Diffuse Cutaneous Angiosarcoma Involving Scalp and Face on 18F-FDG and 68Ga-NODAGA-RGD PET/CT.

Cutaneous angiosarcoma of the scalp is a rare, highly aggressive malignant tumor. A 67-year-old man with initial presentation of intermittent facial puffiness, periorbital swelling, and a gradually increasing painless ulcerative lesion on the right side of his forehead, and biopsy-proven cutaneous angiosarcoma, underwent 18F-FDG-PET/CT for initial staging. FDG-PET/CT demonstrated increased tracer uptake in the scalp and facial regions, encompassing periorbital and perinasal areas.

Comparative Evaluation of 68Ga-FAPI-04 PET/CT and 18F-FDG-PET/CT in Primary Staging of Treatment-naïve Anterior Mediastinal Seminoma.

A comparative evaluation using both 18F-FDG-PET/CT and 68Ga-FAPI-04 PET/CT in primary staging of a treatment-naïve anterior mediastinal seminoma is illustrated in this report. A 30-year-old man presented with elevated human chorionic gonadotropin levels and biopsy-proven seminoma of the anterior mediastinum. The investigation was performed for primary staging, considering that both tracers may show uptake in the germ cell tumors in the anterior mediastinum, and the potential role of 68Ga-FAPI-04 PET/CT in treatment-naïve mediastinal seminoma would be examined.

Convenient one-pot synthesis of 1-(4-(4-(2-[F]fluoroethoxy)phenyl)piperazin-1-yl)ethanone ([F]FEt-PPZ) for imaging tumors expressing sigma-1 receptors.

The overexpression of the sigma-1 receptor (σ1R) in a variety of cancers makes it a potential target for developing anticancer drugs or diagnostic/therapeutic radiopharmaceuticals. Molecules with piperidine or piperazine substructures have shown high binding affinity towards σ1R. Docking and MD simulation studies on commercially available piperidine/piperazine-containing compounds identified 1-(4-(4-hydroxyphenyl)piperazin-1-yl)ethanone (PPZ) as a potential ligand for targeting σ1R.

[68Ga]Ga-DOTATATE PET/CT in Well-differentiated Ovarian Neuroendocrine Tumor Associated With Mature Cystic Teratoma.

A well-differentiated ovarian neuroendocrine tumour (NET) associated with a mature cystic teratoma is rarely reported in the literature: the histologic diagnosis of these tumours is challenging due to the absence of defined guidelines for such lesions. Molecular imaging using [68Ga]Ga-DOTATATE PET/CT can play a pivotal role in evaluating somatostatin receptor (SSTR) expression for NET and assessing morphologic features for diagnosing teratoma, especially in patients of ovarian NET associated with mature cystic teratoma in single individual. In addition, [68Ga]Ga-DOTATATE PET/CT offers advantages for implementing theranostic approaches in the treatment of these rare tumours, should this be contemplated.

The Clinical and Molecular Theranostic Roles of Dual Tracer Positron Emission Tomography-Computed Tomography (Ga-DOTATATE and Fluorodeoxyglucose) and Its Imaging Characteristics in a Patient of Recurrent Glomus Jugulare.

Head and neck paragangliomas are rare; among these, glomus jugulare is the second most common. Due to its rarity, close proximity, and adhesion to vital neurovascular structures, treatment of paraganglioma is challenging. Surgery remains the treatment of choice; however, in scenarios of inoperability, molecular theranostics can aid patient management.

The current status and promising potential of copper-based radiopharmaceutical development towards future theranostics: an overview.

Copper is a naturally abundant element that has primarily five clinically important radioisotopes that can be used for theranostic applications in nuclear medicine ( 60 Cu, 61 Cu, 62 Cu, 64 Cu, and 67 Cu). With similar chemical properties which enable the synthesis of radiopharmaceuticals with similar pharmacokinetic properties, these isotopes of copper have different decay characteristics making them valuable for diagnostic or therapeutic purposes. 60 Cu, 61 Cu, 62 Cu, and 64 Cu have been used for diagnostic purposes owing to their β + decay and relatively short half-lives and 67 Cu has been employed for therapeutic uses because of its β - decay.

Localization of Parathyroid Adenoma With 68Ga-NODAGA-RGD PET/CT and Demonstration of "Metabolic Superscan" With Lincoln Sign and Costochondral Junction Beading: A Potential Clinical Application.

In primary hyperparathyroidism (PHPT), exact preoperative localization of parathyroid adenomas is essential for best surgical planning. While new PET tracers like 18F-fluorocholine and 68Ga-Trivehexin show promise, traditional imaging consists of 99mTc-Sestamibi scintigraphy, SPECT/CT, and 4DCT. Herein, we report the potential new application of another angiogenesis imaging agent, 68Ga-NODAGA-RGD PET/CT, illustrated in a 12-year-old girl with PHPT.

