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Abstract: Extraosseous MDP uptake was not uncommon on the bone scintigraphy. When the extraosseous activity is overlapping the bones, it might cause difficulty in interpreting the result when only static images were acquired. Here we report 2 cases that abnormal MDP activity overlapping the bones on planar images, which were confirmed as soft tissue lesions by SPECT/CT or CT imaging., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Congenital mesoblastic nephroma is an extremely rare, low-grade malignant renal tumor in children. A 10-month-old boy and a 4-month-old girl were admitted to our hospital with a huge abdominal mass. For staging of the mass, 18 F-FDG PET/CT and PET/MR were performed showing a huge heterogeneous abdominal mass accompanied by extensive heterogeneous aggregation. Both of them were highly suspected to be Wilms tumor, the most common renal malignant tumor in children. However, histopathological examination after surgery confirmed congenital mesodermal nephroma., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: "Hepatic superscan" could be caused by a variety of etiologies. Here we report a 68-year-old woman with a medication history of cefoperazone and azithromycin for pneumonia recently who underwent 18 F-FDG PET/CT to detect underlying malignancy due to unexplained liver damage and fever of unknown origin. Unexpectedly, "hepatic superscan" without morphologic changes was noted. Unfortunately, aggressive treatment did not reverse the damaged liver function, and the patient rapidly died. Drug-induced fulminant hepatitis was diagnosed clinically. Our case demonstrates that fulminant hepatitis could result in "hepatic superscan" on 18 F-FDG PET despite negative findings on the ultrasonography, CT, and MRI., Competing Interests: Conflicts of interest and sources of funding: none declared. This work is partially funded by the Medical Research Program of Sichuan Medical Association (S22083), Youth Innovation Project of Sichuan Medical Association (Q2201), and Nature Science Foundation of Hebei Province (H2020206422)., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 68-year-old man with intermittent fever of unknown origin for 5 months underwent 18F-FDG PET/CT to detect causative lesion. An 18F-FDG-avid lesion was revealed in the left pelvic iliac vessel region and was highly suggestive of malignancy. One and a half months later, a giant left internal iliac artery aneurysm was identified by CT angiography, corresponding to the 18F-FDG-avid lesion. Combined with elevated inflammatory markers, he was finally diagnosed as having inflammatory internal iliac artery aneurysm. An abdominal aortic aneurysm with low 18F-FDG uptake was also identified., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Previous publications suggested that vertical appearance of the urinary bladder on 99m Tc-MDP whole-body bone scintigraphy was likely due to an adjacent abnormality. Here we report bone scan findings of a vertical appearance of the urinary bladder in a 66-year-old man with lung cancer without corresponding pathology nearby., Competing Interests: Conflicts of interest and sources of funding: The authors have no conflicts to report. This work is partially funded by Medical and Health Own Fund Guiding Project of Zigong Academy of Medical Sciences (no. 2021ZCYKY01, no. ZGYKY22KF007) and Opening Foundation of Hubei Key Laboratory of Molecular Imaging (no. 2021FZYX026)., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Solitary parasplenic metastatic carcinoma may be misinterpreted as accessory spleen on CT images. In addition, elevated FDG uptake in the spleen may also mimic metastasis in patient with a history of carcinoma. Here we present a case of parasplenic metastasis coexisted with splenic infarction reveled on 18F-FDG PET/CT in a 51-year-old man with history of hepatocellular carcinoma., Competing Interests: Conflicts of interest and sources of funding: The authors declare that they have no conflicts of interest. This work is partially funded by Nature Science Foundation of Hebei Province (no. H2020206422), Medical and Health Own Fund Guiding Project of Zigong Academy of Medical Sciences (no. 2021ZCYKY01), and Opening Foundation of Hubei Key Laboratory of Molecular Imaging (no. 2021fzyx026)., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Nephroptosis is a significant descent (more than 5 cm or 2 vertebral bodies) of the kidney from supine to the upright position. The incidence of nephroptosis is probably more prevalent than reported, as few patients present with typical symptoms. A 55-year-old woman with intermittent abdominal pain was referred for a 99m Tc-DTPA renal dynamic scan. She had a ureteric calculi history. The result showed that the right kidney was significantly lower than the position in the CT scan a week ago. It had been diagnosed as nephroptosis according to these "moving" images. She was considering elective surgery for intervention., Competing Interests: Conflicts of interest and sources of funding: The authors declare that they have no conflicts of interest. This research was supported by the Medical and Health Own Fund Guiding Project of Zigong Academy of Medical Sciences (no. 2021ZCYKY01) and Foundation of Hubei Province Key Laboratory of Molecular Imaging (2021fzyx019 and 2021fzyx026)., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Sarcoidosis is a heterogeneous multisystem disease characterized by noncaseating granulomas. We presented 18 F-FDG PET/CT findings of sarcoidosis in a previously healthy 43-year-old man who presented intermittent cough after the third dose of COVID-19 vaccination. 18 F-FDG PET/CT showed high uptake of one solitary nodule in the right middle lobe, mediastinal lymph nodes, bilateral hila, and multiple nodules under the right pleura, mimicking the malignancy. Nevertheless, the biopsy confirmed distinct noncaseating granulomas. This case emphasizes the onset of sarcoidosis revealed by 18 F-FDG PET/CT after COVID-19 vaccination., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 60-year-old woman with surgically confirmed immunoglobulin G4-related sclerosing cholangitis underwent 18F-FDG PET/CT due to significantly elevated serum CA-19-9 level, which revealed a hypermetabolic lesion in the residual liver. 68Ga-FAPI PET/MR was performed to further evaluate whether the FDG-avid lesion is a malignant tumor. Astonishingly, diffuse intense radioactivity was revealed throughout the liver, suggesting involvement of active immunoglobulin G4-related sclerosing cholangitis, but nonfocal elevated 68Ga-FAPI accumulation in the FDG-avid lesion indicated postoperative change. From this case, we speculated that FAPI imaging could be used for evaluation of chronic liver disease because fibroblast activation protein has a profibrogenic role in chronic liver injury., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 42-year-old woman underwent 131I radiotherapy for thyroid papillary cancer. A focal elevated 131I activity in the right kidney was revealed on the initial whole-body posttherapeutic images, which was located in the region of a renal stone. However, on the follow-up 131I images acquired 6 months later, there was no longer any increased activity in the region of this stone, which had moved into right ureter. Our case indicates that the 131I activity accumulated in the region of urinary stone is due to stagnated radioactive urine rather than due to the stone per se., Competing Interests: Conflicts of interest and sources of funding: This work is supported by the Open Program of Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province (no. HYX19026). None declared to all authors., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Ga-FAPI (Ga-labeled fibroblast activation protein inhibitor) PET imaging has been recently introduced for the diagnosis and staging in various malignant tumors. However, the reports about the utility of FAPI imaging in benign tumor are relatively rare. Here we report a case of pathologically proven recurrent angiomyolipoma in the left retroperitoneal area with low F-FDG uptake but diffuse heterogeneous intense Ga-FAPI uptake together with suspected lung metastases in a 53-year-old woman. Our case illustrates FAPI imaging could be helpful not only for detecting various malignant tumors but also for benign tumor like this case due to fibrotic activity in the disease.

