The rare case of positive FDG-positron emission tomography for giant cavernous hemangioma of the liver

Hemangioma is the most common benign liver tumor and the second most common liver tumor after metastases. Large hemangiomas are often heterogeneous. When they exceed 4 cm in diameter, they are termed giant hemangiomas. These giant hemangiomas often present heterogeneous patterns. These heterogeneous appearances are shown because of intratumoral changes due to several degenerative phenomena. PET/CT is reported to be useful for the differentiation of benign from malignant liver lesions. We report the case of a large hepatic hemangioma characterized by high FDG uptake

Unexpected detection of abscessualized lung carcinoma on tc-99m-hmpao-labeled leukocytes scintigraphy misdiagnosed on chest computed tomography

Teknesyum-99m (Tc-99m)-heksametilpropilen amin oksim (HMPAO) işaretli lökosit sintigrafisi, kemik ve yumuşak dokudaki enfeksiyonları araştırmak ve teşhis etmek ve ayrıca gizli enfeksiyonu saptamak için iyi bir şekilde tasarlanmıştır. Yakın zamanda sağ akciğerde bronkopulmoner nöroendokrin tümörü teşhisi konan 71 yaşındaki bir kadın, son bir ay içinde geceleri üşüme ile ilişkili bilinmeyen kaynaklı aralıklı ateş nedeniyle sevk edildi. Toraks bilgisayarlı tomografisi (BT) taraması, üst vena kavanın trombotik yayılımını ve sağ akciğerin alt lobunun üst segmentindekarşılıklı atelektazisi olan katı patolojik dokuyu gösterdi. Bir kateter portu taşıyıcısı olduğundan, bu cihazın bir enfeksiyonundan şüpheleniliyordu. Bu nedenle, Tc-99m-HMPAO işaretli lökosit tek foton emisyonlu bilgisayarlı tomografi (SPECT) gerçekleştirildi ve eşleşen BT taraması ve Tc-99mHMPAO işaretli beyaz kan hücresi SPECT görüntü çiftleri birleştirildi. Bu yolla, artmış radyofarmasötik tutulumun, sağ akciğerin alt lobunda lokalize BT taraması ile tespit edilen yumuşak doku yoğunluğu kütlesine karşılık geldiği bulundu. Hibrid SPECT/BT füzyon görüntüleme, bilinen akciğer kanseri bölgesi ile uyumlu olarak lokalize edilmiş bir akciğer apsesinin varlığının teşhisi için çok önemliydi.Technetium-99m (Tc-99m)-hexamethylpropylene amine oxime (HMPAO)-labeled leukocytes scintigraphy is well established for investigating and diagnosing infections in bone and soft tissue, as well as for the detection of occult infection. A 71-year-old female who was recently diagnosed with bronchopulmonary neuroendocrine tumor of the right lung was referred for an intermittent fever of unknown origin associated with chill at night for the last month. Chest computed tomography (CT) scan showed a thrombotic widespread of the superior vena cava and a solid pathological tissue in the superior segment of the inferior lobe of the right lung with consensual atelectasis. Being a carrier of port-a-cath, an infection of this device was suspected. Therefore, Tc-99m-HMPAO-labeled leukocytes single-photon emission computed tomography (SPECT) was performed, and matching pairs of CT scan and Tc-99m-HMPAO-labeled white blood cell SPECT images were fused. Through this means, it was found that the area of the radiotracer increased uptake corresponded with the soft tissue density mass detected by CT scan localized at the inferior lobe of the right lung. The hybrid SPECT/CT fused imaging was crucial for diagnosis of the presence of a lung abscess localized in correspondence with the known lung cancer region

Early 18F-FDG PET/CT in COVID-19

We report the case of who has been hospitalized complaining about fever in the last 4 days. Laboratory data revealed lymphocytopenia and leucopenia with an elevation of C-reactive protein and positive real-time reverse transcription-polymerase chain reaction (RT-PCR). Six days before this hospitalization, when the patient was asymptomatic, 18F-FDG PET/CT images were performed for the therapeutic control of liver metastases of colorectal cancer. Lung abnormality findings at 18F-FDG PET/CT images, unrelated to cancer metastases, but suspicious for viral infection, may suggest the presence of COVID-19 disease in its early phase before symptoms onset. Since PET/CT is more sensitive than CT scan in detecting host’s reaction, the added value of this technique could be monitoring disease progression and could be used as a biomarker of lung disease activity and therefore as an important tool for a better understanding of the factors that contribute to the progression of lung disease

