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Oncocytic adenomas are rare benign tumors that typically originate in organs such as the kidneys, thyroid, parathyroid, salivary glands, or pituitary gland. Oncocytic adenoma of the adrenal gland is extremely rare. It often shows heterogeneous, nonspecific features on anatomic imaging, as well as high 18 F-FDG avidity despite its benign nature. The definitive diagnosis relies on histopathologic examination, including immunohistochemistry. We present an incidentally detected benign adrenal oncocytic adenoma with intense 18 F-FDG uptake mimicking sinister pathologies., (© 2024 by the Society of Nuclear Medicine and Molecular Imaging.)

Abstract: Oral squamous cell carcinoma (OSCC) is one of the most common malignancies worldwide. Locoregional nodal involvement by OSCC is commonly encountered. Current conventional and functional imaging modalities have limited diagnostic accuracy in nodal assessment, particularly in head and neck cancer. Thus, definitive management of head and neck malignancies customarily addresses the locoregional nodes along with the primary malignancy. However, OSCC, particularly tongue cancer, shows erratic lymphatic drainage and thus commonly requires extensive bilateral neck dissection, leading to significant morbidity. Cancer integrin imaging with 68Ga-trivehexin PET-CT can offer highly specific result and thus has the potential for effective tailored management., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Peritoneal cancer index is an integral parameter for preoperative assessment of peritoneal disease. Current imaging modalities including 18 F-FDG PET/CT, though superior to CT, underestimate the disease extent, mainly due to its high physiological background activity. Novel "cancer integrin" targeting imaging with 68 Ga-trivehexin demonstrates limited physiological activity in the abdomen with superior target-to-background ratio than 18 F-FDG PET/CT. Thus, we describe the first case demonstrating potential utility of novel "cancer integrin" αvβ6 imaging agent 68 Ga-trivehexin for assessment of disease burden in advanced epithelial ovarian cancer., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The uptake of Tc-99m-uptake of Tc-99m-methylene diphosphonate (MDP) on bone scintigraphy can be seen at sites other than bone in a varying number of benign and malignant conditions. Extraosseous metastatic calcifications can occur in ovarian papillary serous adenocarcinoma (PSAC). These extraosseous calcifications show Tc-99m-MDP uptake. We report a case of a female in her sixties who had a previous history of PSAC of the ovary. The patient had undergone neoadjuvant chemotherapy (NACT) followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. She also received adjuvant chemotherapy. Tc-99m-MDP bone scan was performed post chemotherapy because the patient complained of lower backache. The scan showed increased uptake in the lower thoracic and lumbar vertebral regions. However, single-photon emission computed tomography/computed tomography (CT) localizes the uptake to metastatic calcified peritoneal deposits. Further 18 F-fluorodeoxyglucose positron emission tomography/CT confirmed widespread peritoneal and omental metastatic disease with increased uptake., Competing Interests: Conflict of Interest: No conflicts of interest were declared by the authors., (Copyright© 2024 The Author. Published by Galenos Publishing House on behalf of the Turkish Society of Nuclear Medicine.)

Abstract: Differentiated thyroid carcinoma constitutes over 90% of all thyroid cancers. The standard treatment approach involves total or near-total thyroidectomy with or without neck dissection followed by 131 I whole-body scintigraphy (WBS) to detect local or distant metastases. Radioiodine offers high sensitivity and specificity for detection of metastatic disease in well differentiated thyroid carcinoma. However, despite its high accuracy, 131 I WBS demonstrates false-positive results, mostly at inflammatory or infective site. These false-positive radioiodine accumulation can lead to misdiagnosis and unwarranted radioiodine treatment. This case presents localization of 131 I to the suture site granuloma leading to false-positive results on 131 I WBS., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Thyroid gland metastases from nonthyroidal malignancies are extremely rare. The most common primary malignancies associated with metastasis to thyroid gland include renal cell carcinoma, colorectal carcinoma, lung cancer, and breast cancer. Metastasis to thyroid rarely arises from primary laryngeal cancer. The presence of metastasis to thyroid gland is invariable and associated with poor prognosis and thus, should be differentiated from primary thyroid malignancy. Hereby, we have one such case of metastasis to thyroid gland from laryngeal cancer diagnosed on 18F-fluorodeoxyglucose positron emission tomography/computed tomography scan., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Nuclear Medicine.)

We present the case of a 52-year-old male who was recently diagnosed case of a Pancoast tumor and presented to the pulmonary outpatient department with a complaint of pain in the shoulder and chest region which was burning type, associated with shoulder abduction weakness and poor hand grip. Subsequently, he was referred for a 99m -Tc bone scan for metastatic workup, which showed increased uptake in all the joints and long bones of the ipsilateral upper limb. This case highlights the importance of considering nontraumatic cause of pattern similar to complex regional pain syndrome., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Nuclear Medicine.)

Extracranial metastases of glioblastoma multiforme (GBM) are very rare. The estimated incidence is <2%. We report a case of a 49-year-old woman, who was a known case of GBM in the left temporo-occipital lobe. She was operated and had received radiotherapy and adjuvant chemotherapy for the same. Subsequently, the patient underwent bone scan. On 99 m-Tc methylene diphosphonate (MDP) bone scan, homogenously increased tracer uptake was noted in the axial and appendicular skeletal system, suggesting metastatic skeletal superscan., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Nuclear Medicine.)

