Orofacial Dyskinesia and Intractable Hiccups in a Patient with Varicella-zoster Virus Encephalomyelitis.

A 73-year-old Japanese man with diabetic complications presented with involuntary lip movements and long-lasting hiccups after developing zoster rash. Magnetic resonance imaging revealed lesions involving the medial temporal lobe and C1 level of the spinal cord. Varicella-zoster virus (VZV) encephalomyelitis was diagnosed. We considered attributing the orofacial dyskinesia, a very rare symptom of VZV central nervous system (CNS) complications, to the temporal lobe lesion. Although the culprit lesion for the hiccups was unclear, further examinations may have clarified this issue. As immunocompromised patients with herpes zoster may develop CNS complications with a wide variety of symptoms, special care is needed.

A Case of Ewing Sarcoma of the Mandible on 18F-FDG PET/CT.

  Ewing Sarcoma is the second most common type of bone cancer in children. The dominant features of this malignant bone tumor are the tendency for rapid growth and metastasis. In addition, Ewing sarcoma of the mandible is extremely rare and can be mistaken for odontogenic infection. We report a 14-year-old girl who had had swelling, pain, and hypoesthesia in the left cheek for three weeks. She was diagnosed with pericoronitis initially, and then referred toour hospital due to worsening symptoms. CT and MRI revealed an expanding and destructive mass mainly in the left mandible. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and fused PET/CT demonstratedincreased uptake in the mandibular lesion. Whole-body 18F-FDG PET images showed no abnormal activity except for the mandibular lesion. Histologic examination confirmed Ewing sarcoma. Although this tumor has an aggressive clinical behavior and rapid growth, early diagnosis can reduce patient's morbidity, mortality and thus it is important to distinguish it from periodontal inflammation.

SPECT/CT imaging in ulnocarpal impaction syndrome.

We report a 42-year-old man who presented with ulnar-sided wrist pain. MR image revealed bone marrow edema in the lunate bone. Ulnocarpal impaction syndrome was diagnosed by MRI and arthrography. Bone scintigraphy showed increased uptake in the wrist. SPECT/CT with 2- and 3-dimensional reconstruction images clearly demonstrated abnormal accumulation on the ulnar side of the lunate bone.

18F-FDG PET/CT imaging of extensive systemic sarcoidosis with epididymal involvement.

Sarcoidosis rarely involves the male reproductive tract. We present an unusual case of extensive systemic sarcoidosis with epididymal involvement. The ¹8F-FDG PET/CT demonstrated extensive foci of hypermetabolic activity involving multiple lymph nodes, liver, epididymides, muscles, and subcutaneous tissues. After immunosuppressive therapy, a follow-up PET scan showed almost complete disappearance of the FDG accumulation except for in the hilar lymph nodes.

Correlation of 18F-FLT uptake with tumor grade and Ki-67 immunohistochemistry in patients with newly diagnosed and recurrent gliomas.

UNLABELLED: We evaluated 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) uptake in patients with newly diagnosed and recurrent gliomas and correlated the results with tumor grade and proliferative activity. METHODS: (18)F-FLT PET was investigated retrospectively in 56 patients, including 36 with newly diagnosed gliomas and 20 with recurrent gliomas. The standardized uptake values for tumor and normal contralateral hemisphere were calculated, and the tumor-to-normal (T/N) ratio was determined. Tumor grading and proliferative activity were estimated in tissue specimens. RESULTS: There was a significant difference in T/N ratio among different grades of newly diagnosed gliomas and between low- and high-grade newly diagnosed and recurrent gliomas. (18)F-FLT uptake correlated more strongly with the proliferative activity in newly diagnosed gliomas than in recurrent gliomas. CONCLUSION: (18)F-FLT PET seems to be useful in the noninvasive assessment of grade and proliferation in gliomas, especially newly diagnosed gliomas.

SPECT/CT imaging in 99mTc-PMT hepatobiliary scintigraphy to detect bone metastases from hepatocellular carcinoma.

