Indian journal of nuclear medicine : IJNM : the official journal of the Society of Nuclear Medicine, India
The role of fluorine-18 fluorodeoxyglucose. ((18)F-FDG) positron emission tomography. (PET)/compu... more The role of fluorine-18 fluorodeoxyglucose. ((18)F-FDG) positron emission tomography. (PET)/computed tomography. (CT) in the initial staging of various malignancies is now well established. However, nonspecificity of FDG occasionally results in tracer uptake in benign lung lesions. The authors describe a complicated case of carcinoma stomach with multiple nodules and a cavitary lesion in lungs where (18)F-FDG PET CT done for initial staging revealed FDG avid mass in stomach, FDG avid multiple mediastinal lymph nodes and multiple intensely FDG avid bilateral lung lesions. The FDG avid lung lesions turned out to be due to silicosis as confirmed by histopathology.
Colorectal cancer is the third most common cancer worldwide and the second most common cancer in ... more Colorectal cancer is the third most common cancer worldwide and the second most common cancer in Europe. The role of 18F-FDG (FDG) PET/CT in suspected recurrence, in patients with liver metastases eligible for surgical management, and in treatment response evaluation in colorectal carcinoma is now well established with more data emerging in initial staging of colorectal cancer [1]. FDG PET/CT can influence the management strategies in colorectal patient in up to 30% of the cases [2]. In this context, adequate understanding of the physiological variants, possible artefacts, as well as imaging pitfalls of FDG PET/CT in colorectal carcinoma patients is extremely important.
Colorectal cancer is the third most common cancer worldwide and the second most common cancer in ... more Colorectal cancer is the third most common cancer worldwide and the second most common cancer in Europe. The role of 18F-FDG (FDG) PET/CT in suspected recurrence, in patients with liver metastases eligible for surgical management, and in treatment response evaluation in colorectal carcinoma is now well established with more data emerging in initial staging of colorectal cancer [1]. FDG PET/CT can influence the management strategies in colorectal patient in up to 30% of the cases [2]. In this context, adequate understanding of the physiological variants, possible artefacts, as well as imaging pitfalls of FDG PET/CT in colorectal carcinoma patients is extremely important.
A 64-year-old woman underwent completion thyroidectomy with upper tracheal ring resection and rig... more A 64-year-old woman underwent completion thyroidectomy with upper tracheal ring resection and right-sided neck dissection for papillary carcinoma of the thyroid infiltrating the trachea and was given I radioiodine treatment. Three years later, she presented with hemoptysis. On evaluation, she had increased serum thyroglobulin and negative iodine scan (TENIS). F-FDG PET/CT scan did not identify any site of disease. One year later, Ga-PSMA scan done revealed a moderate focal tracer-avid intratracheal soft tissue; biopsy revealed it to be metastatic papillary carcinoma of the thyroid. This case kindles the possibility of using Ga-PSMA PET/CT to reveal occult disease in cases of TENIS.
Background Imaging of gliomas remains challenging. The aim of the study was to assess the feasibi... more Background Imaging of gliomas remains challenging. The aim of the study was to assess the feasibility of using 68Ga-PSMA-11 PET/CT for imaging gliomas. Methods Fifteen patients with glioma from 2 centers were included in the study. Ten patients were treated cases of glioblastoma with suspected recurrence. Two patients were sent for assessing the nature (primary lesion/metastasis) of space-occupying lesion in the brain; 3 patients were imaged immediately after surgery and before radiotherapy. Target-to-background ratios (TBR) for the brain lesions were calculated using contralateral cerebellar uptake as background. Results Among the 10 cases with suspected recurrence, scan was positive in 9, subsequent surgery was done, and histopathology proved it to be true recurrence. In the scan-negative case on follow-up, no evidence of disease could be made clinically or radiologically. Among the other cases the presence or absence of disease could be unequivocally identified on the 68Ga-PSMA-11 brain scan and correlated with the histopathology or other imaging. Apart from the visual assessment quantitative assessment of the lesions with TBR also showed a significantly high TBR value for those with true disease compared with those with no disease. Conclusions In the evaluation of gliomas, 68Ga-PSMA-11 PET/CT brain imaging is a potentially useful imaging tool. The use of 68Ga-PSMA-11 brain PET/CT in evaluation of recurrent glioma seems promising. Absence of physiological uptake of 68Ga-PSMA-11 in the normal brain parenchyma results in high TBR values and consequently better visualization of glioma lesions.