Calcinosis of soft tissue is a rare but known complication of dermatomyositis (DM), mostly associated with juvenile DM and rare in adult DM. Bone scan with Tc-99m Methylene diphosphonate is useful in disease mapping and has high sensitivity to know the extent of calcinosis. However, there is scanty literature available on the utility of bone scan in treatment response evaluation in DM. Rituximab has been found useful in adult DM with calcinosis unresponsive to conventional treatment. We describe an interesting case showing partial response to rituximab on bone scan with single-photon emission tomography-computed tomography., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Nuclear Medicine.)

Objective: To study the sensitivity and specificity of MRI and bone SPECT-CT in detecting the pain generator in ankle and foot pain with diagnostic dilemma., Methods: Retrospectively data of patients with ankle or foot pain who underwent both MRI and Bone SPECT-CT were analyzed. The lesions and probable pain generator sites were reported as per MRI and bone SPECT-CT findings. These lesions were correlated clinically, managed accordingly and followed up. The patients who had significant improvement in response to the treatment provided were considered to have been diagnosed accurately. The foot and ankle disability index (FADI) was used to evaluate the patient's pre- and postintervention condition., Results: The study included 37 patients retrospectively (18 women and 19 men). The lesions were classified into soft tissue lesions (ligaments/tendons), joint lesions (arthritis) and bony lesions (fractures/osteomyelitis/osteochondral lesions). Overall, MRI had sensitivity, specificity, positive predictive value and negative predictive value of 82, 31, 74 and 42%, respectively, and SPECT-CT had sensitivity, specificity, positive predictive value and negative predictive value of 84, 60, 84 and 60%, respectively. The mean FADI score pretreatment for all patients was 61.5 (SD = 13.8) and posttreatment 88.4 (SD = 13.01) showing significant improvement in the score (P < 0.05), suggesting that the final diagnosis of these patients was accurate. Overall, management change due to bone SPECT-CT over MRI was seen in 26% of patients., Conclusion: Bone SPECT-CT has incremental value over MRI in the diagnosis of pain generator in foot and ankle pain. The overall specificity of bone SPECT-CT is higher than MRI in detection of pain generators. Bone SPECT-CT performed better than MRI in detection of culprit pathology in the bone, whereas MRI is better in soft tissue lesions., Advances in Knowledge: There are only a few published literature with direct comparison of bone SPECT-CT scintigraphy and MRI in detection of foot and ankle pain generator. This study directly compares diagnostic utility of bone SPECT-CT scintigraphy and MRI in foot and ankle pain. In the present study, the bone SPECT-CT performed better than MRI in detection of culprit pathology in the bone, whereas MRI is better in soft tissue lesions., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Marine-Lenhart Syndrome is a rare entity, described as Graves' disease with coexisting functioning thyroid nodules. It is often diagnosed on thyroid scintigraphy as a cold nodule with surrounding extranodular hyperactivity initially and postradioiodine ablation, they regain function on the follow-up thyroid scintigraphy due to endogenous thyroid-stimulating hormone (TSH) stimulation. We retrospectively reviewed all thyroid scintigraphy database performed between January 2018 and March 2020 in our institute. We searched patients with Graves' disease with the following criteria to suggest Marine-Lenhart Syndrome: (a) initial thyroid scintigraphy showing features of Graves' disease with coexistent poorly functioning nodules (b) There is normalization of uptake within the nodule on thyroid scan after radioiodine ablation suggestive of endogenous TSH stimulation (this also indirectly proves nodules are TSH dependent), (c) nodule(s) is/are benign on fine-needle aspiration cytology. Four patients (1.46%) were confirmed as Marine-Lenhart Syndrome as per the criteria. Three patients were female, and one was male. The eye signs were present in two of four patients. Two patients had two hypofunctioning nodules, whereas the remaining two had a single nodule and required re-ablation with radioiodine. Marine-Lenhart Syndrome requires special attention as these patients are relatively radioiodine resistant, require higher activity for iodine-131; however, it is curable with radioiodine treatment., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 World Journal of Nuclear Medicine.)

Ectopic thyroid tissue is a rare entity of embryological aberration along the tract of descend of thyroid gland. Accurate localization and characterization are required for deciding management based on clinical features and symptoms. Ectopic thyroid in the absence of normal thyroid gland is uncommon. However, triple ectopic thyroid with absence of normal thyroid gland is very rare, with only a few cases reported previously. We present a case of triple ectopic thyroid, which appeared as single on planar Tc-sodium pertechnetate image, but was evident on SPECT/CT images.

There is literature evidence showing utility of somatostatin receptor (SSTR) positron emission tomography-CT (PET-CT) imaging in differentiated thyroid cancer with Thyroglobulin Elevated and Negative Iodine Scan (TENIS). These patients are less benefited with I-131 therapy and surgery remains only curable option if disease could be localised. If surgery is not feasible, other therapeutic options are not promising. However, if these patients show strongly positive SSTR imaging, then possibility of peptide receptor radionuclide therapy may be explored. As SSTR PET-CT imaging is expensive and not widely available, Technetium-99m (Tc-99m) hydrazinonicotinyl-Tyr3-octreotide (HYNIC-TOC), which is a Single photon emission computed tomography (SPECT) tracer, can be used. We are documenting a case of raised serum thyroglobulin antibody and negative I-131 whole body scan with disease recurrence localised on Tc-99m HYNIC-TOC scan., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)