksek 74 yaşında bir erkek hasta teknesyum-99mmetilen difosfonat (Tc-99m MDP) kemik sintigrafisi için nükleer tıp bölümüne yönlendirildi. Gecikmiş üç saatlik anterior planar görüntüde sağ orbita üzerinde beklenmeyen yuvarlak ve yoğun tutulum odağı saptandı. Tek-foton emisyon bilgisayarlı tomografi/bilgisayarlı tomografi tutulumu oküler protezde lokalize etti. Oküler implantın hidroksiapatit bileşeni kemiğe benzer dansite ve yoğun Tc-99m MDP tutulumu ile tanınabilir. Hastanın özgeçmişinde, bulgularla uyumlu şekilde, katarakt cerrahisi komplikasyonuna sekonder sağ göz eviserasyonu saptandı.

A 60-year-old female with no significant medical history presented with hematuria. A computed tomography (CT) scan revealed extensive lymphadenopathy with hypodensities in the liver and spleen, and she was referred for anTıbbi anamnezinde özellik olmayan 60 yaşında bir kadın hematüri ile başvurdu. Bilgisayarlı tomografide (BT) yaygın lenfadenopatiyle birlikte karaciğer ve dalakta hipodens alanlar saptanması üzerine primeri bilinmeyen malignite değerlendirilmesi amacıyla 18F-fluorodeoksiglukoz (18F-FDG) pozitron emisyon tomografisi/BT (PET/BT) için yönlendirildi. PET/BT’de 18F-FDG tutan yaygın lenfadenopatiler ve ölçülemeyecek kadar fazla yoğun 18F-FDG tutan akciğer, karaciğer ve dalak nodülleri saptandı, malignite açısından şüpheli bulundu. PET-kılavuzluğunda posterior superior spina iliacadan yapılan kemik iliği biyopsisinde sarkoidoz ile uyumlu non-kazeifiye granülomlar saptandı. Hasta konservatif olarak takip edildi ve 9 yıllık takip süresinde klinik sorun oluşmadı.

Radioactive iodine (RAI) treatment of differentiated thyroid cancer has been used in clinical practice for almost 60 years and is generally accepted to be a safe and efficacious treatment. Severe toxicity in the form of radiation pneumonitis, sometimes progressing to fibrosis, and bone marrow suppression are reported but remain rare. We present a case of severe myelosuppression requiring hospitalization and transfusion support in an otherwise well, young female patient who had received 175 mCi I-131 for low-volume micronodular lung disease one month prior, with a cumulative lifetime administered activity of 575 mCi. The most important risk factors for myelosuppression following RAI are the activity received, the amount of functioning thyroid tissue present, and the lifetime cumulative activity received.Radyoaktif iyot (RAİ) diferansiye tiroid kanseri tedavisinde yaklaşık 60 yıldır klinik uygulamada kullanılmaktadır ve genellikle güvenli ve etkili bir tedavi olarak kabul edilir. Fibrozise ilerleyebilen radyasyon pnömonisi ve kemik iliği süpresyonu gibi ciddi yan etkiler bildirilmiştir ancak nadiren rastlanır. Bu makalede bir ay önce düşük volümlü mikronodüler akciğer hastalığı için 175 mCi I-131 tedavisi, hayat boyu uygulanan kümülatif aktivite 575 mCi, aldıktan sonra ciddi miyelosüpresyon nedeniyle hastane yatışı ve transfüzyon desteği ihtiyacı olan genç bir kadın hasta sunulmaktadır. RAİ sonrası miyelosüpresyon için en önemli risk faktörleri alınan aktivite miktarı, mevcut fonksiyonel tiroid dokusu ve alınan hayat boyu kümülatif aktivite miktarıdır.

A 67-year-old female patient with no prior history of benign thyroid disease was diagnosed with primary thyroid lymphoma and was staged with18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). She was treated with chemotherapy and external beam radiation therapy, and a follow-up PET/CT showed significant reduction in the size of the thyroid lymphoma with persistent intense 18F-FDG uptake, which was interpreted as partial response to therapy. However, two subsequent PET/CT studies showed no change in the persistent intense 18F-FDG uptake in the thyroid and a biopsy confirmed the presence of thyroiditis with no evidence of residual lymphoma. Follow-up PET/CTs performed over the subsequent three years showed stable intensely 18F-FDG avid thyroiditis with no evidence of lymphoma recurrence. We present the imaging characteristics of a long term radiation treatment induced thyroiditis mimicking 18F-FDG avid residual disease on PET/CT.

A 65-year-old male patient with a one year history of liver transplantation was referred for an 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) to rule out post transplant lymphoproliferative disease. Multiple foci of intense abnormal 18F-FDG uptake were seen in the transplanted liver which were concerning for malignancy. Explantation of the liver approximately 1 month following the PET/CT revealed multiple inflammatory and ischemic changes including large bile duct necrosis, acute cholangitis, bile duct obstruction changes and periportal fibrosis, with no evidence of malignancy. We present the 18F-FDG PET/CT image findings of this case.