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Section: Nuclear Medicine / Molecular Imaging

 




Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Small bowel perforation: a rare complication of ventriculoperitoneal shunt placement by Kelsey Bourm et al.

Published: 2016 Jun
Issue: 10(6) :: Pages: 30-35


Free full text article: Small bowel perforation: a rare complication of ventriculoperitoneal shunt placement

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Abstract: Small bowel perforation is a rare complication of ventriculoperitoneal (VP) shunt placement. When seen, it most commonly affects the stomach or colon. We describe a case and image findings of an 8-year-old female who presented with sepsis and erosion of the VP shunt into the small bowel. The imaging findings were confirmed surgically. We also provide an overview of the current literature discussing previously reported cases, clinical features, and treatment.


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Computed Tomography, Nuclear Medicine, Table





Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Maxillary mesenchymal chondrosarcoma presenting with epistaxis in a child by Srinivas Anand Swaroop Uppaluri et al.

Published: 2015 Aug
Issue: 9(8) :: Pages: 33-38


Free full text article: Maxillary mesenchymal chondrosarcoma presenting with epistaxis in a child

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Abstract: Mesenchymal chondrosarcomas are a rare variant of primary chondrosarcomas and can pose a diagnostic dilemma, especially when the features on conventional imaging are equivocal for an aggressive lesion. There is very little PET-CT experience in mesenchymal chondrosarcomas as per the literature and to the best of our knowledge, we are the first to describe a maxillary mesenchymal chondrosarcoma on PET-CT imaging. We report a case where PET-CT not only complemented conventional imaging in suspecting a malignant osseous lesion, but also was indicative of the grade of the tumor.


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Computed Tomography, Nuclear Medicine, Microscopic pathology, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Sialadenitis following low dose I-131 diagnostic thyroid scan with Thyrogen® (recombinant human thyroid stimulating hormone - thyrotropin alfa) by Marta E Gonzalez et al.

Published: 2015 Jun
Issue: 9(6) :: Pages: 44-49


Free full text article: Sialadenitis following low dose I-131 diagnostic thyroid scan with Thyrogen® (recombinant human thyroid stimulating hormone - thyrotropin alfa)

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Abstract: Salivary dysfunction and sialadenitis are well known complications of radioiodine treatment for thyroid cancer. The parotid gland is more frequently affected and the salivary gland injury is dose related. The symptoms may develop shortly after therapeutic Iodine 131(I-131) administration or months later and progress with time. The development of unilateral parotiditis following a low dose, diagnostic I-131 scan performed following Thyrogen stimulation in a patient without prior history of sialadenitis is rare in our experience, and has not been reported in the medical literature.


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Nuclear Medicine, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

18-FDG Uptake in Pulmonary Dirofilariasis by Michael Stone et al.

Published: 2015 Apr
Issue: 9(4) :: Pages: 28-33


Free full text article: 18-FDG Uptake in Pulmonary Dirofilariasis

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Abstract: Solitary pulmonary nodules are a common finding on chest radiography and CT. We present the case of an asymptomatic 59-year-old male found to have a 13 mm left upper lobe nodule on CT scan. The patient was asymptomatic and the CT was performed to follow up mediastinal and hilar lymphadenopathy that had been stable on several previous CT scans. He had a history of emphysema and reported a 15 pack-year smoking history. PET-CT was performed which demonstrated mild 18-FDG uptake within the nodule. Given his age and smoking history, malignancy was a consideration and he underwent a wedge resection. Pathological examination revealed a necrobiotic granulomatous nodule with a central thrombosed artery containing a parasitic worm with internal longitudinal ridges and abundant somatic muscle, consistent with pulmonary dirofilariasis. Dirofilaria immitis, commonly known as the canine heartworm, rarely affects humans. On occasion it can be transmitted to a human host by a mosquito bite. There are two major clinical syndromes in humans: pulmonary dirofilariasis and subcutaneous dirofilariasis. In the pulmonary form, the injected larvae die before becoming fully mature and become lodged in the pulmonary arteries.


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Computed Tomography, Nuclear Medicine, Microscopic pathology, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Systemic Mastocytosis: A Rare Cause of Single Vertebral Body Uptake on Bone Scan by Monzer Chehab et al.

