Small Cell Carcinoma Prostate: A Case Report with Findings on 18-F FDG PET/CT.

Small-cell carcinoma of the prostate (SCCP) is a rare and very aggressive malignancy with neuroendocrine differentiation. In contrast to conventional prostate adenocarcinoma, SCCP is an aggressive carcinoma and portends to have a poor prognosis. Around 50% of these patients have metastatic disease at the first clinical presentation. We report the findings of 18-F fluorodeoxyglucose positron emission tomography/computed tomography in a case of histologically proven SCCP with an unusual finding of the left internal mammary lymph node.

Lymphoma With a Skin Rash.

A 62-year-old female had a generalized vesiculobullous rash on her face for 4 months. It started over the lips and gradually progressed to involve the oral mucosa and skin of the whole body. What is your diagnosis?

Unusual Male Breast Involvement in Burkitt Lymphoma Detected on Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography.

Burkitt lymphoma (BL) is a poorly differentiated, aggressive form of B-cell non-Hodgkin's lymphoma. The clinical presentation of this disease is varied and may be nodal, extranodal, or both. BL of the breast, either primary or secondary, with bilateral breast involvement, is extremely rare. Herein, we present a case of BL in a 27-year-old male with unusual bilateral breast involvement.

Askin's Tumor a Rare Clinical Entity of Thoracopulmonary Region Cresenting as a Case of Paraparesis: Findings on 18F-FDG PET/CT.

Askin's tumors are rare malignant neoplasms located in the thoracopulmonary region and mainly occur in children and adolescents. In this report, we describe a case of histologically proven Askin's tumor in a 24-year-old male. The patient was admitted with a history of 3-month lower back pain and with a rare presentation of paraparesis.

Askin Tumor - Presenting as a Case of Paraparesis: A Rare Clinical Entity. Case Report and Findings on 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography.

Askin tumors are rare malignant neoplasms located in the thoracopulmonary region and mainly occur in children and adolescents. In this report, we describe a case of histologically proven Askin's tumor in a 24-year-old male. The patient was admitted with a history of 3-month lower back pain and with a rare presentation of paraparesis.

Tc-99m Sulfur Colloid Lymphoscintigraphy with Single-photon Emission Computed Tomography/Computed Tomography in a Case of Acquired Vulval Lymphangiomas.

We describe the lymphoscintigraphy findings of a 25-year-old female patient who was undergoing presurgical workup for lymphangiomas of the vulva. She had a history of treatment for disseminated tuberculosis 6 years back and presented with herpetiform oozing vesicles in the external genitalia. Single-photon emission computed tomography/computed tomography (SPECT/CT) confirmed cutaneous tracer accumulation in the vulval lesions and demonstrated the presence of densely calcified inguinal nodes secondary to healed tuberculosis as the etiology of secondary lymphangioma.

PET/Computed Tomography in Breast Cancer: Can It Aid in Developing a Personalized Treatment Design?

PET with fluorodeoxyglucose (FDG-PET)/computed tomography (CT) imaging has significantly improved the management of breast cancer. FDG, however, is not tumor-specific and various image interpretation pitfalls may occur due to false-positive and false-negative causes of FDG uptake. PET/CT imaging with more specific radiopharmaceuticals may provide useful information about the pathophysiology in such cases. In the present article, we reviewed the use of whole-body FDG-PET/CT and (18)F-16α-17ß-Fluoroestradiol PET/CT imaging to determine if these can be used to develop personalized treatment design for the better management of breast cancer.

Detection of perfusion abnormalities in patients with permanent pacemakers on stress-rest 99mTc-tetrofosmin myocardial perfusion single-photon emission computed tomography: comparison between right ventricular apex and right ventricular outflow tract pacing.

OBJECTIVE: The aim of the study was to compare the myocardial perfusion defects in patients with right ventricular outflow tract (RVOT) and right ventricular apex (RVA) pacing on stress-rest Tc-tetrofosmin myocardial perfusion single-photon emission computed tomography. PATIENTS AND METHODS: A total of 31 patients with permanent pacemakers (RVOT: 16 and RVA: 15) underwent stress-rest Tc-tetrofosmin involving a 1-day protocol. All patients underwent 1-day low-dose stress-gated and high-dose rest-gated Tc-tetrofosmin myocardial perfusion single-photon emission computed tomography imaging. RESULTS: Fixed perfusion defects were noted in 13 (42%) of 31 patients. Two (13%) patients of the RVOT group and 11 (69%) patients of the RVA group showed fixed perfusion defects (P=0.003). The fixed perfusion defects were located in the anteroapical, anteroseptal, and apical in the RVOT pacing group and in the apical, distal anteroseptal, inferoapical, distal anterior, and distal inferoseptal in the RVA pacing group. On univariate analysis, the incidence of perfusion defects was significantly associated with apical pacing, longer pQRS duration, and higher percentage of ventricular pacing. On multivariate analysis, the site of pacemaker insertion was found to be the most important pacemaker parameter determining the incidence of perfusion defects. Importantly, the duration of postpacemaker implantation did not show any significant relation to the incidence of perfusion defects. CONCLUSION: Fixed perfusion abnormalities are observed in patients with pacemakers and are independent of duration of time since implantation. RVOT pacing is associated with fewer incidences of myocardial perfusion abnormalities compared with RVA pacing.