We report a 62-year-old man who presented with pain on the right side of his hip. CT revealed destructive masses in the right femur and left ilium. Histological examination indicated metastases from hepatocellular carcinoma, and further investigations revealed the primary tumor in the liver. Hepatobiliary scintigraphy using 99mTc N-pyrydoxyl-5-methyltryptophan and fused SPECT/CT clearly showed abnormal accumulation in these bone metastases from hepatocellular carcinoma.

A case of primary pericardial mesothelioma detected by 18F-FDG PET/CT.

Primary pericardial mesothelioma is an extremely rare malignancy. We report a case of a 58-year-old woman who presented with fever and fatigue. She had no apparent history of occupational or incidental exposure to asbestos. A postcontrast-enhanced chest CT revealed a 77 × 56-mm mass lesion in the pericardium. The FDG PET/CT was carried out, which demonstrated an intense FDG uptake to a main pericardial tumor and disseminated lesions in the pericardium. Histologic examination confirmed the primary malignant pericardial mesothelioma.

Hypoxia assessed by 18F-fluoromisonidazole positron emission tomography in newly diagnosed gliomas.

OBJECTIVE: The aim of this study was to evaluate the degree of hypoxia in newly diagnosed gliomas using 18F-fluoromisonidazole (FMISO) PET and to compare the results with tumor grade. METHODS: A total of 30 patients with newly diagnosed gliomas were examined using FMISO PET. Grading of the tumor was performed according to the WHO classification. The FMISO PET images were scaled to the venous blood concentration of FMISO activity to produce tumor-to-blood (T/B) values. Hypoxia was defined as a region with a T/B ratio of at least 1.2, and the maximum T/B (T/Bmax) value was calculated by region-of-interest analysis. RESULTS: There was a correlation between FMISO uptake and glioma grade, with all low-grade gliomas (grades I and II) demonstrating no hypoxia and all high-grade gliomas (grades III and IV) showing hypoxia. The mean T/Bmax in grade IV gliomas was significantly higher than that in grade III gliomas (P<0.02). CONCLUSION: FMISO PET is a potential tracer in the assessment of noninvasive tumor grading in newly diagnosed gliomas.

2-[Fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography versus whole-body diffusion-weighted MRI for detection of malignant lesions: initial experience.

OBJECTIVES: The new magnetic resonance whole body diffusion-weighted imaging with background body signal suppression (DWIBS) uses short tau inversion recovery-echo planar imaging sequence under normal respiration. DWIBS is different from 2-[fluorine-18]-fluoro-2-deoxy-D: -glucose positron emission tomography ((18)F-FDG PET) imaging in technology, but their images are similar. We compared the two modalities regarding the detection and characterization of malignant tumors. METHODS: DWIBS and (18)F-FDG PET/computed tomography (CT) were performed on 16 cancer patients on the same day. The diagnoses were the following: lung cancer (n = 12), colon cancer (n = 2), breast cancer (n = 1), and pulmonary metastasis (n = 1). A total of 27 malignant tumors (15 lung cancer, 5 pulmonary metastases of parathyroid cancer, 3 pulmonary metastases of lung cancer, 3 colon cancer, 1 breast cancer) and seven reference organs around malignant lesions (two liver regions, four normal lymph nodes, one muscle region) were evaluated visually and quantitatively using the apparent diffusion coefficient (ADC) (x10(-3) mm(2)/s) and standardized uptake value (SUV). RESULTS: Twenty-five (92.6%) of the 27 malignant lesions were detected visually with DWIBS imaging in contrast to 22 malignant tumors (81.5%) with (18)F-FDG PET/CT imaging. The quantitative evaluation showed that there was a significant difference between the mean SUVs of the reference organs (n = 7, 1.48 +/- 0.62) and the malignant (n = 22, 5.36 +/- 2.80) lesions (P < 0.01). However, there was no significant difference between the mean ADCs of the reference organs (n = 7, 1.54 +/- 0.24) and the malignant (n = 25, 1.18 +/- 0.70) lesions. CONCLUSIONS: DWIBS can be used for the detection of malignant tumors or benign tumors; however, it may be difficult to differentiate between benign and malignant lesions by ADC.