Published: 2015 Feb
Issue: 9(2) :: Pages: 31-41


Free full text article: Systemic Mastocytosis: A Rare Cause of Single Vertebral Body Uptake on Bone Scan

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Abstract: Systemic Mastocytosis is a rare condition characterized by the abnormal proliferation of Mast Cells. Presentation as a solitary vertebral body lesion is extremely uncommon and may be confused with more ominous conditions such as metastasis. Familiarity with the condition can heighten clinical suspicion, direct tissue diagnosis, guide management and indicate appropriate follow up. We present a case of a 64-year-old woman undergoing staging for recently diagnosed breast cancer who was found to have Systemic Mastocytosis of a single vertebral body.


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Conventional Radiography, Ultrasound, Nuclear Medicine, Computed Tomography, Microscopic pathology, Table





Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

FDG Positron Emission Tomography and Computed Tomography Demonstration of Carcinoma Arising in an Epiphrenic Diverticulum by Thomas J Eluvathingal Muttikkal et al.

Published: 2014 Nov
Issue: 8(11) :: Pages: 42-46


Free full text article: FDG Positron Emission Tomography  and Computed Tomography Demonstration of  Carcinoma Arising in an Epiphrenic Diverticulum

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Abstract: Esophageal carcinoma arising within an epiphrenic diverticulum is rare. We describe a case of a carcinoma in a long-standing epiphrenic diverticulum in a 62-year-old patient. Fluorine-18-2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography and Computed Tomography, and endoscopic ultrasound revealed a hypermetabolic mass within the diverticulum. A preoperative diagnosis was made via endoscopic biopsy. The patient underwent Ivor-Lewis esophagectomy. He remains well and free of recurrence 18 months after surgery.


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Clinical image, Ultrasound, Nuclear Medicine, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

The Hypermetabolic Giant: 18F-FDG avid Giant Cell Tumor identified on PET-CT by Wendi O`Connor et al.

Published: 2014 Jun
Issue: 8(6) :: Pages: 27-38


Free full text article: The Hypermetabolic Giant:  18F-FDG avid Giant Cell Tumor identified on PET-CT

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Abstract: An 87 year-old white female presented with a two-year history of intermittent discomfort in her left foot. PET-CT identified intense18F-fluorodeoxyglucose (FDG) uptake corresponding to the lesion. Histology of a fine needle aspiration and open biopsy were consistent with a benign giant cell tumor (GCT) of the bone. GCT of bone is an uncommon primary tumor typically presenting as a benign solitary lesion that arises in the end of the long bones. While GCT can occur throughout the axial and appendicular skeleton, it is exceedingly uncommon in the bone of the foot. While 18F-FDG has been established in detecting several malignant bone tumors, benign disease processes may also be identified. The degree of 18F-FDG activity in a benign GCT may be of an intensity that can be mistakenly interpreted as a malignant lesion. Therefore, GCT of the bone can be included in the differential diagnosis of an intensely 18F-FDG-avid neoplasm located within the tarsal bones.


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Nuclear Medicine, Magnetic Resonance Imaging, Microscopic pathology, Table





Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Bilateral cryptorchidism mimicking external iliac lymphadenopathy in a patient with leg melanoma: role of FDG-PET and ultrasound in management by Samuel Kyle et al.

Published: 2014 Jan
Issue: 8(1) :: Pages: 13-19


Free full text article: Bilateral cryptorchidism mimicking external iliac lymphadenopathy in a patient with leg melanoma: role of FDG-PET and ultrasound in management

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Abstract: Cryptorchidism is the most common congenital anomaly present at birth in males. Spontaneous testicular descent occurs in the majority of patients, typically before 6 months of age. Radiology plays an important role, predominantly in the assessment of the nonpalpable testis, with ultrasound being the most commonly employed modality. Magnetic resonance imaging is however the most accurate modality for the assessment of the nonpalpable testis, particularly with the use of fat suppressed T2 and diffusion weighted sequences. While traditionally treated in infancy, the untreated or occult form can radiologically be mistaken for lymphadenopathy. Fluorodeoxyglucose (FDG) positron emission tomography can play an important role in differentiating cryptorchidism from lymphadenopathy, most commonly in patients with known malignancy, although FDG uptake can be variable. We present a case of bilateral cryptorchidism in an adult male which masqueraded as lymphadenopathy in a patient with lower limb melanoma.