Objective To assess the feasibility of gallium 68 (68Ga)-prostate specific membrane antigen (PSMA... more Objective To assess the feasibility of gallium 68 (68Ga)-prostate specific membrane antigen (PSMA) PET/computed tomography (CT) to identify patients who truly harbor clinically significant prostate cancer (PCa) in a cohort of patients with clinical and biochemical/radiological suspicion of PCa. Patients and methods A total of 118 patients with suspected PCa who underwent 68Ga-PSMA PET/CT between May 2015 and June 2016 were prospectively included. Final decision on performing biopsy was left to the referring urologist after considering the clinical data, scan findings and discussion with the patient. Results Overall, 51 patients were scan negative, among whom six underwent biopsy but was negative for malignancy. In 45 patients, an immediate biopsy could be avoided and put on follow-up. None of these patients were documented to have PCa in the short average follow-up of 6 months. Among 67 patients who were scan positive, 56 patients underwent transrectal ultrasonography-guided biopsy, and malignancy could be documented in 46 of them. In addition, comprehensive initial staging information could be obtained in them, with organ-confined disease demonstrated in 33 patients and metastatic disease in 13 patients. Conclusion 68Ga-PSMA PET/CT can act as a gate keeper in selecting patients with suspected PCa who should undergo an immediate transrectal ultrasonography-guided biopsy and who could be kept on active surveillance.
A 66-year-old man on hormonal therapy with prostate cancer was referred for Ga-PSMA PET/CT scan f... more A 66-year-old man on hormonal therapy with prostate cancer was referred for Ga-PSMA PET/CT scan for biochemical recurrence. Ga-PSMA PET/CT scan detected moderate heterogeneous tracer concentration in bilateral breast parenchyma, in addition to the abnormal tracer concentration in enlarged prostate gland, right external iliac lymph node, and sclerotic lesion in L4 vertebra. On clinical examination, he was found to have bilateral gynecomastia. Abnormal concentration of Ga-PSMA in breast cancer is now well known, and in this context, it is important to know that tracer localization can occur in gynecomastia as well, as evidenced in this case.
Fibrous dysplasia (FD) is a benign bone lesion with a rare but potential for malignant transforma... more Fibrous dysplasia (FD) is a benign bone lesion with a rare but potential for malignant transformation. Neither Tc-MDP nor F-FDG PET/CT can differentiate between FD and areas of malignant transformation in FD. We described a case of osteosarcoma developing in FD with selective uptake of tracer in malignant transformation areas demonstrated on a Ga-PSMA PET/CT scan. Our case highlights the ability of Ga-PSMA PET/CT to map tumor neoangiogenesis in osteosarcoma arising in FD, which can have potential implications in prognostication, possibility of antiangiogenesis-based therapeutic options, and in response assessment following chemotherapy.
A 74-year-old man with suspected prostate cancer and a previously negative transrectal ultrasound... more A 74-year-old man with suspected prostate cancer and a previously negative transrectal ultrasound-guided prostate biopsy underwent Ga-PSMA PET/CT. Scan showed no abnormal tracer concentration in enlarged prostate gland to suggest prostate cancer. Note was made of an incidentally detected well defined soft tissue lesion in the greater curvature of the stomach with moderate tracer concentration in its intraluminal portion. Biopsy of the lesion revealed gastrointestinal stromal tumor.
A 68-year-old man presented with right-side facial numbness. MRI showed an extra-axial mass infil... more A 68-year-old man presented with right-side facial numbness. MRI showed an extra-axial mass infiltrating the right temporal bone. It was debulked surgically, and histopathology revealed metastatic adenocarcinoma. Ga PSMA PET/CT done in view of increased PSA levels and clinically suspicious hard lesion in prostate showed primary lesion in left side of prostate with metastases to the right temporal bone. Primary carcinoma of the prostate and metastases to the right temporal bone were proven histopathologically. Our case highlights the usefulness of Ga PSMA PET/CT in identifying the primary site in suspected prostate cancer and mapping the metastatic sites.
The potential applications of Ga-labeled prostate-specific membrane antigen (PSMA) PET/CT in the ... more The potential applications of Ga-labeled prostate-specific membrane antigen (PSMA) PET/CT in the imaging of prostate cancer are now well established. A few case reports regarding the potential use of Ga-PSMA PET/CT in nonprostate cancer malignancies are also published. Apparently, the tumor neoangiogenesis is the mechanism attributed to increased Ga-PSMA uptake in the tumor sites in nonprostatic malignancies. We describe the use of Ga-PSMA PET/CT in imaging multiple myeloma. The intense Ga-PSMA avidity of the lesions also opens up the possibility of theranostics with Lu-PSMA.