111In-Octreoscan SPECT/CT hybrid imaging and 68Ga-DOTANOC PET/CT in neuroendocrine adenoma of the middle ear (NAME)

Neuroendocrine adenoma of the middle ear (NAME) represents a rare tumour consisting of an adenoma with mixed neuroendocrine differentiation. A 40-year-old woman was referred to our attention to further investigate the occurrence of a pathological tissue located in the mastoid process of the left temporal bone depicted by head CT and MRI scans. Histopathological examination revealed an epithelial neoplasm with neuroendocrine differentiation features, consistent with the diagnosis of NAME. In order to obtain an accurate differential diagnosis and confirmation of this rare disease, 111In-Octreoscan single photon emission computed tomography (SPECT)/CT and 68Ga-DOTANOC positron emission tomography (PET)/CT were performed, both showing overexpression of somatostatin receptors and thus corroborating the histopathological findings

The relation between cardiac 123I-mIBG scintigraphy and functional response 1 year after CRT implantation

Cardiac resynchronization therapy (CRT) is a disease-modifying therapy in patients with chronic heart failure (CHF). Current guidelines ascribe CRT eligibility on three parameters only: left ventricular ejection fraction (LVEF), QRS duration, and New York Heart Association (NYHA) functional class. However, one-third of CHF patients does not benefit from CRT. This study evaluated whether 123I-meta-iodobenzylguanidine (123I-mIBG) assessed cardiac sympathetic activity could optimize CRT patient selection

Role of PET gamma detection in radioguided surgery: a systematic review

Purpose This systematic review aimed to collect published studies concerning intraoperative gamma detection of positronemitting tracers for radioguided surgery (RGS) applications. Methods A systematic literature search of studies published until October 2022 was performed in Pubmed, Web Of Science, Central (Cochrane Library) and Scopus databases, including the following keywords: “Positron Emission Tomography” OR “PET” AND “Gamma” OR “γ” AND “Probe” AND “Radioguided Surgery” OR “RGS”. The included studies had to concern RGS procedures performed in at least 3 patients, regardless of the administered radiopharmaceutical and the field of application. Results Among to the 17 selected studies, all published between 2000 and 2022, only 2 investigations were conducted with gallium-68 (68Ga)-labeled somatostatin analogues, with fluorine-18-fluoro-2-deoxyglucose ([ 18F]FDG) being the most commonly used agent for RGS applications. Almost all studies were performed in oncologic patients, with only one paper also including inflammatory and infectious findings. The analysis showed that the largest part of procedures was performed through the intraoperative use of conventional gamma probes, not specifically designed for the detection of annihilation photons (n = 9), followed by PET gamma probes (n = 5) and with only three studies involving electronic collimation. Conclusions Regardless of the intraoperative devices, RGS with positron emitters seems to lead to significant improvements in surgeons’ ability to obtain a complete resection of tumors, even if the nature of photons resulting from positron–electron collision still remains extremely challenging and requires further technical advances

Comparison of the imaging performances for recently developed monolithic scintillators: CRY018 and CRY019 for dual isotope gamma ray imaging applications

The growing interest for new scintillation crystals with outstanding imaging performances (i.e. resolution and efficiency) has suggested the study of recently discovered scintillators named CRY018 and CRY019. The crystals under investigation are monolithic and have shown enhanced characteristics both for gamma ray spectrometry and for Nuclear Medicine imaging applications such as the dual isotope imaging. Moreover, the non-hygroscopic nature and the absence of afterglow make these scintillators even more attractive for the potential improvement in a wide range of applications. These scintillation crystals show a high energy resolution in the energy range involved in Nuclear Medicine, allowing the discrimination between very close energy values. Moreover, in order to prove their suitability of being powerful imaging systems, the imaging performances like the position linearity and the intrinsic spatial resolution have been evaluated obtaining satisfactory results thanks to the implementation of an optimized algorithm for the images reconstruction. © 2017 IOP Publishing Ltd and Sissa Medialab srl