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Computed Tomography, Nuclear Medicine, Ultrasound, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Rare lymphoid malignancies of the breast: report of two cases illustrating potential diagnostic techniques by Orazio Schillaci et al.

Published: 2012 Dec
Issue: 6(12) :: Pages: 43-50


Free full text article: Rare lymphoid malignancies of the breast: report of two cases illustrating potential diagnostic techniques

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Abstract: Two cases of lymphoid malignancy involving the breast are herein presented. Both patients were admitted with a palpable breast mass. Ultrasound demonstrated hypoechoic, ill-defined lesions of the breast in both patients; mammogram also showed spiculated breast densities. Both patients underwent core biopsy, which revealed lymphomatous cells. Total-body evaluation was also performed by computed tomography and positron emission tomography/computed tomography revealing no other fluorodeoxyglucose-avid foci in the first case and supra and subdiaphragmatic disease in the second one.


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Conventional Radiography, Ultrasound, Microscopic pathology, Nuclear Medicine, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Flare Response versus Disease Progression in Patients with Non-small Cell Lung Cancer by Khalsa Al-Nabhani et al.

Published: 2012 Nov
Issue: 6(11) :: Pages: 34-42


Free full text article: Flare Response versus Disease Progression in Patients with Non-small Cell Lung Cancer

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Abstract: We present a case report of a patient with metastatic non-small cell lung cancer (NSCLC) who had a series of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans for assessment of response to treatment. A restaging 18F-FDG PET/CT scan after six cycles showed increased FDG activity in the bone lesions with reduced activity in the lung and liver lesions. The increased bone activity was considered to be due to flare phenomenon rather than metastasis. A short interval follow up scan after 1 month was advised to confirm this interpretation but this repeat scan showed disease relapse. Although the flare phenomenon does exist, caution should be exercised in attributing increased tracer uptake in the lesions in patients with adenocarcinoma of lung and especially those who have received erlotinib during the course of their treatment. Distinguishing the `flare phenomenon` and `disease progression` is at times difficult but is important since misdiagnosis may result in an unnecessary delay in patient management.


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Conventional Radiography, Computed Tomography, Magnetic Resonance Imaging, Nuclear Medicine, Microscopic pathology, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Nuclear scintigraphy findings for Askin tumor with In111-pentetreotide, Tc99m-MIBI and F18-FDG. by Johnathan Chen et al.

Published: 2012 Oct
Issue: 6(10) :: Pages: 32-39


Free full text article: Nuclear scintigraphy findings for Askin tumor with In111-pentetreotide, Tc99m-MIBI and F18-FDG.

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Abstract: Askin tumor is a rare disease which had previously been reported as being thallium-201 and gallium-67 avid. Varying data regarding 18F-fluorodeoxyglucose metabolism has been described with Ewing family of soft tissue tumors. In this case, we present a patient found to have an Askin tumor of the left chest wall which demonstrated indium-111 pentetreotide and technetium-99m MIBI avidity. The lesion did not show 18F-fluorodeoxyglucose hypermetabolism in this case despite the aggressiveness of the tumor. The patient was treated with surgical excision of the tumor and chemotherapy. Subsequently, contrast enhanced CT, indium-111 pentetreotide and technetium 99m-MIBI showed that the lesion had regressed. These findings suggest that Askin tumor can demonstrate Indium-111 pentetreotide and technetium 99m-MIBI uptake and need not be hypermetabolic on 18F-fluorodeoxyglucose exam.


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Conventional Radiography, Nuclear Medicine, Microscopic pathology, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Unusual Concentration of Tc-99m methylendiphosphonate in Rhabdomyosarcoma by Arie Franco et al.