To evaluate the feasibility of using Ga PSMA-11 PET/CT for imaging brain lesions and its comparis... more To evaluate the feasibility of using Ga PSMA-11 PET/CT for imaging brain lesions and its comparison with F-FDG. Ten patients with brain lesions were included in the study. Five patients were treated cases of glioblastoma with suspected recurrence. F-FDG and Ga PSMA-11 brain scans were done for these patients. Five patients were sent for assessing the nature (primary lesion/metastasis) of space occupying lesion in brain. They underwent whole body F-FDG PET/CT scan and a primary site elsewhere in the body was ruled out. Subsequently they underwent Ga PSMA-11 brain PET/CT imaging. Target to background ratios (TBR) for the brain lesions were calculated using contralateral cerebellar uptake as background. In five treated cases of glioblastoma with suspected recurrence the findings of Ga PSMA-11 PET/CT showed good correlation with that of F-FDG PET/CT scan. Compared to the F-FDG, Ga PSMA-11 PET/CT showed better visualization of the recurrent lesion (presence/absence) owing to its significantly high TBR. Among the five cases evaluated for lesion characterization glioma and atypical meningioma patients showed higher SUVmax in the lesion with Ga PSMA-11 than with F-FDG and converse in cases of lymphoma. TBR was better with Ga PSMA PET/CT in all cases. Ga PSMA-11 PET/CT brain imaging is a potentially useful imaging tool in the evaluation of brain lesions. Absence of physiological uptake of Ga PSMA-11 in the normal brain parenchyma results in high TBR values and consequently better visualization of metabolically active disease in brain.
We describe a case of metastatic clear cell renal cell carcinoma with intensely tracer concentrat... more We describe a case of metastatic clear cell renal cell carcinoma with intensely tracer concentrating lesions in left suprarenal region, mediastinal lymph nodes, lytic bone lesions, thyroid nodules, and mild abnormal tracer-avid lung nodules in Ga-prostate-specific membrane antigen (PSMA) PET/CT. On the other hand F-FDG PET/CT showed mild to no significant abnormal uptake in these lesions. Complimentary uptake pattern was observed in Ga-PSMA and F-FDG PET images in thyroid lesions and D5 vertebral lesion. This case highlights the possibilities of imaging clear cell renal cell carcinoma with Ga-PSMA and opens the possibility of treatment with Lu-PSMA.
Indian journal of nuclear medicine : IJNM : the official journal of the Society of Nuclear Medicine, India
The role of fluorine-18 fluorodeoxyglucose. ((18)F-FDG) positron emission tomography. (PET)/compu... more The role of fluorine-18 fluorodeoxyglucose. ((18)F-FDG) positron emission tomography. (PET)/computed tomography. (CT) in the initial staging of various malignancies is now well established. However, nonspecificity of FDG occasionally results in tracer uptake in benign lung lesions. The authors describe a complicated case of carcinoma stomach with multiple nodules and a cavitary lesion in lungs where (18)F-FDG PET CT done for initial staging revealed FDG avid mass in stomach, FDG avid multiple mediastinal lymph nodes and multiple intensely FDG avid bilateral lung lesions. The FDG avid lung lesions turned out to be due to silicosis as confirmed by histopathology.
Colorectal cancer is the third most common cancer worldwide and the second most common cancer in ... more Colorectal cancer is the third most common cancer worldwide and the second most common cancer in Europe. The role of 18F-FDG (FDG) PET/CT in suspected recurrence, in patients with liver metastases eligible for surgical management, and in treatment response evaluation in colorectal carcinoma is now well established with more data emerging in initial staging of colorectal cancer [1]. FDG PET/CT can influence the management strategies in colorectal patient in up to 30% of the cases [2]. In this context, adequate understanding of the physiological variants, possible artefacts, as well as imaging pitfalls of FDG PET/CT in colorectal carcinoma patients is extremely important.
Colorectal cancer is the third most common cancer worldwide and the second most common cancer in ... more Colorectal cancer is the third most common cancer worldwide and the second most common cancer in Europe. The role of 18F-FDG (FDG) PET/CT in suspected recurrence, in patients with liver metastases eligible for surgical management, and in treatment response evaluation in colorectal carcinoma is now well established with more data emerging in initial staging of colorectal cancer [1]. FDG PET/CT can influence the management strategies in colorectal patient in up to 30% of the cases [2]. In this context, adequate understanding of the physiological variants, possible artefacts, as well as imaging pitfalls of FDG PET/CT in colorectal carcinoma patients is extremely important.
