Nocardia masquerading as pulmonary malignancy in a patient with adult-onset immunodeficiency on F-FDG PET/CT.

A 77-year-old man with a history of left nephrectomy for renal cell carcinoma and partial hepatectomy for cholangiocarcinoma underwent F-FDG PET/CT for assessment of an irregular lung lesion. FDG-PET demonstrated development of an intensely avid spiculated left lower lobe pulmonary lesion and intensely avid left pulmonary hilar nodes, raising suspicion for a malignancy. Eleven days following the PET study, the patient was admitted to hospital with an altered mental state.

Sonothrombolysis Before and After Percutaneous Coronary Intervention Provides the Largest Myocardial Salvage in ST Segment Elevation Myocardial Infarction.

Background: Sonothrombolysis is a therapeutic application of ultrasound with ultrasound contrast for patients with ST elevation myocardial infarction (STEMI). Recent trials demonstrated that sonothrombolysis, delivered before and after primary percutaneous coronary intervention (pPCI), increases infarct vessel patency, improves microvascular flow, reduces infarct size, and improves ejection fraction. However, it is unclear whether pre-pPCI sonothrombolysis is essential for therapeutic benefit.

Incidental Prostate-Specific Membrane Antigen-Avid Vestibular Schwannoma Detected on 68 Ga-Prostate-Specific Membrane Antigen PET/CT.

A 62-year-old man was referred for a 68 Ga-prostate-specific membrane antigen (PSMA) PET/CT scan for newly diagnosed prostate cancer (ISUP grade 5), on the background of left vestibular schwannoma treated with surgical excision 25 years ago. PSMA PET study confirmed the presence of PSMA-avid malignancy in the left prostate lobe with no evidence of PSMA-avid nodal or distant metastasis. An incidental PSMA-avid focus (SUV max , 4.

False-Positive Metastatic Bone Disease on FDG PET/CT Due to Multilevel Tophaceous Gout of the Spine.

A 74-year-old woman was referred for 18 F-FDG PET/CT for the evaluation of incidental CT finding of expansile destruction of left L4/5 facet joint with associated soft tissue mass concerning for a metastatic deposit. The FDG PET/CT revealed variable abnormally increased FDG activity involving multiple facet joints in all regions of the spine with corresponding expansile "punched-out" lytic lesions with sclerotic rims and overhanging margins on CT, raising the possibility of inflammatory polyarthropathy, including gout, as a differential diagnosis. Dual-energy CT of lumbar spine and CT-guided biopsy and culture of the left L4/5 facet joint demonstrated the presence of urate crystal deposition with no evidence of malignancy or infection, confirming the diagnosis of multilevel tophaceous gout of the spine.

Diagnostic accuracy of bone scan at different PSA levels in biochemical recurrence of prostate cancer.

Objective: To determine the diagnostic accuracy of Bone Scan at different PSA levels for detecting skeletal metastases in men with biochemical recurrence of prostate cancer.

Methods: We conducted a retrospective review of the statewide RIS-PACS to identify 251 men with biochemical recurrence who underwent both a Bone Scan and Ga68 PSMA PET/CT (within 2 months of each other) between September 2019 and December 2022 at a single institution. The Ga68 PSMA PET/CT report was considered to be the reference standard.

False positive metastatic disease due to combined thoracic and subcutaneous splenosis.

A 56-year-old man presented with dyspnea secondary to pulmonary emboli and dilated cardiomyopathy. His past medical history included a history of emergency laparotomy, splenectomy, and splenic flexure resection following a gunshot injury 30 years ago. CT and MRI imaging demonstrated multiple homogeneously enhancing lobulated lesions at the left-sided pleura and chest wall with an irregular calcified spleen.

Gastric Schwannoma Demonstrated on 18 F FDG PET/CT With Pathological Correlation.

A 66-year-old man with background hypertension and type 2 diabetes presented with 1 month history of epigastric pain for investigation. Abdominal CT and MRI identified round homogeneously enhancing mass arising from the lesser curvature of the stomach. On 18 F-FDG PET/CT, the gastric mass demonstrated intense FDG uptake (SUV max , 9.

False-Positive Metastatic Disease Due to Bilateral Ectopic Adrenal Tissue.

A 60-year-old man was referred for staging of prostate cancer. Initial CT scan demonstrated soft tissue lesions in bilateral renal hila, which demonstrated mild 68 Ga-PSMA avidity and moderate FDG avidity on sequential PET scans suspicious for malignancy. Biopsy confirmed adrenal cortical tissue.

Intra-individual comparison of prostate-specific membrane antigen positron emission tomography/computed tomography versus bone scan in detecting skeletal metastasis at prostate cancer diagnosis.

Objectives: To compare the diagnostic performance and radiological staging impact of Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) compared to Tc whole-body bone scan (WBBS) for the detection of skeletal metastasis in the primary staging of prostate cancer (PCa).

Patients And Methods: A prospective institutional database was retrospectively examined for patients who underwent both PSMA PET and WBBS within a 1 week interval for PCa primary staging. Lesions were categorised as 'negative', 'equivocal', or 'definite' based on nuclear medicine physician interpretation.

Solitary Prostate Carcinoma Penile Metastasis on 18 F-DCFPyL PET/CT.

An 83-year-old man was referred for an 18 F-DCFPyL PET scan for the evaluation of rising serum prostate-specific antigen level on the background of previous radical prostatectomy for prostate adenocarcinoma and urinary outflow tract obstruction requiring in-dwelling catheter insertion. The PET scan demonstrated focal increased activity (SUV max , 35.7) at the dorsal aspect of the mid penile shaft, with histopathological confirmation of penile metastasis from primary prostate cancer.