Pleural and pericardiac effusion could have radioiodine accumulation and be potential pitfall on posttherapeutic I whole-body scintigraphy. However, the volume of the effusion was relatively massive in the previous publications. We report a case of pleural effusion with a very small volume also had radioiodine uptake in a 37-year-old man.

Osteosarcoma is usually F-FDG-avid. Here we report a case of an 18-year-old young man with widespread osteoblastic and slight osteolytic changes, which had diffusely increased Ga-DOTATATE uptake in the osseous lesions, whereas the F-FDG PET/CT was unrevealing. The final diagnosis is synchronous multifocal osteosarcoma based on the pathological, clinical, and imaging features.

Extravasation of various imaging tracers during administration was not a rare complication during nuclear medicine practice. However, the occurrence of extravasation of therapeutic radiopharmaceutical was rarely reported. Here we reported a 60-year-old woman with breast cancer and diffuse painful bone metastases who received strontium chloride (SrCl2) therapy to palliate her bone pain. Accidental subcutaneous extravasation in the injection site occurred. The extravasated Sr was absorbed rapidly by arm elevation, squeezing a stress ball, local warming, and gently massaging. Follow-up results showed the patient's bone pain significantly relieved and her right arm remained normal.

A 39-year-old man with bone pain underwent Tc-MDP bone scan to assess skeletal lesions, which demonstrated multiple fractures and a focus of subtle extraosseous activity in the left thigh. A Tc-hynic-octreotide imaging was performed due to the suspected diagnosis of tumor-induced osteomalacia, which revealed a hypermetabolic subcutaneous nodule in the left thigh, which exactly corresponded to the same site of MDP activity. Biopsy confirmed the subcutaneous nodule as the culprit tumor of tumor-induced osteomalacia. Bone scan, as a conventional imaging, provided useful information for detecting culprit tumor as shown in our case.