Published: 2012 Sep
Issue: 6(9) :: Pages: 29-34


Free full text article: Unusual Concentration of Tc-99m methylendiphosphonate in Rhabdomyosarcoma

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Abstract: Extraosseous accumulation of bone-seeking agents is rare, but has been previously reported in pediatric sarcomas and neuroblastomas. We present an unusual case of a 5-month-old male with an abdominal mass observed clinically by his parents and referring pediatrician. Contrast abdominal computerized tomography confirmed the presence of a large pelvic mass that was diagnosed pathologically as embryonal rhabdomyosarcoma. A bone scintigraphy that was performed for staging of the disease revealed accumulation of the radiopharmaceutical in the tumor. There was no evidence for skeletal metastatic disease. This case further demonstrates the nonspecificity of soft-tissue tumor uptake on bone scintigraphy.


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Computed Tomography, Nuclear Medicine, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

F-18 FDG PET/CT and Tc-99m Sulfur Colloid SPECT imaging in the diagnosis and treatment of a case of dual solitary fibrous tumors of the retroperitoneum and pancreas by Javad Azadi et al.

Published: 2012 Mar
Issue: 6(3) :: Pages: 32-37


Free full text article: F-18 FDG PET/CT and Tc-99m Sulfur Colloid SPECT imaging in the diagnosis and treatment of a case of dual solitary fibrous tumors of the retroperitoneum and pancreas

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Abstract: Although FDG PET is increasingly used for the staging of many types of sarcoma, little has been written regarding the FDG PET imaging characteristics of solitary fibrous tumor. We report a patient undergoing FDG PET/CT surveillance for squamous cell carcinoma of the tongue who was incidentally found to have two soft tissue masses in the retroperitoneum and pancreatic tail. Due to their low degree of FDG avidity, they were followed conservatively for approximately one year as they gradually increased in size. Technetium-99m sulfur colloid SPECT helped confirm that the pancreatic tail mass was not a splenule, after which both lesions were surgically resected and found to be extrathoracic solitary fibrous tumors without malignant features. These findings suggest that, as with other low-grade sarcomas, benign extrathoracic solitary fibrous tumors exhibit relatively little glycolytic metabolism in vivo.


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Nuclear Medicine, Microscopic pathology, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

False Positive GI Bleed on Tc-99m RBC Scintigraphy Due to Ileal Varices by Paul Ning-Chuan Chen et al.

Published: 2012 Feb
Issue: 6(2) :: Pages: 23-28


Free full text article: False Positive GI Bleed on Tc-99m RBC Scintigraphy Due to Ileal Varices

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Abstract: Tc-99m labeled RBC scintigraphy is commonly employed in the evaluation of acute gastrointestinal bleeding. On Tc-99m RBC studies gastrointestinal bleeding is seen as an initial focus of increased radiotracer activity that on subsequent images increases in intensity and changes position in a pattern that conforms to segments of bowel. We report a case of a patient with multiple episodes of hematochezia that presented with lower gastrointestinal hemorrhage. A Tc-99m labeled RBC scan was performed and the findings suggested a GI bleed. However, subsequent angiography revealed prominent ileal varices simulating an acute bleed. Although most varices fill promptly and should not be misinterpreted as a focus of hemorrhage, slow filling varices can simulate an acute bleed and lead to a false positive interpretation.


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Nuclear Medicine, Angiography, Interventional, Ultrasound, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Inflammatory Pseudotumor of the Spleen: Review of clinical presentation and diagnostic methods by Hooman Yarmohammadi et al.

Published: 2011 Sep
Issue: 5(9) :: Pages: 16-22


Free full text article: Inflammatory Pseudotumor of the Spleen: Review of clinical presentation and diagnostic methods

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Abstract: We describe a 91-year-old woman with a clinical history of invasive ductal carcinoma of the breast diagnosed in 1991 who was admitted because of dizziness, poor appetite, and some swelling and tenderness over her cheeks. The patient`s initial work up revealed a 5-cm well-demarcated hypodense solid lesion in her spleen with abnormally intense uptake on PET/CT scan raising suspicion for malignancy i.e. breast metastasis versus lymphoma. Further review demonstrated the presence of this splenic lesion, though slightly smaller, on a CT scan from ten years earlier (2000). An ultrasonographic guided core needle splenic biopsy was performed and the pathology result revealed histological findings compatible with inflammatory pseudotumor of the spleen. As a result, unnecessary splenectomy was avoided.


