Incidental Finding of Acute Lymphocytic Leukemia in a Prostate-Specific Membrane Antigen PET/CT.

PSMA PET/CT is known to show uptake in various benign and malignant processes. The following PSMA PET/CT was performed for prostate carcinoma staging (Gleason 3 + 4 left apex; PSA 5.8). It shows incidental diffuse PSMA marrow uptake, not typical for prostate metastatic disease. No treatment had been commenced at the time of the scan. Serology and bone marrow biopsy showed B-cell acute lymphocytic leukemia. Focal PSMA uptake in the right ischium was correlated with a T1 hypointense lesion on a previous MRI and was convincing for a skeletal metastasis. Alternative diagnoses in diffuse skeletal PSMA uptake need therefore to be considered.

FDG PET/CT of Metabolic Myopathy With Posttreatment Follow-up.

A 38-year-old woman presented with extreme fatigue and multiple lung nodules. She was referred for a PET/CT, which demonstrated multiple FDG-avid pulmonary nodules and lymph nodes with intense uptake within multiple muscle groups predominantly involving the paraspinal muscles and muscles of mastication. Histopathology of a paraspinal muscle biopsy revealed increased skeletal muscle lipid stores and increased mitochondria with normal morphology. This abnormality is seen in metabolic myopathy due to a disorder of fatty acid oxidation. Transbronchial biopsy showed no evidence of sarcoidosis. The patient was commenced on carnitine and riboflavin supplementation, and a follow-up PET/CT was performed.

68Ga-PSMA-Ligand PET/CT Uptake in Anthracosilicosis.

This interesting image illustrates a case of biopsy-proven pulmonary anthracosilicosis, a mixed dust pneumoconiosis, associated with Ga-PSMA-ligand uptake. Prostate-specific membrane antigen (PSMA) is an emerging imaging biomarker, with clinical application in evaluation of prostate cancer using Ga-PSMA-ligand PET/CT. Contrary to its name, PSMA is expressed in a number of other normal tissues and pathological states. Prostate-specific membrane antigen expression has been linked to tumor angiogenesis in various other epithelial neoplasms, as well as neovasculature associated with tissue regeneration and repair. Awareness of nonneoplastic inflammatory conditions associated with Ga-PSMA-ligand uptake aids in patient assessment and management.

68Ga-dotatate avid medullary thyroid cancer with occult liver metastases.

A 50-year-old male patient with a history of medullary thyroid cancer and extensive previous investigation including FDG PET 18 months earlier presented for a Ga-dotatate scan. A single area of abnormal uptake was identified in the right ninth rib. An MRI scan and bone scan confirmed the bony metastasis; however, the MRI of the liver demonstrated multiple liver metastases not apparent on the PET study. These remained occult despite coregistration of the MRI and PET data. The occult nature of these lesions may have been due to a similar degree of uptake in the liver and metastases.

Rural GPs' satisfaction with radiology services to their communities: a qualitative study.

INTRODUCTION: Despite the acknowledged clinical importance of radiology and an awareness of issues surrounding the rural radiology workforce and access to services and equipment, there is a paucity of information assessing the adequacy of rural radiology services in Australia. Assessing the satisfaction of rural GPs with the radiology services available to them is one way of assessing the adequacy of these services. This research aimed to contribute to this important knowledge gap by identifying the factors influencing rural GPs' satisfaction with the rural radiology services available to them. METHODS: We used purposive sampling from Tasmanian general practice workforce data to select rural GPs with a range of demographics from all three regions of Tasmania, Australia. We performed semi-structured interviews with these GPs, in which they discussed rural radiology services in their local area. Interviews were performed by telephone and transcribed verbatim. The transcribed interviews were analysed using an iterative and interpretive technique aimed at identifying major themes and providing insight into the issues raised by the research participants. RESULTS: Out of 15 GPs approached, two interviews were lost due to equipment problems and 10 interviews were successfully recorded. Major factors influencing GP satisfaction with rural radiology services included: access to service (particularly convenience for their patients and the level of direct and indirect costs to patients); the promptness and reliability of services; equipment; and access to training and skills levels. The GPs also described the added challenges that they and their communities face with dealing with problems requiring the use of radiology services after hours. CONCLUSIONS: These new insights into rural radiology services can help to inform policy makers, funding bodies and private radiology providers responsible for rural radiology services of issues requiring further consideration. This contribution to the creation of an evidence base is important as a platform for further research and for the development of strategies to further assess and improve radiology services for rural communities.