Peritoneal Carcinomatosis From Metastatic Prostate Cancer Identified on 68 Ga-Prostate-Specific Membrane Antigen PET/CT.

A 69-year-old man with locally advanced prostate adenocarcinoma (Gleason score 9), who had completed hormone therapy and definitive radiotherapy, presented to hospital with abdominal pain and distension. A CT scan of the abdomen and pelvis revealed ascites and extensive peritoneal/omental nodules. Serum prostate-specific antigen was not raised (0.

FDG PET/CT Imaging of Severe Polymyalgia Rheumatica.

A 68-year-old woman was referred for an 18 F-FDG PET/CT for evaluation of arthralgia and raised inflammatory markers, which demonstrated intense FDG activity (SUV max , 25.5) at numerous periarticular and extra-articular sites including the cervical and lumbar interspinous bursae, lumbar facet joints, bilateral ischial tuberosities, and greater trochanters and the aorta consistent with active polymyalgia rheumatica.

Incidental Adiposis Dolorosa (Dercum's Disease) Detected on 18 F-DCFPyL PET/CT.

A 64-year-old man with recently diagnosed prostate adenocarcinoma and Gleason score 4 + 3 = 7 with a mildly elevated prostate-specific antigen of 5.17 μg/L was referred for 18 F-DCFPyL PET/CT for primary staging. The scan demonstrated incidental innumerable moderately avid subcutaneous nodules due to adiposis dolorosa (Dercum's disease), which is a rare adipose tissue disease.

Iron Polymaltose Infusion Effects on Bone Scintigraphy and Remodeling.

A 73-year-old woman with metastatic breast cancer and known widespread skeletal metastases was referred for bone scintigraphy. Delayed images acquired at 2 and 5 hours postinjection of 30 mCi (1089 MBq) 99mTc-HDP demonstrated markedly reduced bony uptake, markedly increased renal activity, and significantly increased soft tissue accumulation. By contrast, appropriate skeletal uptake of 99mTc-HDP was seen in prior bone scans.

Peritoneal-scrotal dialysate leakage demonstrated on SPECT/CT imaging in a patient on peritoneal dialysis.

A 62-year-old male with end-stage renal failure on peritoneal dialysis presented with sudden onset scrotal swelling following a violent coughing fit. He was referred for a peritoneal leak study to evaluate the scrotal swelling. This case illustrates the benefit of SPECT/CT imaging in the diagnosis and anatomic localization of peritoneal leakage as a complication of peritoneal dialysis.

Incidental prostate-specific membrane antigen-avid glioblastoma detected on Ga-prostate-specific membrane antigen PET/CT.

A 74-year-old man was referred for a Ga-prostate-specific membrane antigen (PSMA) PET/CT scan for newly diagnosed prostate cancer which confirmed the presence of PSMA avid cancer in the right gland with no evidence of PSMA metastasis. Incidentally, there was a markedly PSMA avid (SUVmax 7.0) lobulated periventricular mass in the region of the left basal ganglia which was T2 hyperintense and T1 hypointense with perilesional oedema and vivid Gadolinium enhancement on MRI.

A rare case of urachal mucinous adenocarcinoma detected by 18F-FDG PET/CT and MRI.

Urachal adenocarcinomas are rare cancers of the urinary bladder. Both CT and MRI are useful imaging modalities for the diagnosis and evaluation of urachal adenocarcinoma. Unlike CT or MR, there have been variable FDG PET findings with urachal tumours potentially due to considerable variation in their hypermetabolism.

Steroid responsive inflammatory myofibroblastic tumor of the lung evaluated by FDG PET/CT imaging.

A 68-year-old gentleman was referred for F-FDG PET/CT for a pulmonary mass in the left upper lobe which demonstrated intensely FDG-avid confluent pulmonary consolidation in the left upper lobe (SUV 15.1). Histopathologic biopsy of the left upper lobe lung mass was consistent with inflammatory myofibroblastic tumor (IMT).

Incidental Intrahepatic Hepatocellular Cholangiocarcinoma Detected on 68Ga-PSMA PET/CT.

A 69-year-old man with intermediate-risk prostate cancer and a mildly elevated prostate-specific antigen of 8.2 μg/L was referred for 68Ga-prostate-specific membrane antigen (68Ga-PSMA) PET/CT for primary staging. An incidental intensely 68Ga-PSMA-avid hepatic focus was seen on PSMA PET and subsequent FDG PET/CT and MRI cholangiogram.

FDG avid pulmonary amyloid nodule in a patient with metastatic renal cell cancer on 18F-FDG PET/CT.

A 60-year-old man with a background of resected clear cell renal cancer and resected colorectal adenocarcinoma presented with a pulmonary mass lesion in the left upper lobe which was avid on 18-F FDG PET/CT. Needle biopsy confirmed metastatic renal cell cancer, which was surgically excised with wedge resection. Follow-up imaging 6 months later demonstrated a second slowly enlarging subcentimeter nodule in the contralateral lung with increasing FDG avidity, suspicious of further small volume oligometastatic disease.

Disseminated sarcoidosis involving lymph nodes, bone and spleen with progressive cardiac sarcoidosis on F-FDG PET/CT and cardiac MRI.

A 63-year-old lady with a background of ischemic heart disease was referred for F-FDG PET/CT for multiple lytic bone lesions which showed disseminated FDG avid lesions in the skeleton, nodal stations as well as spleen simulating advanced malignancy such as diffuse lymphomatous disease. A diagnosis of sarcoidosis was pathologically confirmed with bone biopsy. Following treatment, repeat PET/CT revealed significant regression of FDG avid lesions, however prominent uptake in the lateral ventricular wall was suspicious for active cardiac sarcoidosis, particularly given recurrent chest pain.