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Computed Tomography, Nuclear Medicine, Ultrasound, Microscopic pathology, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Retroperitoneal Fibrosis as a Cause of Positive FDG PET/CT by Amar Mehta et al.

Published: 2011 July
Issue: 5(7) :: Pages: 35-41


Free full text article: Retroperitoneal Fibrosis as a Cause of Positive FDG PET/CT

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Abstract: This article educates the reader on idiopathic retroperitoneal fibrosis and emphasizes the importance of considering conditions that mimic this disease on PET/CT through an illustrative case of a 58 year-old man presenting with intermittent abdominal, back, and scrotal pain undergoing successive PET/CT scans, both for diagnosis and following treatment.


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Nuclear Medicine, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Impact of geometric mean imaging in the accurate determination of partial function in MAG3 renal scanning in a patient with retroperitoneal mass by Mustafa Takesh* et al.

Published: 2011 June
Issue: 5(6) :: Pages: 9-17


Free full text article: Impact of geometric mean imaging in the accurate determination of partial function in MAG3 renal scanning in a patient with retroperitoneal mass

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Abstract: Liposarcoma frequently occurs in the retroperitoneum and lower extremities, accounting for 20% of all mesenchymal malignancies. Liposarcomas vary by histology and can be classified into four types. Those four types are well differentiated, myxoid/round cell, pleomorphic and dedifferentiated. Due to retroperitoneal location of this tumor, it is expected to affect the kidney position. Renography has provided a unique tool for noninvasive evaluation of various functional parameters e.g. relative renal function. Most renography studies are carried out using the posterior view, under the assumption that the depths of both kidneys are similar so that the radiotracer counts in the region of interest will be attenuated to the same extent. Errors in estimation of the relative renal function may arise if the kidneys are at different depths e.g. secondary to a pushing tumor. Geometric mean imaging from combined anterior and posterior views helps to overcome this issue. This case shows the impact of geometric mean imaging in the truthful determination of partial function in patients with retroperitoneal liposarcoma.


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Nuclear Medicine, Magnetic Resonance Imaging, Ultrasound, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Particle Disease on Fluoride-18 (NaF) PET/CT imaging by Jonathan Kuo et al.

Published: 2011 May
Issue: 5(5) :: Pages: 24-30


Free full text article: Particle Disease on Fluoride-18 (NaF) PET/CT imaging

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Abstract: Particle disease is a loss of bone that commonly occurs about five years after arthroplasty. The cause is secondary to microabrasive wear and shedding of any portion of the prosthesis, and the microscopic foreign bodies activate inflammation which can lead to pain. This report describes the imaging findings of an 80-year-old female with particle disease detected with 18F-fluoride PET/CT.


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Computed Tomography, Nuclear Medicine, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Extraperitoneal Urinary Bladder Perforation Detected by FDG PET/CT by Brian Wosnitzer et al.

Published: 2011 Apr
Issue: 5(4) :: Pages: 32-40


Free full text article: Extraperitoneal Urinary Bladder Perforation Detected by FDG PET/CT

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Abstract: Accurate localization of areas of increased metabolic activity on PET only imaging can be challenging. Fusion of PET with CT imaging provides anatomic detail which aids in localization of functional information. As a result, the overall sensitivity and specificity of information provided by PET or CT alone is improved with combined PET/CT resulting in improved diagnosis and patient management. We report a case of an unexpected emergent finding of urinary bladder perforation on PET/CT to stress the importance of accurately interpreting the anatomic and functional data. To our knowledge, diagnosis of bladder perforation on PET/CT has not been previously reported in the literature. Failure to recognize such complications may lead to adverse outcomes.


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Computed Tomography, Microscopic pathology, Nuclear Medicine, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Imaging Keratitis-Icthyosis-Deafness (KID) syndrome with FDG-PET (F18-fluorodeoxiglucose-Positron Emission Tomography) by Carina Mari Aparici et al.

