{"title":"A Rare Case of Adrenal Gland Metastasis from Parotid Adenocarcinoma: Unveiling the Potential Augmented Utility of FAPI PET/CT.","authors":"Akram Al-Ibraheem, Marwah Abdulrahman, Medyan Alrousan, Mohamad Haidar","doi":"10.4103/ijnm.ijnm_13_24","DOIUrl":"10.4103/ijnm.ijnm_13_24","url":null,"abstract":"<p><p>Conventional imaging techniques, while essential, occasionally fall short in identifying elusive metastatic lesions, leading to delayed diagnoses and compromised patient outcomes. Gallium-68 fibroblast activating protein inhibitor (<sup>68</sup>Ga-FAPI) positron emission tomography/computed tomography (PET/CT), leveraging the distinct affinity of fibroblast activation protein for cancer-associated fibroblasts, emerges as a promising solution to bridge this diagnostic gap. Parotid gland adenocarcinoma is a relatively rare malignancy with metastasis typically occurring in regional lymph nodes and distant sites such as the lungs and bones. However, there have been limited reported cases of rare metastatic sites such as the adrenal gland. This exceptional case report details the clinical presentation, diagnostic workup, and management steps of a rare case of a 47-year-old female patient diagnosed with parotid gland adenocarcinoma with confusing metastasis to the ipsilateral adrenal gland which was confirmed later with a follow-up <sup>68</sup>Ga-FAPI PET/CT scan. We aim to highlight FAPI unique ability to illuminate metastatic foci in challenging anatomical locations.</p>","PeriodicalId":45830,"journal":{"name":"Indian Journal of Nuclear Medicine","volume":"39 4","pages":"309-312"},"PeriodicalIF":0.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Radiosynthesis of [18F]-flumazenil Using an Isotopic Approach.","authors":"Riptee Thakur, Aishwarya Kumar, Raman Kumar Joshi, Pardeep Kumar","doi":"10.4103/ijnm.ijnm_82_24","DOIUrl":"10.4103/ijnm.ijnm_82_24","url":null,"abstract":"<p><strong>Background: </strong>Fluorine-18 (<sup>18</sup>F) flumazenil (FMZ) has been synthesized using various precursors, and its role has been explored in imaging Gamma-aminobutyric acid-A receptors.</p><p><strong>Aim and objective: </strong>The main objective was to synthesize (<sup>18</sup>F) FMZ using isotopic substitution.</p><p><strong>Materials and methods: </strong>Around 18 ± 2 GBq was added to the module, dried, and radiolabeling was standardized with 3.0 mg of the FMZ precursor at various temperatures (110°C -160°C) for 10-30 min. The product was finally eluted with 20% ethanol (in phosphate buffer). The final product was characterized by high-performance liquid chromatography (HPLC). The stability was evaluated in water, saline, and phosphate-buffered saline for 4 h.</p><p><strong>Results: </strong>The radiolabelling efficiency of cartridge-based purification was 16 ± 4% (<i>n</i> = 10) with a radiochemical purity of 96.5 ± 1.8%, whereas in HPLC-based purification, the yield was 10 ± 4% (<i>n</i> = 5) with a radiochemical purity of 97.3 ± 1.4%. The specific activity was 120 ± 20 GBq/μmol.</p><p><strong>Conclusions: </strong>(<sup>18</sup>F) FMZ was successfully synthesized using an isotopic approach and could be used as an alternative cheaper option for the synthesis.</p>","PeriodicalId":45830,"journal":{"name":"Indian Journal of Nuclear Medicine","volume":"39 4","pages":"286-291"},"PeriodicalIF":0.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Role of [18F]FDG - PET/CT Scan in Cervical Tuberculosis.","authors":"Sanjeev Kumar, Pankaj Singh, Survesh Kumar Gupta, Ajay Kumar Verma, Suresh Kumar","doi":"10.4103/ijnm.ijnm_106_23","DOIUrl":"10.4103/ijnm.ijnm_106_23","url":null,"abstract":"<p><strong>Background: </strong>Distribution and quantification of extra-pulmonary tuberculosis and elicitation of response antitubercular therapy via F18-Fluorodeoxyglucose Positron Emission-based Tomography/ Computed Tomography(F18-FDG PET/CT).</p><p><strong>Materials and methods: </strong>This was a prospective Pilot study. In this study 30 patients of age between 15 to 36 years(mean 26.8±6.13years) were included. PET/CT scan was performed at the time of presentation(baseline) and after 2 months of anti-tubercular therapy to evaluate bacterial activity in different levels of cervical lymph nodes and changes in various parameters of lymph nodes such as size, conglomeration and abscess formation were included in the evaluation.