18F-fluorodeoxyglucose (18F-FDG) functionalized gold nanoparticles (GNPs) for plasmonic photothermal ablation of cancer. A review

The meeting and merging between innovative nanotechnological systems, such as nanoparticles, and the persistent need to outperform diagnostic-therapeutic approaches to fighting cancer are revolutionizing the medical research scenario, leading us into the world of nanomedicine. Photothermal therapy (PTT) is a non-invasive thermo-ablative treatment in which cellular hyperthermia is generated through the interaction of near-infrared light with light-to-heat converter entities, such as gold nanoparticles (GNPs). GNPs have great potential to improve recovery time, cure complexity, and time spent on the treatment of specific types of cancer. The development of gold nanostructures for photothermal efficacy and target selectivity ensures effective and deep tissue-penetrating PTT with fewer worries about adverse effects from nonspecific distributions. Regardless of the thriving research recorded in the last decade regarding the multiple biomedical applications of nanoparticles and, in particular, their conjugation with drugs, few works have been completed regarding the possibility of combining GNPs with the cancer-targeted pharmaceutical fluorodeoxyglucose (FDG). This review aims to provide an actual scenario on the application of functionalized GNP-mediated PTT for cancer ablation purposes, regarding the opportunity given by the 18F-fluorodeoxyglucose (18F-FDG) functionalization

Prognostic and theranostic applications of positron emission tomography for a personalized approach to metastatic castration‐resistant prostate cancer

Metastatic castration‐resistant prostate cancer (mCRPC) represents a condition of pro-gressive disease in spite of androgen deprivation therapy (ADT), with a broad spectrum of mani-festations ranging from no symptoms to severe debilitation due to bone or visceral metastatization. The management of mCRPC has been profoundly modified by introducing novel therapeutic tools such as antiandrogen drugs (i.e., abiraterone acetate and enzalutamide), immunotherapy through sipuleucel‐T, and targeted alpha therapy (TAT). This variety of approaches calls for unmet need of biomarkers suitable for patients’ pre‐treatment selection and prognostic stratification. In this sce-nario, imaging with positron emission computed tomography (PET/CT) presents great and still unexplored potential to detect specific molecular and metabolic signatures, some of whom, such as the prostate specific membrane antigen (PSMA), can also be exploited as therapeutic targets, thus combining diagnosis and therapy in the so‐called “theranostic” approach. In this review, we per-formed a web‐based and desktop literature research to investigate the prognostic and theranostic potential of several PET imaging probes, such as18F‐FDG,18F‐choline and68Ga‐PSMA‐11, also covering the emerging tracers still in a pre‐clinical phase (e.g., PARP‐inhibitors’ analogs and the radioligands binding to gastrin releasing peptide receptors/GRPR), highlighting their potential for defining personalized care pathways in mCRPC

Somatostatin receptor PET/CT imaging for the detection and staging of pancreatic NET. A systematic review and meta-analysis

We investigated the diagnostic performance of Somatostatin Receptor Positron Emission Tomography/Computed Tomography (SSR-PET/CT) for the detection of primary lesion and initial staging of pancreatic neuroendocrine tumors (pNETs). A comprehensive literature search up to January 2020 was performed selecting studies in presence of: sample size ≥10 patients; index test (i.e., 68Ga-DOTATOC or 68Ga-DOTANOC or 68Ga-DOTATATE PET/CT); and outcomes (i.e., detection rate (DR), true positive, true negative, false positive, and false-negative). The methodological quality was evaluated with QUADAS-2. Pooled DR and pooled sensitivity and specificity for the identification of the primary tumor were assessed by a patient-based and a lesion-based analysis. Thirty-eight studies were selected for the qualitative analysis, while 18 papers were included in the meta-analysis. The number of pNET patients ranged from 10 to 142, for a total of 1143 subjects. At patient-based analysis, the pooled sensitivity and specificity for the assessment of primary pNET were 79.6% (95% confidence interval (95%CI): 71–87%) and 95% (95%CI: 75–100%) with a heterogeneity of 59.6% and 51.5%, respectively. Pooled DR for the primary lesion was 81% (95%CI: 65–90%) and 92% (95%CI: 80–97%), respectively, at patient-based and lesion-based analysis. In conclusion, SSR-PET/CT has high DR and diagnostic performances for primary lesion and initial staging of pNETs