A 64-year-old woman underwent completion thyroidectomy with upper tracheal ring resection and rig... more A 64-year-old woman underwent completion thyroidectomy with upper tracheal ring resection and right-sided neck dissection for papillary carcinoma of the thyroid infiltrating the trachea and was given I radioiodine treatment. Three years later, she presented with hemoptysis. On evaluation, she had increased serum thyroglobulin and negative iodine scan (TENIS). F-FDG PET/CT scan did not identify any site of disease. One year later, Ga-PSMA scan done revealed a moderate focal tracer-avid intratracheal soft tissue; biopsy revealed it to be metastatic papillary carcinoma of the thyroid. This case kindles the possibility of using Ga-PSMA PET/CT to reveal occult disease in cases of TENIS.
Background Imaging of gliomas remains challenging. The aim of the study was to assess the feasibi... more Background Imaging of gliomas remains challenging. The aim of the study was to assess the feasibility of using 68Ga-PSMA-11 PET/CT for imaging gliomas. Methods Fifteen patients with glioma from 2 centers were included in the study. Ten patients were treated cases of glioblastoma with suspected recurrence. Two patients were sent for assessing the nature (primary lesion/metastasis) of space-occupying lesion in the brain; 3 patients were imaged immediately after surgery and before radiotherapy. Target-to-background ratios (TBR) for the brain lesions were calculated using contralateral cerebellar uptake as background. Results Among the 10 cases with suspected recurrence, scan was positive in 9, subsequent surgery was done, and histopathology proved it to be true recurrence. In the scan-negative case on follow-up, no evidence of disease could be made clinically or radiologically. Among the other cases the presence or absence of disease could be unequivocally identified on the 68Ga-PSMA-11 brain scan and correlated with the histopathology or other imaging. Apart from the visual assessment quantitative assessment of the lesions with TBR also showed a significantly high TBR value for those with true disease compared with those with no disease. Conclusions In the evaluation of gliomas, 68Ga-PSMA-11 PET/CT brain imaging is a potentially useful imaging tool. The use of 68Ga-PSMA-11 brain PET/CT in evaluation of recurrent glioma seems promising. Absence of physiological uptake of 68Ga-PSMA-11 in the normal brain parenchyma results in high TBR values and consequently better visualization of glioma lesions.
Objective To assess the feasibility of gallium 68 (68Ga)-prostate specific membrane antigen (PSMA... more Objective To assess the feasibility of gallium 68 (68Ga)-prostate specific membrane antigen (PSMA) PET/computed tomography (CT) to identify patients who truly harbor clinically significant prostate cancer (PCa) in a cohort of patients with clinical and biochemical/radiological suspicion of PCa. Patients and methods A total of 118 patients with suspected PCa who underwent 68Ga-PSMA PET/CT between May 2015 and June 2016 were prospectively included. Final decision on performing biopsy was left to the referring urologist after considering the clinical data, scan findings and discussion with the patient. Results Overall, 51 patients were scan negative, among whom six underwent biopsy but was negative for malignancy. In 45 patients, an immediate biopsy could be avoided and put on follow-up. None of these patients were documented to have PCa in the short average follow-up of 6 months. Among 67 patients who were scan positive, 56 patients underwent transrectal ultrasonography-guided biopsy, and malignancy could be documented in 46 of them. In addition, comprehensive initial staging information could be obtained in them, with organ-confined disease demonstrated in 33 patients and metastatic disease in 13 patients. Conclusion 68Ga-PSMA PET/CT can act as a gate keeper in selecting patients with suspected PCa who should undergo an immediate transrectal ultrasonography-guided biopsy and who could be kept on active surveillance.
A 66-year-old man on hormonal therapy with prostate cancer was referred for Ga-PSMA PET/CT scan f... more A 66-year-old man on hormonal therapy with prostate cancer was referred for Ga-PSMA PET/CT scan for biochemical recurrence. Ga-PSMA PET/CT scan detected moderate heterogeneous tracer concentration in bilateral breast parenchyma, in addition to the abnormal tracer concentration in enlarged prostate gland, right external iliac lymph node, and sclerotic lesion in L4 vertebra. On clinical examination, he was found to have bilateral gynecomastia. Abnormal concentration of Ga-PSMA in breast cancer is now well known, and in this context, it is important to know that tracer localization can occur in gynecomastia as well, as evidenced in this case.
Fibrous dysplasia (FD) is a benign bone lesion with a rare but potential for malignant transforma... more Fibrous dysplasia (FD) is a benign bone lesion with a rare but potential for malignant transformation. Neither Tc-MDP nor F-FDG PET/CT can differentiate between FD and areas of malignant transformation in FD. We described a case of osteosarcoma developing in FD with selective uptake of tracer in malignant transformation areas demonstrated on a Ga-PSMA PET/CT scan. Our case highlights the ability of Ga-PSMA PET/CT to map tumor neoangiogenesis in osteosarcoma arising in FD, which can have potential implications in prognostication, possibility of antiangiogenesis-based therapeutic options, and in response assessment following chemotherapy.