Osteosclerotic and osteolytic manifestations of hyperparathyroidism in a case of Tc99m SestaMIBI positive parathyroid adenoma.

Primary hyperparathyroidism is the first differential diagnosis when a patient presents with asymptomatic hypercalcemia. The symptoms of hyperparathyroidism can be as grave as skeletal, cardiovascular, and neuropsychological changes. Skeletal manifestations are relatively common, and patient may present with generalized or focal bone pains, fragility fractures, subperiosteal bone resorption, and osteolytic lesions like brown tumors and salt and pepper appearance of the skull. However, focal osteosclerotic lesions of the skull are rare findings in hyperparathyroidism. Only a few cases of associated osteosclerosis are reported in the literature. Here, we report a case of Tc99m SestaMIBI positive parathyroid adenoma with coexisting osteolytic and osteosclerotic skull lesions on Tc99m methylene diphosphonate bone scan.

SPECT-CT for characterization of extraosseous uptake of 99mTc-methylene diphosphonate on bone scintigraphy.

Bone scintigraphy is a sensitive and popular method for imaging a wide array of benign or malignant skeletal abnormalities. However, the uptake of tracers used for bone scintigraphy may be observed in various extraosseous sites, thereby limiting its specificity. It is difficult to correctly localize such sites of uptake on planar bone scintigraphy alone. The addition of hybrid single-photon emission computed tomography-computed tomography (SPECT-CT) under such circumstances is very useful. The present essay illustrates the commonly encountered extraosseous uptake of 99mTc-methylene diphosphonate (MDP) and the usefulness of hybrid SPECT-CT in clarifying 99mTc-MDP uptake.

Hybrid SPECT-CT with 99mTc-labeled red blood cell in a case of blue rubber bleb nevus syndrome: added value over planar scintigraphy.

Blue rubber bleb nevus syndrome (BRBNS) is a rare clinical entity characterized by multiple venous malformations (hemangiomas) of the skin and gastrointestinal tract. These hemangiomas usually cause episodes of occult gastrointestinal bleeding leading to iron deficiency anemia, and also carry a significant potential for serious hemorrhage. The 99mechnetium (99mTc)-labeled red blood cell scintigraphy has traditionally been utilized in the localization of occult bleeding sites in patients with suspected vascular malformations, angiodysplasia, and Meckel's diverticulum. We report the incremental value of 99mTc-labeled red blood cell hybrid single-photon emission computed tomography-computed tomography (SPECT-CT) over planar scintigraphy alone in a 12-year-old female patient with BRBNS.

Metastatic neuroendocrine carcinoma presenting as a "Superscan" on 68Ga-DOTANOC somatostatin receptor PET/CT.

PET/CT imaging using Ga-labeled somatostatin analogs has become a popular noninvasive diagnostic modality in the workup of patients with neuroendocrine tumors. A 65-year-old man with pancreatic neuroendocrine tumor with confirmed liver metastases on conventional imaging underwent restaging Ga-DOTANOC PET/CT to monitor response to cold octreotide therapy. Previous PET/CT had shown presence of multiple liver and skeletal metastases along with a primary pancreatic tumor showing intense tracer uptake. The present PET/CT study showed an increase in number and uptake of the metastatic lesions suggestive of progressive disease resulting in the appearance of a superscan.

Detection and localization of post-operative and post-traumatic bile leak: hybrid SPECT-CT with 99mTc-Mebrofenin.

PURPOSE: To evaluate the role of single photon emission tomography-computed tomography (SPECT-CT) with 99mTc-N-(3-bromo-2,4,6-trimethylacetanilide) iminodiacetic acid (Mebrofenin) for detection and localisation of post-operative and post-traumatic bile leak and compare the same with planar hepatobiliary scintigraphy (HBS). METHODS: Data of 32 consecutive patients (Age--35.7 ± !15.3 years; Female--53.2%) who underwent 99mTc-Mebrofenin planar HBS and SPECT-CT for suspected bile leak was prospectively collected and retrospectively analyzed. Twenty-six patients were post-operative and six had history of abdominal trauma. Planar HBS and SPECTCT images were evaluated by two experienced nuclear medicine physicians. Sensitivity, specificity and predictive values, were calculated for planar HBS and SPECT-CT. Final diagnosis was established based on a combination of re-operative findings, follow up imaging and clinical follow up (1-4 week).For evaluation of observer confidence a third observer used a scoring scale of 1-5, with 1 being definite bile leak and 5 being no leak. Receiver operating characteristic (ROC) curves were drawn and the areas under the curves were compared. RESULTS: The sensitivity, specificity and accuracy of SPECT-CT were 88.8%, 100% and 96.8% while that of planar HBS were 77.7%, 60.8% and 65.6%, respectively. Planar HBS showed very low diagnostic accuracy compared to SPECT-CT (65.6%vs. 96.8%; P = 0.021). It was false positive in nine patients. SPECT-CT also correctly localised the site of bile leak in eight of nine patients. On ROC analysis the observer confidence for SPECT-CT was significantly better than that for planar scintigraphy (P = 0.045). CONCLUSION: 99mTc-Mebrofenin hybrid SPECT-CT is highly sensitive and specific for detection and localisation of post-operative and post-traumatic bile leak. It is more accurate than planar HBS and should be routinely done in such patients.