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Paragangliomas (PGLs) are neuroendocrine tumors originating from the neural crest. They usually arise from the adrenal medulla and sympathetic or parasympathetic ganglions. Approximately 10% of PGLs are located in the extra-adrenal gland. Renal PGL is a rare condition. In this case report, we present the 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and 68 Ga-DOTATATE PET/CT findings of polycystic kidney-derived PGL., Competing Interests: Conflict of Interest: No conflicts of interest were declared by the authors., (Copyright© 2024 The Author. Published by Galenos Publishing House on behalf of the Turkish Society of Nuclear Medicine.)

Abstract: Pheochromocytomas (PHEOs) are neural crest-derived tumors originating from the chromaffin cells of the adrenal medulla and were recognized as one of the subtypes of paragangliomas by the World Health Organization in 2022. 68Ga-labeled somatostatin analog (68Ga-DOTA-NOC, 68Ga-DOTA-TOC, and 68Ga-DOTA-TATE) PET imaging has shown significant performance compared with 123MIBG scintigraphy in the diagnosis of paragangliomas. It is now known that fibroblast activation protein (FAP) is overexpressed by various cancer-associated fibroblasts, including PHEOs. We would like to present the findings of 68Ga-DOTA-FAPI-46 PET/CT and 68Ga-DOTA-TATE PET/CT imaging performed for restaging on a 42-year-old man diagnosed with metastatic PHEO., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: This study aimed to compare the diagnostic capabilities of 18 F-FDG PET/CT and 68 Ga-FAPI-04 PET/CT imaging in staging gastric carcinoma, exploring the impact of 68 Ga-FAPI-04 PET/CT on treatment planning and its prognostic significance., Methods: The research included 31 patients undergoing staging for gastric cancer, who received both 18 F-FDG PET/CT and 68 Ga-FAPI-04 PET/CT scans. We compared the SUV max and SUV mean of the primary tumor and lymph nodes, the count of organ metastases, tumor-to-background ratios, and overall staging accuracy. Additionally, the study evaluated radiological progression-free survival and overall survival rates., Results: The 68 Ga-FAPI-04 PET/CT demonstrated superior efficacy in identifying the primary tumor compared with 18 F-FDG PET/CT, particularly in cases of poorly cohesive, signet-ring cell, and mucinous subtypes, with detection rates of 96.7% versus 77.4% ( P = 0.006 and P = 0.008, respectively). Analysis of lymph nodes showed a significantly higher detection of positive nodes with 68 Ga-FAPI-04 ( P = 0.026), although no significant differences were observed in SUV max and tumor-to-background ratio on a patient basis ( P > 0.05). SUV max and tumor-to-background ratios for peritoneal involvement were notably higher with 68 Ga-FAPI-04 PET/CT compared with 18 F-FDG PET/CT ( P = 0.04 for both). No significant differences were found in the detection of organ metastases and disease stage between the 2 imaging modalities ( P > 0.05). Primary tumor uptake did not significantly impact radiological progression-free survival or overall survival in either modality., Conclusions: 68 Ga-FAPI-04 PET/CT imaging surpasses 18 F-FDG PET/CT in detecting the primary tumor, especially in poorly cohesive and signet-ring cell gastric cancer types, and offers improved accuracy in disease staging. This indicates its potential to enhance treatment management and prognostic assessment in gastric cancer patients., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Rasmussen encephalitis is a rare condition characterized by chronic, progressive encephalitis. Typically, it involves one cerebral hemisphere and manifests through intractable epileptic seizures. Its occurrence in adults is notably infrequent. In this case, we presented the observations from an 18F-FDG PET/CT scan of a 70-year-old man diagnosed with Rasmussen encephalitis, where MRI displayed nonspecific findings., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 76-year-old woman was diagnosed breast carcinoma and treated with breast-conserving surgery and chemoradiotherapy. A year after the treatment completion, restaging 18 F-FDG PET/CT scan detected no any pathological finding. However, due to a lesion detected during physical examination on the right thoracic wall adjacent to the primary tumor bed, 18 F-FDG PET/CT imaging was performed 9 months later for restaging. Highly intense FDG uptake was detected in an approximately 1-cm nodular lesion, and metastasis was reported as suspicious, and histopathological confirmation