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FDG-PET/CT has the potential to play an important role in the diagnosis of sternal wound infections (SWI). The purpose of this study was to analyze the diagnostic accuracy of FDG-PET/CT for SWI in patients following sternotomy. We performed a single-center, retrospective analysis of patients who had undergone median sternotomy and FDG-PET/CT imaging. The gold standard consisted of positive bacterial culture and/or the presence of purulent material at surgery. Qualitative patterns of sternal FDG uptake, SUVmax, and associated CT findings were determined, and an imaging scoring system was developed. The diagnostic performances were studied in both the recent (≤ 6 months between sternotomy and imaging) and remote surgery phase (> 6 months). A total of 40 subjects were identified with 11 confirmed SWI cases. Consensus interpretation was associated with a sensitivity of 91% and specificity of 97%. Combination of uptake patterns yielded an AUC of 0.96 while use of SUVmax yielded an AUC of 0.82. Results suggest that FDG-PET/CT may be useful for the diagnosis of SWI with optimal diagnostic accuracy achieved by identifying specific patterns of uptake. SUVmaxcan be helpful in assessing subjects with remote surgery, but its use is limited in the context of recent surgery. Further studies are required to confirm these results.

Sinus tarsi syndrome is a common cause of hindfoot pain in adults; however, diagnosis on planar bone scintigraphy can be challenging. We present 3 cases of sinus tarsi syndrome, review the spectrum of imaging findings associated with sinus tarsi syndrome, and show the key role that SPECT/CT can play in its diagnosis.

Haglund syndrome—the combination of Haglund’s deformity, retrocalcaneal bursitis, and achilles tendinopathy—is a common cause of hind foot pain in adults; however, diagnosis on planar scintigraphy can be challenging. We present a case of Haglund syndrome and show the key role that SPECT/CT can play in its diagnosis.

Cholesterol granulomas are benign lesions, rarely seen in the breast, which are indistinguishable from malignancy on anatomical imaging. The FDG PET/CT of a patient referred for melanoma staging revealed a mildly FDG-avid, soft tissue nodule in the left breast. This finding was felt unlikely to represent metastatic melanoma due to the relatively low level of uptake. The lesion was not seen on follow-up mammography. Ultrasound-guided biopsy was performed, which identified this lesion as a cholesterol granuloma. This case illustrate that cholesterol granuloma can be misinterpreted as a malignant lesion on both anatomical imaging and FDG PET/CT.

The gold standard to diagnose vasospastic angina is intracoronary reactivity testing, which is performed selectively at dedicated centres. Noninvasive imaging with single-photon emission computerized tomography (SPECT) or echocardiography does not enable accurate localization of spasm or quantification of change in myocardial perfusion in response to an abnormal vasoreactivity. Rubidium-82 positron emission tomography myocardial perfusion imaging (82Rb PET-MPI) with intravenous ergonovine was used to diagnose refractory vasospastic angina in a patient with a complex ischemic syndrome, recent coronary stenting, and persistent atypical angina despite maximal tolerable doses of guideline-directed medical therapy.

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Blastic plasmacytoid dendritic cell neoplasm is a rare malignancy characterized by cutaneous involvement and hematological dissemination. Most affected patients are older, usually in the sixth or seventh decade of life, and this condition has rarely been described in the pediatric population. This report presents the case of a 9-year-old boy with blastic plasmacytoid dendritic cell neoplasm and demonstrates the utility of FDG PET/CT for staging and treatment follow-up.

82Rb is frequently used in PET myocardial perfusion imaging to detect ischemia. We present the case of a 64-year-old man referred for PET myocardial perfusion imaging to rule out ischemia. On PET images, an abnormal focus of uptake was present in the subcutaneous soft tissue overlying the right chest, which corresponded to a soft-tissue nodule on CT. This lesion was biopsied and proved to be a mammary fibromyoblastoma, an extremely rare and benign lesion. This case is presented to emphasize the importance of reviewing extracardiac structures on PET/CT myocardial perfusion studies.