Published: 2010 Jul
Issue: 4(7) :: Pages: 6-11


Free full text article: Imaging Keratitis-Icthyosis-Deafness (KID) syndrome with FDG-PET (F18-fluorodeoxiglucose-Positron Emission Tomography)

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Abstract: Keratitis-Icthyosis-Deafness (KID) syndrome is a rare dysplasia characterized by vascularizing keratitis, congenital sensorineural hearing-loss, and progressive erythrokeratoderma. To our knowledge, this is the first KID syndrome imaged with FDG-PET in the literature. This paper is intended to help familiarize with the FDG abnormalities related to this rare entity.


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Nuclear Medicine, Magnetic Resonance Imaging, Computed Tomography, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

FDG PET/CT diagnosis of hepatic lymphoma mimicking focal fatty infiltration on CT by Eugene Lin et al.

Published: 2010 Apr
Issue: 4(4) :: Pages: 34-37


Free full text article: FDG PET/CT diagnosis of hepatic lymphoma mimicking focal fatty infiltration on CT

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Abstract: Areas of hypoattenuation in the liver which do not have mass effect are typically thought to represent focal fatty infiltration. Rarely, tumors can present without mass effect in the liver. We present a case in which areas of liver hypoattenuation which were initially thought to represent focal fatty infiltration on CT due to lack of mass effect had abnormal uptake on a FDG PET/CT exam; these areas were due to secondary hepatic involvement from non-Hodgkin`s lymphoma.


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Nuclear Medicine, Microscopic pathology

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

FDG uptake in sternoclavicular joint synovitis: Mimic of internal mammary adenopathy. by Eugene Lin

Published: 2010 Mar
Issue: 4(3) :: Pages: 31-34


Free full text article: FDG uptake in sternoclavicular joint synovitis: Mimic of internal mammary adenopathy.

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Abstract: False-positive FDG uptake has been noted in a wide range of benign processes. In this report, we describe a case of FDG uptake in unilateral sternoclavicular synovitis which mimicked an internal mammary node in appearance. Knowledge of this potential false-positive is particularly important in breast cancer patients with a propensity of internal mammary nodal metastases.


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Nuclear Medicine, Computed Tomography

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Calcified Lymph Nodes Causing Clinically Relevant Attenuation Correction Artifacts on PET/CT Imaging by Amar Mehta et al.

Published: 2010 Feb
Issue: 4(2) :: Pages: 31-37


Free full text article: Calcified Lymph Nodes Causing Clinically Relevant Attenuation Correction Artifacts on PET/CT Imaging

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Abstract: There are several artifacts unique to PET/CT imaging, with CT-based attenuation correction (AC) artifacts being among the most commonly reported. AC artifacts from calcified lymph nodes represent clinically significant and easily misinterpreted PET/CT artifacts that have received little attention in the literature. In this case series, we report three cases of calcified lymph nodes causing an AC artifact and one case of a highly calcified lymph node without an AC artifact. All three cases of calcified lymph nodes causing an AC artifact would have resulted in a change in patient staging, and likely management, if the nodes had been misinterpreted as malignant nodes. In PET/CT imaging, this artifact needs to be considered as a potential cause of apparent FDG activity when calcified lymph nodes are present on the CT portion of a PET/CT study in order to avoid misinterpretation and potential patient mismanagement.


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Nuclear Medicine

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Expansive Masses Arising From The Clivus: The Role Of FDG-PET/CT In The Metabolic Assessment Of Skeletal Lesions by Angelina Cistaro et al.

Published: 2009 Nov
Issue: 3(11) :: Pages: 33-40


Free full text article: Expansive Masses Arising From The Clivus: The Role Of FDG-PET/CT In The Metabolic Assessment Of Skeletal Lesions

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Abstract: A patient with neurological symptoms underwent CT scan that showed a sellar and suprasellar mass with bone erosions, involving especially the clivus and the right petrous apex. The first diagnostic hypothesis was chordoma in relation to the mass position. The MRI showed a solid well-enhancing mass; moreover another circumscribed lesion, with similar signal pattern, was found in the left mandibular condyle. the signal and the presence of another lesion did not agree with diagnosis of chordoma. FDG-PET/CT study showed multiple pathological uptakes suggesting a metastatic disease. A trans-sphenoidal excisional biopsy was performed and the histopathological analysis showed a population of cells consistent with a plasmacell tumor, confirmed by the presence of a monoclonal gammopathy on blood analysis. Our case suggests that FDG-PET/CT can modify the diagnostic and therapeutic procedures in myeloma, by evaluating the bone marrow involvement.