</p><p><strong>Result: </strong>In this study, 18 patients were of 18 to 30 years(60.0%), 3 patients were below 18 years(10.0%) and 9 patients above 30 years(30%). The female proportion was higher in our study population(53.3%). Node-positive status, conglomeration, and abscess were evaluated clinically. Maximum percentages were found in level II and level V groups. While minimum percentage was found in level I and level VI. We also found that in all patients of tubercular cervical lymphadenopathy, tubercular bacterial activity was found at some distant sites also the common sites were the lung(56.7%), mediastinum(53.3%), abdomen(36.7%) and bone(23.3%). The response of antitubercular therapy by F18 - FDG PET/CT scan after 2 months of treatment was checked. There was a significant change in standardized uptake value(SUV-max) pre-treatment and post-treatment at all distant sites except the bony site.</p><p><strong>Conclusion: </strong>F18-FDG PET/CT scan is a non-invasive tool in monitoring the response of antitubercular chemotherapy in patients of extrapulmonary and multiorgan lymphadenopathy.</p>","PeriodicalId":45830,"journal":{"name":"Indian Journal of Nuclear Medicine","volume":"39 4","pages":"251-253"},"PeriodicalIF":0.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Harpreet Singh, Bhagwant Rai Mittal, Saurabh Mehrotra, Dinkar Bhasin
{"title":"An Unusual ECG Finding during Adenosine Stress Myocardial Perfusion Imaging.","authors":"Harpreet Singh, Bhagwant Rai Mittal, Saurabh Mehrotra, Dinkar Bhasin","doi":"10.4103/ijnm.ijnm_16_24","DOIUrl":"10.4103/ijnm.ijnm_16_24","url":null,"abstract":"<p><p>Adenosine is extensively utilized in myocardial stress perfusion imaging for the detection and risk stratification of coronary artery disease. It has a well-established safety profile. The majority of the undesirable effects experienced during adenosine infusion are transient (owing to its brief half-life of ~10 s) and arise from the stimulation of receptors in the atrio-ventricular (AV) node (AV block) and bronchial smooth muscles (bronchospasm). We hereby report an unusual electrocardiographic finding during adenosine stress perfusion imaging, in a patient who had previously undergone single chamber pacemaker insertion and was referred for the assessment of atypical chest pain.</p>","PeriodicalId":45830,"journal":{"name":"Indian Journal of Nuclear Medicine","volume":"39 4","pages":"327-328"},"PeriodicalIF":0.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Atypical Presentation of Carcinoma Breast as Paraneoplastic Cerebellar Degeneration on [18F]FDG PET/CT.","authors":"Priyank Rajput, Deepanksha Datta, Divya Aggarwal, Rohit Kushwah, Rajesh Kumar","doi":"10.4103/ijnm.ijnm_35_24","DOIUrl":"10.4103/ijnm.ijnm_35_24","url":null,"abstract":"<p><p>Paraneoplastic neurological syndrome (PNS) represents a rare group of central nervous system disorders that are unrelated to direct tumor invasion or metastasis but may be triggered by an immune system reaction to a neoplasm or malignant tumor. In many patients, PNS is diagnosed before identifying the primary cancer. In such instances, positron emission tomography/computed tomography scan can assess individuals with suspected PNS enabling the detection of hidden malignancies. We share an interesting image of paraneoplastic cerebellar degeneration in a case of invasive ductal carcinoma breast.</p>","PeriodicalId":45830,"journal":{"name":"Indian Journal of Nuclear Medicine","volume":"39 4","pages":"325-326"},"PeriodicalIF":0.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[18F]FDG PET/CT in Benign and Malignant Diseases Involving the Biliary Tract.","authors":"Meghana Prabhu, Fahad Nisamudeen, H Vikas","doi":"10.4103/ijnm.ijnm_5_23","DOIUrl":"https://doi.org/10.4103/ijnm.ijnm_5_23","url":null,"abstract":"<p><p>Role of FDG PET/CT in evaluation of biliary tract diseases remains relatively unexplored. PET/CT with FDG helps in evaluation of both infective / inflammatory as well as neoplastic diseases as increased glucose utilization is observed in both the conditions. In this article, we describe the spectrum of FDG PET/CT findings in various diseases affecting the biliary tract. Role of FDG PET/CT in neoplastic diseases involving the biliary duct has been described at the time of staging and response evaluation; in characterization of the intrahepatic mass (abscess v/s cholangiocarcinoma). In addition, we have discussed about the false positive FDG uptake along the biliary duct stent, which interfere with scan interpretation. Few of the benign conditions described are Langerhans cell histiocytosis and IgG4 related disease involving the biliary duct and adenomyomatosis and Xanthogranulomatous cholecystitis involving the gall bladder.</p>","PeriodicalId":45830,"journal":{"name":"Indian Journal of Nuclear Medicine","volume":"39 3","pages":"185-190"},"PeriodicalIF":0.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dikhra Khan, Sambit Sagar, Shamim Ahmed Shamim, Prateek Kaushik, Rakesh Kumar