A 74-year-old man with suspected prostate cancer and a previously negative transrectal ultrasound... more A 74-year-old man with suspected prostate cancer and a previously negative transrectal ultrasound-guided prostate biopsy underwent Ga-PSMA PET/CT. Scan showed no abnormal tracer concentration in enlarged prostate gland to suggest prostate cancer. Note was made of an incidentally detected well defined soft tissue lesion in the greater curvature of the stomach with moderate tracer concentration in its intraluminal portion. Biopsy of the lesion revealed gastrointestinal stromal tumor.
A 68-year-old man presented with right-side facial numbness. MRI showed an extra-axial mass infil... more A 68-year-old man presented with right-side facial numbness. MRI showed an extra-axial mass infiltrating the right temporal bone. It was debulked surgically, and histopathology revealed metastatic adenocarcinoma. Ga PSMA PET/CT done in view of increased PSA levels and clinically suspicious hard lesion in prostate showed primary lesion in left side of prostate with metastases to the right temporal bone. Primary carcinoma of the prostate and metastases to the right temporal bone were proven histopathologically. Our case highlights the usefulness of Ga PSMA PET/CT in identifying the primary site in suspected prostate cancer and mapping the metastatic sites.
The potential applications of Ga-labeled prostate-specific membrane antigen (PSMA) PET/CT in the ... more The potential applications of Ga-labeled prostate-specific membrane antigen (PSMA) PET/CT in the imaging of prostate cancer are now well established. A few case reports regarding the potential use of Ga-PSMA PET/CT in nonprostate cancer malignancies are also published. Apparently, the tumor neoangiogenesis is the mechanism attributed to increased Ga-PSMA uptake in the tumor sites in nonprostatic malignancies. We describe the use of Ga-PSMA PET/CT in imaging multiple myeloma. The intense Ga-PSMA avidity of the lesions also opens up the possibility of theranostics with Lu-PSMA.
To evaluate the feasibility of using Ga PSMA-11 PET/CT for imaging brain lesions and its comparis... more To evaluate the feasibility of using Ga PSMA-11 PET/CT for imaging brain lesions and its comparison with F-FDG. Ten patients with brain lesions were included in the study. Five patients were treated cases of glioblastoma with suspected recurrence. F-FDG and Ga PSMA-11 brain scans were done for these patients. Five patients were sent for assessing the nature (primary lesion/metastasis) of space occupying lesion in brain. They underwent whole body F-FDG PET/CT scan and a primary site elsewhere in the body was ruled out. Subsequently they underwent Ga PSMA-11 brain PET/CT imaging. Target to background ratios (TBR) for the brain lesions were calculated using contralateral cerebellar uptake as background. In five treated cases of glioblastoma with suspected recurrence the findings of Ga PSMA-11 PET/CT showed good correlation with that of F-FDG PET/CT scan. Compared to the F-FDG, Ga PSMA-11 PET/CT showed better visualization of the recurrent lesion (presence/absence) owing to its significantly high TBR. Among the five cases evaluated for lesion characterization glioma and atypical meningioma patients showed higher SUVmax in the lesion with Ga PSMA-11 than with F-FDG and converse in cases of lymphoma. TBR was better with Ga PSMA PET/CT in all cases. Ga PSMA-11 PET/CT brain imaging is a potentially useful imaging tool in the evaluation of brain lesions. Absence of physiological uptake of Ga PSMA-11 in the normal brain parenchyma results in high TBR values and consequently better visualization of metabolically active disease in brain.
We describe a case of metastatic clear cell renal cell carcinoma with intensely tracer concentrat... more We describe a case of metastatic clear cell renal cell carcinoma with intensely tracer concentrating lesions in left suprarenal region, mediastinal lymph nodes, lytic bone lesions, thyroid nodules, and mild abnormal tracer-avid lung nodules in Ga-prostate-specific membrane antigen (PSMA) PET/CT. On the other hand F-FDG PET/CT showed mild to no significant abnormal uptake in these lesions. Complimentary uptake pattern was observed in Ga-PSMA and F-FDG PET images in thyroid lesions and D5 vertebral lesion. This case highlights the possibilities of imaging clear cell renal cell carcinoma with Ga-PSMA and opens the possibility of treatment with Lu-PSMA.
Uploads
Papers by ajith joy k