was recommended. Excision was performed and pathological examination diagnosed benign cellular fibrous histiocytoma., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Metastatic insulinomas can cause recurrent hypoglycemia requiring continuous IV glucose infusion. Various medical and chemotherapeutic treatment options are used to reduce the patient's risk of death due to hypoglycemia. Treatment-resistant hepatic metastatic insulinomas may benefit clinically from 90Y transarterial radioembolization therapy. In this case, we present a case of liver metastatic insulinoma that achieved clinical improvement after 2 cycles of 90Y microspheres transarterial radioembolization, and the presence of active metastases was demonstrated with 68Ga-NODAGA-exendin-4 PET/CT imaging., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: An 84-year-old man with prostate adenocarcinoma underwent 68 Ga-PSMA PET/CT due to PSA recurrence. Foci of 68 Ga-PSMA uptake were observed in bilateral adrenal glands. Adrenal MRI showed metastasis only in the left adrenal gland. Metastatic 68 Ga-PSMA uptake was also observed in the mediastinum and bone. Enzalutamide treatment was started. Follow-up 68 Ga-PSMA PET/CT scan showed regression in both adrenal gland metastases and other metastases., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: We present an 87-year-old man diagnosed with prostate cancer and neuroendocrine differentiation, posttherapy results to consecutive 177 Lu-prostate-specific membrane antigen and 177 Lu-DOTATATE. Despite hormonal therapy and chemoradiotherapy, the patient progressed rapidly, and multiple liver and bone metastases showed regression after 177 Lu-prostate-specific membrane antigen and 177 Lu-DOTATATE treatment. Prostate cancer with neuroendocrine differentiation is resistant to treatments; however, treatment with the combination of 177 Lu-DOTATATE therapy may be promising., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Prostate-specific membrane antigen (PSMA)-targeted PET/CT is a well-established imaging method in prostate cancer (PC) for both staging and restaging, and also for theranostic applications. An alternative imaging method is crucial for 15% PSMA-negative cases. We aimed to investigate the contribution of 68 Ga-DOTA-FAPI-04 PET/CT to PC imaging., Patients and Methods: Thirty-six patients diagnosed with PC were included. Patients underwent both 68 Ga-PSMA PET/CT and 68 Ga-DOTA-FAPI-04 PET/CT imaging within 1 week. In staging group, primary tumor uptake values were compared, and also correlations were done with histopathological findings, MRI findings, and total PSA levels. In biochemical recurrence group, the uptake values in prostatic region and metastases were evaluated to define the local recurrence or metastatic disease., Results: In staging group, PSMA PET showed increased uptake in the primary lesion area in 14/27 (52%) patients, whereas 20/27 (74%) patients were positive in FAPI-04 PET. FAPI-04 positivity was found to be quite high, such as 54%, in PSMA-negative patients. A significant difference was observed between ISUP grade 1-3 patients and ISUP grade 4-5 patients in FAPI-04 PET ( P = 0.03). Local recurrence was detected in 3 patients, pelvic lymph node metastasis in 1 patient, and sacrum metastasis in 1 patient in biochemical recurrence group, and all of the lesions had more intense uptake in PSMA PET than FAPI-04 PET., Conclusions: FAPI PET imaging seems to have a potential to contribute PSMA PET imaging with FAPI positivity in more than half of PSMA-negative cases. Also, FAPI-targeted radionuclide therapy may be a promising method in patients resistant to PSMA-targeted therapy., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Peliosis hepatis (PH) and sclerosing angiomatoid nodular transformation of the spleen are uncommon benign lesions. Diagnosis can be difficult in some patients. Herein, we present the case of a 28-year-old woman referred with abdominal pain who had spleen lesions. 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography revealed multiple non-FDG avid lesions in the liver and hypermetabolic lesions in the spleen. In addition, abdominal magnetic resonance imaging was performed. Histopathology revealed sclerosing angiomatoid nodular transformation in the spleen and PH in the liver., Competing Interests: Conflict of Interest: No conflicts of interest were declared by the authors., (Copyright© 2024 The Author. Published by Galenos Publishing House on behalf of the Turkish Society of Nuclear Medicine.)