Epithelioid hemangioendothelioma is a rare vascular sarcoma, and it rarely leads abnormal serum calcium. Here we presented a 61-year-old woman with suspected tumor-induced osteomalacia who underwent Ga-DOTATATE PET/CT to detect possible culprit tumor. The images showed a hypermetabolic paraspinal soft nodule in the right upper posterior mediastinum, which suggested a somatostatin receptor-positive tumor. The tumor was resected and pathologically confirmed as epithelioid hemangioendothelioma.

The radioiodine in the gallbladder usually mimics focal hepatic activity on the planar I whole-body scintigraphy. Here we describe an abnormal uptake in the hepatic region on postablative I scintigraphy in a 37-year-old woman with papillary thyroid cancer. The SPECT/CT images revealed this "hepatic activity" corresponded to gallbladder stone.

Bone scintigraphy is often utilized to detect the osseous etiology of lower back pain. Here we report a 70-year-old man with lower back pain who was referred a Tc-MDP bone scan to identify possible vertebral compression fracture. The images did not detect any osseous lesion. However, the images revealed photopenic regions in the both kidneys, which were confirmed as renal cysts on the CT images. The patient received laparoscopic unroofing of renal cysts, and his symptoms improved. Our case illustrated that back pain is not always due to osseous etiology, it might be caused by urinary disorder.

Extrapulmonary tuberculosis could involve multiple organs. However, thymic tuberculosis is relatively rare. We report a 21-year-old man who was referred for an F-FDG PET/CT imaging to assess his newly detected pulmonary nodule. The images showed the pulmonary nodule had minimal activity uptake. Unexpectedly, the thymus with elevated FDG accumulation was noted. The pulmonary nodule and thymic lesion were confirmed as tuberculosis by pathology.

Intracranial infiltration is a rare complication of multiple myeloma (MM), which is usually seen in advanced stage. Here, we report a 47-year-old woman with only cavernous sinus syndrome as first manifestation. Brain MR revealed cavernous sinus masses, leptomeningeal nodules, and osseous erosion, which were considered metastases. F-FDG PET/CT, which was further performed to identify potential primary lesions, showed increased uptake not only in cavernous sinus and leptomeninges but also in diffuse bone lesions, hepatic nodules, lymph nodes, subcutaneous nodules, and bilateral ovarian masses. Multiple myeloma with intracranial involvement was confirmed by biopsy and cerebrospinal fluid examination.

Giant cell tumor of tendon sheath (GCTTS) is benign mesenchymal neoplasm, and it rarely induces hypophosphatemia. We report a 49-year-old woman with suspicious tumor-induced osteomalacia underwent Ga-DOTA-TATE PET/CT to identify potential causative tumor, which showed a hypermetabolic soft tissue nodule in the right foot. Pathology confirmed it as GCTTS following surgical resection. The patient's symptoms improved rapidly, and the serum phosphate normalized after surgery, which supports the diagnosis of tumor-induced osteomalacia. Our case showed GCTTS can be rich of somatostatin receptor and cause osteomalacia.

Various etiologies could cause focal I accumulation. Hepatic cyst is one of these etiologies. Here we present a 59-year-old man with a history of papillary thyroid cancer resection who received radioiodine therapy for three times. The images after the I therapy of the second and third time showed variable activity uptake in the same hepatic cysts.

Familial adenomatous polyposis is a rare autosomal dominant intestinal syndrome with a high rate of malignant transformation. Here, we report a 20-year-old woman with a diagnosis of familial adenomatous polyposis by pathologic examination after colonoscopy biopsy, who underwent an F-FDG PET/CT to assess the extent of this disease. The images showed diffuse elevated FDG uptake along the entire colorectum. Additionally, focal enlarged lymph nodes with increased FDG uptake were noted. These findings promoted proctocolectomy and lymphadenectomy.

A 52-year-old woman with newly diagnosed cervical carcinoma was referred an F-FDG PET/CT for staging. The PET/CT images demonstrated the known carcinoma and multiple enlarged lymph nodes with increased FDG activity. In addition, there was a focus of intense FDG activity characteristic of hypermetabolic malignancy in the region of gastric antrum. Finally, this lesion was confirmed as gastric ulcer by biopsy. This patient responded well to antiulcer treatment.

Many reasons could lead to abnormal increased extraosseous tracer uptake on Tc-MDP bone scintigraphy. A 75-year-old man was referred a bone scintigraphy to evaluate his chest pain. The images revealed rib fractures. In addition, increased MDP activity in the muscle of the lower extremities was noted. The abnormal increased uptake in the muscles was likely related to the arterial thromboses revealed by vascular ultrasonography. The patient received interventional embolectomy.