Atypical Presentation of Liver Metastasis in Medullary Thyroid Carcinoma: Variable Pattern and Interlesional Heterogeneity Observed on 18F-FDG, 68Ga-DOTATATE, and 68Ga-DOTA-FAPI-04 PET/CT.

Metastatic medullary thyroid carcinoma (MTC) can exhibit variable progression, with liver metastases occurring in up to 62% of cases. We report an unusual case of 50-year-old man with progressive MTC and atypical hypodense metastasis in the left lobe of liver that showed no tracer avidity on conventional 18F-FDG and 68Ga-DOTATATE PET/CT but was intensely avid on 68Ga-DOTA-FAPI-04 PET/CT, implying a possible role of FAPI PET/CT imaging in diagnosing unusual metastatic lesions that may be missed on conventional PET imaging and also its theranostic potential for future management.

Symptom Management for Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors: ASCO Guideline.

Purpose: To develop a clinical practice guideline and recommendations for symptom management of patients with well-differentiated grade 1 to grade 3 metastatic gastroenteropancreatic neuroendocrine tumors.

Methods: ASCO convened an Expert Panel to develop a clinical practice guideline by reviewing the literature for relevant guidelines, systematic reviews, randomized controlled trials (RCTs), and observational studies to develop recommendations for clinical practice.

Results: The literature review identified eight guidelines, 19 systematic reviews, and three RCTs that informed the development of guideline recommendations.

PET-based Quantitative Techniques in Assessing Efficacy of Interventional Radiology Procedures in Oncology.

Interventional radiology (IR) is a super specialised branch where imaging modalities are employed to guide disease specific diagnostic and therapeutic interventions. IR interventions have gained popularity in various oncological and non-oncological indications due to it's ability to effectively diagnose the disease and direct specific targeted treatment. Hybrid imaging using PET CT and PET MRI combines the best of morphological and functional informations and offers improved sensitivity and specificity for detection of lesion; helps in accurate mapping of tumour burden, thereby aiding in planning curative vs palliative intent intervention; more accurate response evaluation to plan redo session in cases of residual / recurrent disease or for follow up evaluation and for prognostication and predicting response.

An Unusual Observation in Metastatic Neuroendocrine Neoplasm: Diffuse Pattern Hepatic [ Ga]Ga-DOTATATE Uptake Related to Micro-metastatic Disease and Discordance between Dual-Tracer PET-CT Findings and MIB-1 Labelling Index.

Neuroendocrine neoplasms (NENs) are a rare and diverse group of neoplasms that can originate from neuroendocrine cells in any organ. We herein present a patient with Grade II neuroendocrine tumor (NET) of the pancreas with bilobar liver metastasis and a MIB-1 labelling index of 15%, who underwent various systemic and targeted therapies. On follow-up, dual-tracer PET-CT imaging with [ Ga]Ga-DOTATATE PET/CT showed new onset skeletal metastases and diffuse pattern SSTR (somatostatin receptor) expression in the left lobe of the liver (Krenning score 3), contrasted by absent uptake on [ F]FDG.

An Unusual Case of Primary Aldosteronism with Negative Ga-Pentixafor PET/CT and Positive FDG-PET/CT in a Left Adrenal Adenoma.

A 65-year-old male with systemic hypertension, progressively rising aldosterone levels, low plasma renin activity, contrast Magnetic resonance imaging (MRI) described left adrenal lesion isointense to liver parenchyma on T2-weighted images and other features suggestive of left adrenal incidentaloma underwent Ga-Pentixafor Positron emission tomography-computed tomography (PET/CT), which unexpectedly did not show tracer uptake in the known left adrenal adenoma. However, the said nodule showed significant focal tracer uptake on F-18 Fluorodeoxyglucose (FDG)-PET/CT that was done within 2 weeks of Ga-Pentixafor PET/CT study. This unusual finding, which has hitherto been unreported in known patients of primary aldosteronism needs further exploration to determine its clinical significance.

Insulin Autoimmune Syndrome: Imaging Findings and Uptake Pattern With 68Ga-Exendin-4 and 68Ga-DOTATATE PET-CT.

A 62-year-old woman who experienced a seizure was found to be hypoglycemic. A prolonged fasting test revealed raised critical insulin and C-peptide levels. CECT of the abdomen demonstrated an isodense focus in the tail of the pancreas.

Evaluating the prognostic significance of the pre-treatment neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios in Lu-DOTATATE PRRT treated patients with advanced metastatic neuroendocrine tumors.

Purpose: This study aimed to investigate the role of pre-treatment neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) in the prognosis assessment of Lu-DOTATATE Peptide Receptor Radionuclide Therapy (PRRT) treated patients with advanced metastatic neuroendocrine tumors (NETs).

Methods: Eligible PRRT-treated patients (n = 247, 2010-2019) were included. Pre-PRRT NLR and MLR were calculated from complete blood count data.