Gallbladder perforation is one of the most serious complications of cholecystitis and is rarely seen in 2-11% of cases. Pericholecystic abscesses secondary to gallbladder perforation are rare. Rapid diagnosis is important because of high morbidity and mortalityrates. A subcapsular abscess secondary to gallbladder microperforation is presented on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography performed for restaging in a patient with maxillary sinus cancer., Competing Interests: Conflict of Interest: No conflicts of interest were declared by the authors., (Copyright© 2024 The Author. Published by Galenos Publishing House on behalf of the Turkish Society of Nuclear Medicine.)

Abstract: Prostate-specific membrane antigen (PSMA) is a transmembrane protein physiologically expressed in nonprostatic tissues. Inflammation and infectious diseases could show false-positive PSMA uptake. Herein, we present a 55-year-old patient's findings of inflammation in the lower respiratory tract due to inhaler use in 68 Ga-PSMA PET/CT in a patient with prostate cancer., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Medication-related osteonecrosis of the jaw (ONJ) is rare adverse effect of zoledronic acid. We present ONJ detected in a 65-year-old man with prostate cancer who underwent 18 F-FDG PET/CT for metabolic characterization and to exclude a second primary malignancy of the liver lesion observed in 68 Ga-PSMA PET/CT. ONJ has high metabolic activity on 18 F-FDG PET/CT and no PSMA receptor activation on the 68 Ga-PSMA PET/CT. In this case, we wanted to underline the importance of 18 F-FDG PET/CT imaging of medication-related ONJ in patients receiving zoledronic acid therapy and to emphasize that rapid and appropriate treatment can be provided., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The aim of this study was to evaluate the correlation between clinical histopathologic features and micropapillary (MP) ratio with the maximum standardized uptake value (SUV max ) derived from 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) in treatment naïve breast cancer., Methods: Twenty-nine patients diagnosed with breast cancer with a MP component who underwent PET/CT imaging before any local and/or systemic treatment were included in this retrospective study. All clinical histopathological features were recorded. SUV max values were measured from 18 F-FDG PET images for primary tumors and metastatic axillary lymph nodes., Results: MP component percentage did not correlate with any clinical histopathological features except age. At early ages, the MP component ratio was significantly higher. Our results showed that there is no significant correlation between the SUV max value and MP component percentage., Conclusion: A high SUV max value is generally expected in aggressive malignancies. However, this assumption may not be valid for the MP subgroup, which has an aggressive course compared to other subgroups in breast cancer., Competing Interests: Conflict of Interest: No conflicts of interest were declared by the authors., (©Copyright 2023 by the Turkish Society of Nuclear Medicine / Molecular Imaging and Radionuclide Therapy published by Galenos Publishing House.)

A 70-year-old man with newly diagnosed rectum adenocarcinoma was referred to 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) for staging, and 68 Ga-fibroblast activation protein inhibitor (FAPI)-04 PET/CT for ongoing trial. Both 18 F-FDG PET/CT and 68 Ga-FAPI-04 PET/CT showed intense uptake in the primary rectal tumor, and also in nodular areas in the right lung. Due to intense 68 Ga-FAPI-04 and 18 F-FDG uptake, the lung lesions were considered as metastases. However the lesions were reduced in size on CT after 20 days antibiotherapy and diagnosed as pneumonia., Competing Interests: Conflict of Interest: No conflicts of interest were declared by the authors., (©Copyright 2023 by the Turkish Society of Nuclear Medicine / Molecular Imaging and Radionuclide Therapy published by Galenos Publishing House.)

Abstract: We present a case of bilateral Phyllodes tumor located in both breasts in a 41-year-old woman who was detected with increased uptake on 68 Ga-FAPI-04 (fibroblast activation protein inhibitor) and 18 F-FDG PET/CT imaging. The tumor filling up the right breast was identified as borderline Phyllodes. The tumor with mild uptake in the left breast was reported as a benign Phyllodes tumor., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: Benign colonic lesions like tubular adenoma may show intense uptake on F-18-FDG PET/CT and can be mistaken for malignancy. In this study, we evaluated the role of 68Ga-FAPI-04 PET/CT for discriminating the benign and malignant colonic lesions., Methods: Forty patients with diagnosis of colorectal cancer who had undergone 18F-FDG-PET/CT and 68Ga-FAPI-04 PET/CT for initial staging were retrospectively analyzed. The unexpected foci of uptake in colon on 18F-FDG PET/CT were compared with 68Ga-FAPI-04 PET/CT with lesion and background SUVmax., Results: The primary colorectal lesion SUVmax on both PET/CTs was similar. A total of 9 incidental colon lesions in 7 patients were detected showing intense 18F-FDG uptake and no 68Ga-FAPI-04 uptake. All of the lesions were consistent with tubular adenoma histopathologically., Conclusion: 68Ga-FAPI PET/CT may have a crucial role for discrimination of benign and malignant colonic lesions and avoid the unnecessary interventions and extended surgeries in patients with colorectal cancer., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: In this prospective study, PET findings of 18 F-FDG PET/CT in breast cancer staging were compared with 68 Ga-FAP inhibitor (FAPI) 04 PET/CT findings in selected cases with relatively low 18 F-FDG uptake in the primary tumor or with suspected nodal or distant metastases., Patients and Methods: Twenty-four women with a median age of 45 years (range, 36-67 years) who underwent initial staging 18 F-FDG PET/CT for breast cancer underwent 68 Ga-FAPI-04 PET/CT imaging within the same week. SUV max and quantities of primary tumors and locoregional and distant metastatic lesions were recorded from both images, and these data were compared statistically., Results: The histological subtypes of primary tumors were 11 invasive lobular, 8 invasive ductal, and 5 mucinous subtypes. More intense 68 Ga-FAPI-04 uptake (mean, 17.1 ± 7.9; 7.4-38.5) was detected in all primary tumoral lesions compared with 18 F-FDG (mean, 6.3 ± 3.9; 1.5-20.5) ( P = <0.001, Z = 4.107). Additional lesions showing 68 Ga-FAPI-04 uptake in the breast were detected in 29.2% (n = 7) of patients. In 8.3% (n = 2) of the patients, the primary lesion showed only 68 Ga-FAPI-04 uptake. In 68 Ga-FAPI-04 PET/CT, 25% (n = 6) of the patients showed more lymph node involvement and more intense uptake in the ipsilateral axilla. In addition, infraclavicular (level 3) lymph nodes in 4 patients (16.7%), supraclavicular lymph nodes in 1 patient, and internal mammary lymph nodes in 1 patient were detected only on 68 Ga-FAPI-04 PET/CT. In a patient with lung and bone metastases, 68 Ga-FAPI-04 uptake was higher, and the lung nodule showed only 68 Ga-FAPI-04 uptake., Conclusions: In selected low-FDG-affinity breast cancer patients, 68 Ga-FAPI-04 PET/CT showed the primary tumor with higher sensitivity and higher SUV max values compared with 18 F-FDG PET/CT. In addition, it is believed that this method may contribute to the management of patients' treatment by increasing the nodal stage., Competing Interests: Conflicts of interest and sources of funding: This study was carried out with the support of the University of Health Sciences-Türkiye Scientific Research Project (2020/080). The authors have no conflicts of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Neuroendocrine tumors are slow-growing tumors originating from neuroendocrine cells and capable of metastasis. Most of them are found in the gastrointestinal tract; however, they can also be rarely seen in other organs. Testicular neuroendocrine tumors account for less than 1% of all testicular neoplasms. They may present as primary testicular or secondary tumors from extratesticular sources. Jejunal neuroendocrine tumor metastasis to the testis is extremely rare. We present the case of a 61-year-old man with a jejunal neuroendocrine tumor and metastases to bilateral testicles revealed on Gallium-68-DOTATATE positron emission tomography/computed tomography., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2023 by the Turkish Society of Nuclear Medicine / Molecular Imaging and Radionuclide Therapy published by Galenos Publishing House.)