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Magnetic Resonance Imaging, Computed Tomography, Nuclear Medicine, Microscopic pathology

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

Asymmetric 18F-FDG Uptake in the Infradiaphragmatic Brown Adipose Tissue (BAT) Mimicking Adrenal Metastasis: A Relatively Rare Site of Brown Fat and a Potential Source for False Positive FDG-PET Study by Sandip Basu et al.

Published: 2009 Oct
Issue: 3(10) :: Pages: 19-22


Free full text article: Asymmetric 18F-FDG Uptake in the Infradiaphragmatic Brown Adipose Tissue (BAT) Mimicking Adrenal Metastasis: A Relatively Rare Site of Brown Fat and a Potential Source for False Positive FDG-PET Study

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Abstract: FDG uptake in the metabolically active brown adipose tissue (BAT) is a source of significant concern while interpreting FDG-PET studies. It is also of great interest due to its potential implications for obesity research. In this communication, we describe hitherto unreported asymmetric BAT uptake in the abdomen, persisting after diazepam intervention in the repeat PET study on a separate day. The patient did not have any evidence of disease even at 24 months` follow up. The present case is a useful addition to the current body of literature of false positive FDG-PET due to BAT uptake in unusual location and underscores the importance of high index of suspicion and careful correlation, whenever one comes across an unusual PET finding in a given clinical situation. This assumes important diagnostic value particularly when it coexists in the setting of malignancy where the disease can be falsely upstaged by misinterpretation. The literature relevant to the report is discussed and a schema is suggested for correct interpretation.


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Nuclear Medicine





Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

SPECT/CT imaging of a retroperitoneal nodule in a patient with history of infiltrating renal urothelial carcinoma by Duane Schonlau et al.

Published: 2009 Sep
Issue: 3(9) :: Pages: 18-21


Free full text article: SPECT/CT imaging of a retroperitoneal nodule in a patient with history of infiltrating renal urothelial carcinoma

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Abstract: A 62 year old woman status post radical nephroureterectomy for high grade urothelial carcinoma was found on CT to have a 1 cm retroperitoneal nodule in the nephrectomy bed. The nodule`s differential diagnosis included recurrent urothelial carcinoma versus relocation of the patient`s splenule seen on earlier CT imaging. We report using SPECT/CT with Tc-99m labeled denatured red blood cells to definitively diagnose the nodule as a relocated splenule.


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Computed Tomography, Nuclear Medicine

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Symptomatic Calvarial Cavernous Hemangioma: Presurgical Confirmation by Scintigraphy by Ajeet Gordhan et al.

Published: 2009 Aug
Issue: 3(8) :: Pages: 25-29


Free full text article: Symptomatic Calvarial Cavernous Hemangioma: Presurgical Confirmation by Scintigraphy

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Abstract: Hemangiomas are rare tumors in the calvarium and represent 2% of osseous calvarial lesions. Dynamic Tc-99m RBC blood pool scintigraphy has a high positive predictive value for cavernous hemangiomas of the liver. This scintigraphic technique can be used for identifying cavernous hemangiomas at other anatomic sites. We present a case in which a tagged RBC blood pool scan was used for further characterizing a symptomatic calvarial lesion as a cavernous hemangioma. This avoided an unnecessary workup for metastatic disease and was valuable in surgical planning for anticipated increased intra-operative blood loss. Histological confirmation of a cavernous hemangioma was made after surgical resection.


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Computed Tomography, Magnetic Resonance Imaging, Nuclear Medicine, Microscopic pathology

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Testicular relapse of non-Hodgkin Lymphoma noted on FDG-PET by Stephen D. Scotti et al.