Serendipitous Discovery and Characterization of Two Different Pathologies on 68 Ga-DOTATATE and 68 Ga-Exendin PET/CT in a Patient With Hyperinsulinemic Hypoglycemia Leading to Diagnosis of MEN-1.

The complementary role of multi-tracer PET in deciphering 2 different pathologies in multiple endocrine neoplasia 1 (MEN-1) is illustrated in this report. A 22-year-old man, with a history of altered behavior over the past 1 year and suspected to have hyperinsulinemic hypoglycemia based on a positive 72-hour fasting test and CT abdomen revealing a lesion in the pancreas, was referred for 68 Ga-Exendin-4 PET/CT. The 68 Ga-Exendin PET/CT revealed focal uptake in the pancreatic lesion, and 68 Ga-DOTATATE PET/CT did not show any avidity in the pancreatic lesion; however, it demonstrated somatostatin receptor (SSTR) expression in a soft tissue mass, just posterior to the thyroid.

CXCR4-A Potential Novel Theranostic Target in Adrenocortical Carcinoma.

Adrenocortical carcinoma (ACC) is a highly aggressive malignancy with high recurrence rates and poor prognosis. There are only limited treatment options with poor response rates. ACCs are documented to express chemokine receptor CXCR4, which can be visualized using 68 Ga-pentixafor PET/CT.

Metastatic Malignant Paraganglioma of Rare Sites Failed on Conventional Treatments Demonstrating Beneficial Response to Lu-DOTATATE PRRT.

The incidence of paraganglioma (PGL) is rising due to better imaging modalities employed for evaluating incidentaloma and surveillance of the asymptomatic carriers. Benign and malignant PGLs often cannot be reliably diagnosed on histology alone, and the documentation of metastases is important in the diagnosis of malignancy. Advancement in genomics has improved our understanding of PGL.

Progressive Unilateral Proptosis and [ F]FDG-Avid Lesions Connoting Aggressive Disease in Radioiodine-Refractory Differentiated Thyroid Carcinoma.

Radioiodine-refractory differentiated thyroid carcinoma (RAIR-DTC) have poor prognosis as compared with radioiodine concentrating thyroid carcinoma. We present a case of follicular thyroid carcinoma presenting as a disseminated disease initially, underwent thyroid surgery and radioiodine (RAI) therapy. Following RAI, the patient developed a sudden-onset unilateral proptosis, finally diagnosed as orbital metastasis.

Rare Combination of Multiple Endocrine Neoplasia 1 with Medullary Thyroid Carcinoma and Clinical Value of Ga-DOTATATE PET/CT in Diagnosing Different Lesions and Exploring Theranostic Strategy.

Multiple endocrine neoplasia type 1 (MEN1) syndrome is characterized by the presence of hyperplastic or neoplastic tumors in the parathyroid, pituitary, and gastroenteropancreatic endocrine tissues. The presence of lesions in at least two out of the three glands (pituitary, parathyroid, and pancreas) is indicative of MEN1 syndrome. Medullary thyroid carcinoma (MTC) is a type of tumor that originates from the parafollicular C cells of the thyroid gland.

Technetium-99m-labeled stealth liposomes: A new Strategy to Identify metastasis in tumour model.

Objective: Stealth liposomes are useful carriers for delivering drugs to cancer sites. In this paper we describe the preparation and evaluation of Tc labelled stealth liposomes (PEG-Liposomes) as potential radiopharmaceuticals for SPECT imaging of cancer. This study is first to describe targeted localisation of radiolabeled stealth liposomes in tumourous cells, sparing normal cells of various organs in metastatic L1210 mouse tumour model in BDF1 mice.

Tumor Lesion Uptake of [ 177 Lu]Lu-DOTA-Rituximab in Skeletal and Splenic Disease in Diffuse Large B-Cell Lymphoma.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma, and a sizable fraction of the DLBCL patients presents with advanced, relapsed, and refractory disease, demonstrating poor response to standard chemotherapy regimens. Radioimmunotherapy (RIT) has shown to be clinically effective in refractory DLBCL. We present the case of a patient with DLBCL with [ 18 F]FDG-avid widespread skeletal as well as splenic involvement as poor prognostic extranodal disease on FDG PET/CT.

[18F]FDG PET/CT in Necrotizing Fasciitis: A Case Series Investigating the Clinical Utility in a Challenging and Rare Condition.

Necrotizing fasciitis is a deadly yet rare soft tissue and skin infection that is usually diagnosed clinically. At times, clinical signs may betray the underlying etiology and masquerade as cellulitis in the early course of the disease. We report four cases with clinical suspicion of necrotizing fasciitis, some after the failure of therapy for cellulitis who underwent 18-F fluorodeoxyglucose positron emission tomography-computed tomography (18-F FDG PET/CT) showing the extent of the disease, showing subclinical sites of involvement in patients with necrotizing fasciitis on baseline scan as well as its role in assessing response to treatment using 18-F FDG PET/CT.