False negative I accumulation in metastatic lesions of thyroid carcinoma could be due to various etiologies. Here we present a 33-year-old woman with a history of papillary thyroid cancer who had increased Tc pertechnetate activity in the mediastinal metastatic lymph nodes, which was not clearly seen on whole body I scan due to adjacent activity from lung metastases.

A 62-year-old man with esophageal cancer was referred for a Tc-MDP bone scintigraphy for staging. No metastatic lesion in the bone was identified. However, the images showed focally increased activity in the left pelvis, which were confirmed as ureteral stone on the SPECT/CT images.

A 28-year-old man with papillary thyroid cancer underwent bone scintigraphy to assess possible osseous metastasis. He had vigorous workouts 5 days prior, which involved pectorals, rectus abdominis, quadriceps, and glutei. However, the images only showed increased activity in the rectus abdominis, whereas other involved muscles had no obvious uptake. No lesion in the bone was identified.

A 48-year-old man was referred for an F-NaF PET/CT to examine his lower back pain. The images did not identify any osseous lesion. Unexpectedly, the images showed elevated activity in a urethral stone. The patient received urinary surgery for stone removal.

Increased extraosseous uptake of sodium fluoride can be visualized because of many different etiologies. A 62-year-old man with a history of osteoporosis had an F-sodium fluoride PET/CT scan for accessing chest pain caused by an accident. The images showed multiple fractures. Unexpectedly, diffuse activity was noted in the gastric wall, which was suggestive of possible hypercalcemia. The serum calcium level confirmed the patient had hypercalcemia.

Increased muscular FDG uptake could be due to various causes. Detailed analysis combined with history might be helpful for image interpretation. We present FDG PET/CT findings of a 69-year-old woman with lung cancer. The images demonstrated intense FDG uptake in multiple muscles, likely due to cough before the PET/CT study. To relieve the patient's cough, codeine was administrated. The second F-FDG PET/CT was performed 2 days later. The images showed that the abnormal muscular activity had become decreased, which was slightly lower than hepatic activity.

A 6-year-old boy underwent I-MIBG therapy for recurrent neuroblastoma. On posttherapy scan, there were new foci of increased MIBG activity in the anterior abdomen, which were not seen on pretherapy I-MIBG scan. Physical examination demonstrated that these new foci of activity corresponded to the sites of asymptomatic erythema, which had of unknown etiology and was spontaneously resolved without treatment.

A 62-year-old woman had an elevated serum creatinine. Physical examination detected a left inguinal mass, suggestive of possible malignancy. An F-FDG PET/CT was performed to evaluate the nature of the mass. The images showed multiple juxta-articular foci of increased activity in all extremities. Amyloidosis was confirmed histopathologically following the biopsy.

An MRI of the spine was performed in a 5-month-old girl to assess the cause of lower-extremity paralysis. The images showed a left paraspinal mass at the lumbar level invading the spinal canal, which suggested possible neuroblastoma. A subsequent MIBG scan showed abnormal activity in the spinal canal. Neuroblastoma was confirmed pathologically.

A 72-year-old man underwent F-NaF PET/CT to evaluate causes of lower back pain. The PET images revealed multiple foci of increased activity in several vertebral bodies, which might account for the patient's symptoms. In addition, the CT image revealed partially calcified soft tissue mass in the posterior wall of the urinary bladder, which was photopenic relative to the radioactive urine on early PET images but became intense on delayed PET images. The diagnosis of transitional cell carcinoma was made pathologically after a transurethral resection of the mass.

A 17-year-old girl underwent F-NaF PET/CT to evaluate bone pain after an accident. The images did not identify any osseous lesion. However, there was a focally increased activity in the left upper chest, which corresponded to a partially calcified soft tissue mass in the mediastinum, suggestive of malignancy. The result led to subsequent F-FDG PET/CT imaging, which demonstrated intense activity in the mediastinal mass and in multiple cervical, supraclavicular, and mediastinal lymph nodes. Hodgkin lymphoma was diagnosed histopathologically following the biopsy.

An 82-year-old man with known Eddison disease, osteoporosis, and a right buttock soft tissue mass underwent Tc-MDP bone scintigraphy with SPECT/CT and F-NaF PET/CT, both of which showed elevated uptake in a bladder stone.

A 48-year-old illiterate woman who is congenitally deaf and mute underwent 18F-NaF PET/CT study to evaluate bone metastases from newly diagnosed breast cancer. Unexpectedly, a fetus in early second trimester was noted on CT images. In addition, subtle 18F-NaF uptake by the fetus could also be observed.