ABSTRACT
Peptide receptor radionuclide therapy (PRRT) has become an established treatment for patients with inoperable and/or metastatic, well-differentiated neuroendocrine tumors with overexpression of somatostatin receptor type 2 (SSTR-2). The post-therapy 177Lu-DOTATATE whole-body scan not only assesses the biodistribution of the lesions seen on pre-therapy68 Ga-SSTR PET/CT scan but also provides a quick assessment of disease status and dosimetry during treatment. Like any other radionuclide scan, the whole-body 177Lu-DOTATATE scan may also show abnormal radiotracer uptake, which may require further imaging to establish its exact etiology. Though radiotracer emboli mimicking focal pulmonary lesions have been described with 18F-FDG and 68 Ga-DOTANOC PET/CT scans, similar artifacts with post-therapy 177Lu-DOTATATE scans have not been described. Herein, we report two cases of hot emboli in the post-therapy 177Lu-DOTATATE scans.
ABSTRACT
Chondrosarcoma is a cartilaginous tumor of mesenchymal origin. The histology and grade of the tumor determine the chances of relapse and survival. These tumors usually respond poorly to chemo-radiotherapy in cases of non-resectable and recurrent disease. 18F-FDG PET/CT has been used in evaluation of recurrence. However, these tumors show only mild to moderate FDG avidity due to their lower mitotic activity and large acellular matrix. These tumors are known to have a high degree of angiogenesis, especially in those of higher grade. We present a case of a 53-year-old man with grade II chondrosarcoma of the left femur showing only mild avidity on 18F-FDG PET/CT but showing moderate to intense tracer avidity on 68Ga-DOTA-RGD2PET/CT. This may enable the use of angiogenesis-targeted positron and beta-emitting radiopharmaceuticals as a potentially new theranostic alternative treatment in cases of refractory metastatic chondrosarcoma.
ABSTRACT
Somatostatin receptor (SSTR)-based imaging and therapy has emerged as well-established modality in neuroendocrine tumors. However, its role in inflammation imaging is still evolving. We present a 48-year-old male with metastatic neuroendocrine tumor who underwent lutetium-177-based somatostatin receptor-based therapy. The post-therapy scan showed a focal tracer uptake in the left calf muscle in addition to the expected tracer uptake at the primary and metastatic sites. Further, cross-sectional imaging and biochemical investigations revealed peripheral vascular disease (PVD). The incidental tracer uptake in the calf on post-therapy scan potentiates the role of somatostatin receptor scintigraphy in identifying macrophagespecific inflammatory reactions.
ABSTRACT
Pulmonary blastoma (PB) is a rare thoracic malignancy and preoperative diagnosis is challenging. A young man presented with dyspnea and chest pain for 3–4 months and chest-computed tomography (CT) revealed large mass in the left lung upper lobe and pleural effusion. Repeated CT-guided fine-needle aspiration cytology from the lesion and pleural fluid aspiration was negative for malignancy. F-18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) revealed heterogeneous tracer avidity in left lung mass with areas of necrosis. Real-time PET-CT-guided biopsy from metabolically active component of the lesion revealed biphasic PB on histopathology.
ABSTRACT
Owing to an oversight in manuscript preparation, the name of the fifth author was rendered incorrectly. The correct spelling is Divya Dahiya.
ABSTRACT
Owing to an oversight in manuscript preparation, the name of the fifth author was rendered incorrectly. The correct spelling is Divya Dahiya.
ABSTRACT
¹â¸F-Fluorocholine (FCH) PET/CT is evolving as a functional imaging modality for the preoperative imaging of abnormal parathyroid tissue(s) helping to localize eutopic and ectopic parathyroid tissue and limit the extent of surgery. FCH PET/CT may show incidental uptake in various thyroid lesions necessitating further evaluation, whereas the role of ¹â¸F-fluorodeoxyglucose (FDG) PET/CT in the detection of incidental thyroid nodules is well documented. The case of a middle-aged woman with dual pathology of parathyroid adenoma and papillary thyroid cancer detected on FCH and FDG PET/CT is presented.