{"title":"An Unusual Occurrence of Metastases to Multiple Muscles in Neuroblastoma.","authors":"Dikhra Khan, Sambit Sagar, Shamim Ahmed Shamim, Prateek Kaushik, Rakesh Kumar","doi":"10.4103/ijnm.ijnm_37_23","DOIUrl":"https://doi.org/10.4103/ijnm.ijnm_37_23","url":null,"abstract":"<p><p>Neuroblastoma presenting with multiple muscles and subcutaneous tissue metastases is rarely reported in the literature. We would like to highlight such infrequent occurrences for increasing the clinical acumen of the medical fraternity with an aim to deliver proper therapy to patients.</p>","PeriodicalId":45830,"journal":{"name":"Indian Journal of Nuclear Medicine","volume":"39 3","pages":"222-223"},"PeriodicalIF":0.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lymphoscintigraphy - Beyond Lymphedema.","authors":"Geethanjali Reddy, Madhur Kumar Srivastava, Sree Bhushan Raju, Ranganath Ratnagiri, Gongati Kruparao Paramjyothi","doi":"10.4103/ijnm.ijnm_20_24","DOIUrl":"https://doi.org/10.4103/ijnm.ijnm_20_24","url":null,"abstract":"<p><p>Lymphoscintigraphy is an established modality for imaging the lymphatic system using radiocolloids and is routinely indicated to find the cause of limb lymphedema. However, in this case series, we are highlighting other less-known indications of lymphoscintigraphy like chylothorax and chyluria which present as lymphatic leaks in the thorax and abdomen, respectively. Once the site of the lymphatic leak is established by lymphoscintigraphy, definitive management like thoracic duct ligation or sclerotherapy can be done. The other indication discussed is postrenal transplant perinephric fluid collection which can be challenging to confirm whether it is urinoma, lymphocele, or any other collection. And finally, sentinel lymph node localization is another, now, well-established indication of lymphoscintigraphy.</p>","PeriodicalId":45830,"journal":{"name":"Indian Journal of Nuclear Medicine","volume":"39 3","pages":"198-206"},"PeriodicalIF":0.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mediastinal Hemangioma Mimicking as Bronchial NET.","authors":"Siven Kar, Harshita Gupta, Nusrat Shaikh, Vikram Lele","doi":"10.4103/ijnm.ijnm_29_24","DOIUrl":"https://doi.org/10.4103/ijnm.ijnm_29_24","url":null,"abstract":"<p><p>We present a rare case of mediastinal capillary hemangioma in a 54-year-old female. She presented with back pain in the left suprascapular region, and the chest radiograph revealed left pleural effusion. On further workup with high-resolution computed tomography (CT) chest, a hypervascular pleural-based neoplastic lesion in the left upper hemithorax with gross left pleural effusion and subtotal collapse of the left lung was identified. <sup>18</sup>F-fluorodeoxyglucose positron emission tomography/CT was suggestive of a weakly metabolic well-defined pleural-based soft tissue lesion in the left upper hemithorax along the mediastinal side. Neuroendocrine tumor was suspected. <sup>68</sup>Ga-DOTATATE PET/CT was advised, which showed intense uptake in the lesion. The mass was resected completely. Histopathological examination established the final diagnosis as benign vascular tumor consistent with a capillary hemangioma.</p>","PeriodicalId":45830,"journal":{"name":"Indian Journal of Nuclear Medicine","volume":"39 3","pages":"213-215"},"PeriodicalIF":0.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sara Zouggari, Mohamed Aziz Bsiss, Aboubaker Matrane
{"title":"White Thyroid Scintigraphy.","authors":"Sara Zouggari, Mohamed Aziz Bsiss, Aboubaker Matrane","doi":"10.4103/ijnm.ijnm_146_23","DOIUrl":"https://doi.org/10.4103/ijnm.ijnm_146_23","url":null,"abstract":"<p><p>White thyroid scintigraphy corresponds to an absence or near-absence of radiotracer fixation in the cervical region. After eliminating technical causes, the main etiologies are iodine overload, thyroiditis, and congenital hypothyroidism. We report the case of a 22-day-old newborn with congenital hypothyroidism. As part of the etiological assessment, a cervical ultrasound was performed and showed a normal echostructured thyroid gland with no detectable lesions or vascular anomalies. On the other hand, a Tc 99m thyroid scintigraphy was also performed and revealed a lack of radiotracer uptake in the thyroid area in favor of a white thyroid scintigraphy. Congenital hypothyroidism is the main cause of mental retardation. Thyroid scintigraphy plays an important role in the etiological diagnosis of congenital hypothyroidism. A white thyroid scan and a thyroid in place on cervical ultrasound point to iodine transporter deficiency caused by sodium/iodide symporter gene mutations.</p>","PeriodicalId":45830,"journal":{"name":"Indian Journal of Nuclear Medicine","volume":"39 3","pages":"232-233"},"PeriodicalIF":0.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}