Published: 2009 Aug
Issue: 3(8) :: Pages: 18-24


Free full text article: Testicular relapse of non-Hodgkin Lymphoma noted on FDG-PET

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Abstract: Testicular relapse of leukemia and lymphoma is a well-recognized phenomenon, with testicular relapse of lymphoma being more common in the adult population and leukemia relapse being more common in the pediatric population. With the advent of F-18 fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) in the evaluation of lymphoma it is possible to evaluate testicular uptake of FDG and to detect primary testicular lymphoma or testicular relapse on the FDG-PET examination. Testicular relapse of non-Hodgkin lymphoma (NHL) detected on FDG-PET has been reported previously. We report an additional case in which there was testicular activity at presentation, a response to therapy (orchiectomy not performed) and then testicular relapse followed by orchiectomy. We review the literature with regard to testicular recurrence and testicular uptake of FDG-PET. There have been studies that have examined normal standardized uptake value maximum (SUVmax) values in the testicle, with normal values ranging from 2.81 ( 30-39 years) to 2.18 (80-89 years), depending upon age. However, it should be noted that there could be considerable variability in SUVmax values depending upon the units used (e.g. normalized to lean body mass vs. body weight) and depending upon examination variables such as dietary conditions, muscle uptake or extravasation of FDG. Elevated activity or lateralizing activity should be viewed with suspicion, with etiologies including primary testicular tumor, primary or secondary testicular lymphoma and metastatic disease with other etiologies less likely.


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Computed Tomography, Nuclear Medicine, Ultrasound, Microscopic pathology

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Detection of neoplastic meningitis in a patient with gastric cancer by thallium-201 SPECT by Yasuyo Tonomura et al.

Published: 2009 Apr
Issue: 3(4) :: Pages: 9-13


Free full text article: Detection of neoplastic meningitis in a patient with gastric cancer by thallium-201 SPECT

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Abstract: We describe the usefulness of thallium-201 SPECT in a patient with neoplastic meningitis (NM) from gastric carcinoma. Thallium-201 SPECT is of value for the diagnosis of cancer; retention of thallium-201 on delayed images strongly suggests malignancy. NM is a lethal, major neurologic complication of cancer. The standard for the diagnosis of NM is cytologic confirmation of malignant cells in CSF, but cytologic results are often negative (estimated false negative rate, 50%), even when NM is strongly suspected clinically. In patients with equivocal findings, our findings suggest that thallium-201 SPECT is one helpful tool for the detection of NM, particularly when associated with signet-ring cell carcinoma.


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Nuclear Medicine (SPECT and PET) and MRI, Computed Tomography, Nuclear Medicine, Microscopic pathology

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Iodine 131 ablation of an obstructive lingual thyroid by Zeal Patel et al.

Published: 2009 Feb
Issue: 3(2) :: Pages: 3-6


Free full text article: Iodine 131 ablation of an obstructive lingual thyroid

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Abstract: A 48-year-old woman undergoing surgery could not be intubated because of an oropharyngeal mass. CT and MRI revealed a 3 cm possible lingual thyroid mass, confirmed by Iodine-123 SPECT/CT. The patient underwent successful Iodine-131 ablation and has done well on thyroid hormone-replacement therapy. This case also demonstrates how modern cross-sectional imaging like SPECT/CT can appropriately be used in the patient diagnosis and management, and is of additional interest for including pre- and post-therapy MRI documenting efficacy morphologically.


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Magnetic Resonance Imaging, Nuclear Medicine

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Lithium therapy: an unusual cause of elevated and diffuse radioactive iodine uptake by Ebenezer A Nyenwe et al.

Published: 2008 Oct
Issue: 2(4) :: Pages: 1-4


Free full text article: Lithium therapy: an unusual cause of elevated and diffuse radioactive iodine uptake

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Abstract: Lithium carbonate, a widely used treatment for bipolar disorders, is associated with goiter, hypothyroidism and thyrotoxicosis. However, the effect of lithium to increase radioactive iodine uptake has received little attention, thus, making Lithium a confounding factor in the interpretation of thyroid radionuclide studies. We herein report a case of misinterpreted high radioactive iodine uptake in a euthyroid, lithium-treated goitrous patient. We conclude that lithium therapy should be considered in the etiologic diagnoses of patients with goiter and homogenously elevated radioiodine uptake. It is pertinent to recognize this phenomenon in order to prevent unwarranted treatment with radioactive iodine or thionamides.


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Ultrasound, Nuclear Medicine





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