ABSTRACT
Primary synovial osteochondromatosis (PSOC) is a rare but clinically significant cause of morbidity especially in the male population. Surgery is the primary treatment of choice, but the recurrence rate is reported to be high. Moreover, the presence of widespread loose bodies makes it a cumbersome procedure. The complete removal of the disease is tough at times and results in early recurrence. Radiosynovectomy is an established technique for treating various joint arthropathies. The role of radiosynovectomy in case of PSOC has not yet been explored. This case report described the case of a young male with PSOC of the knee joint who was treated with radiosynovectomy for pain relief. The patient reported complete relief from the pain along with significant improvement in joint mobility. The post-therapy three-phase bone scan also validated the reduction in joint inflammation. The patient was taken for surgical removal of the redundant loose bodies after a significant improvement in the pain and reduction in inflammation. Post-therapy radiation fibrosis of the synovium also helped in the en bloc removal of the disease. The role of radiosynovectomy in PSOC needs to be further explored concerning its potential role as an adjuvant to surgical procedures.
Subject(s)
Humans , Male , Chondromatosis, Synovial , Inflammation , Joints , Knee Joint , Knee , Radiation Pneumonitis , Recurrence , Synovial MembraneABSTRACT
Primary hyperparathyroidism is caused by parathyroid adenoma in the majority of cases and diagnosis is usually made biochemically. Pre-surgical localization of parathyroid adenoma is essential to limit the extent of surgery and avoid missing them at ectopic sites. Anatomical and functional imaging are used for the localization, but may fail to identify the small and ectopic parathyroid adenoma. We present a case of small sized ectopic parathyroid adenoma at unusual location detected by F-18 fluorocholine (FCH) PET/CT, where other imaging modalities failed. The post-operative histopathology confirmed the diagnosis of ectopic parathyroid adenoma.
Subject(s)
Diagnosis , Hyperparathyroidism, Primary , Parathyroid Neoplasms , Positron Emission Tomography Computed Tomography , UltrasonographyABSTRACT
We aimed to study whether sedation reduces discomfort during endoscopy and a comparison of longer-acting diazepam with shorter-acting midazolam. A prospective, randomized, single-blinded study was conducted at the Department of Medicine at Government Medical College and Hospital, Chandigarh, and was completed over a period of 6 months. The patients were randomized to receive either placebo or sedation with midazolam or diazepam before endoscopy. The endoscopist and the observer recording patient's/physician's responses were blinded to the drugs administered. Two hundred and fifty two consecutive patients undergoing diagnostic or therapeutic upper gastrointestinal endoscopy were recruited. The patient's discomfort and the physician's comfort during the procedure were recorded on a visual analogue scale rated from 1-10 with-in 10 minutes of the procedure by an independent observer. The Patient's discomfort ratings were further divided into 3 groups, comfortable [score, 1-3], satisfactory [score, 4-7] and uncomfortable [a score of >7]. Similarly the physician's ease of performing the procedure was also recorded on the same scale. This was again divided into 3 groups: easy [score, 1-3], satisfactory [score, 4-7] and difficult [a score of >7]. Out of the total of 252 patients, 82 patients received no sedation [group I], 85 received diazepam [group II] and 85 received midazolam [group III]. There was no statistical difference in the discomfort experienced by the patients during endoscopy when sedation was used [P=0.0754]. Out of 252 patients, 49 underwent endoscopic procedures. Nineteen patients were included in group I, 18 in group II and 12 in group III. Only 10 [20%] patients undergoing endoscopic procedures complained of significant discomfort, but there was no difference in the ones undergoing interventions with or without sedation [P=0.854]. The physicians were more comfortable in performing endoscopic procedure in sedated patients, however, the difference between patients in group II and group III was not statistically significant [P=0.0461]. Both diazepam and midazolam fared equally well in increasing physician's comfort [P=0.617]. There was no difference in the patient's discomfort with regard to the sedative used [midazolam or diazepam]. Although endoscopy was easy or satisfactory in the majority of patients in the unsedated as well as the sedated groups, more often the endoscopist found it difficult to do endoscopy on the unsedated patients