Rectal neuroendocrine carcinomas constitute <1% of all neuroendocrine carcinomas and <1% of all gastrointestinal tract malignancies. Cutaneous metastases of rectal neuroendocrine carcinoma are rarer than visceral metastases. We represent a 71-year-old man who was diagnosed with neuroendocrine tumor grade 3 originating from the rectum 1 year ago. He was referred for 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography for restaging after 6 cycles of chemotherapy and radiotherapy. Intensely increased 18 F-FDG uptake in the right cutaneous inguinal region was consistent with neuroendocrine carcinoma metastasis with biopsy from the same region., Competing Interests: Conflict of Interest: No conflict of interest was declare by the authors., (©Copyright 2023 by the Turkish Society of Nuclear Medicine / Molecular Imaging and Radionuclide Therapy published by Galenos Publishing House.)

Fibroblast activation protein (FAP) is expressed as a pro-inflammatory agent from fibrous tissue in liver cirrhosis and in the tumor microenvironment. Cirrhosis is the last stage of any chronic liver disease, and the natural course of cirrhosis is the progression from the asymptomatic phase to the symptomatic decompensated phase with the development of ascites. Although various clinical features suggest cirrhosis in patients with chronic liver disease, non-invasive methods should follow the clinical approach before a definitive diagnosis. Herein, we present three cases of liver cirrhosis with fibroblast activation protein inhibitor (FAPI) uptake to demonstrate the usefulness of 68 Ga-FAPI-04 positron emission tomography/computed tomography (PET/CT) scan in cirrhosis., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2023 by the Turkish Society of Nuclear Medicine / Molecular Imaging and Radionuclide Therapy published by Galenos Publishing House.)

Abstract: We presented a 69-year-old man with liver cirrhosis who underwent 68 Ga-fibroblast activation protein (FAPI)-04 PET/CT imaging for an ongoing study. In addition to the significant activity in liver cirrhosis on FAPI PET, a primary prostate tumor was incidentally detected with bone metastases. Further, FAPI-negative metastases were not observed on CT evaluation. In this context, we think that FAPI may be helpful with the potential theranostic aspect, especially in selected patients when current treatment options are not applicable or unresponsive. However, we should await the results of prospective studies investigating both prognostic and theranostic use of FAPI and demonstrating its effectiveness in cancer therapy., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 79-year-old man with prostate cancer was evaluated with 68Ga-prostate-specific membrane antigen (PSMA), 68Ga-FAPI-04, and 18F-FDG PET/CT scans since a rise in prostate-specific antigen was seen at last control while receiving chemotherapy. Abnormal FDG uptakes were observed in the tumoral areas of the left half of the prostate and walls of the bladder, although PSMA and FAPI activity were absent or lower in the relevant tumoral areas. Restaging 68Ga-PSMA and 18F-FDG PET/CT scans were obtained on the patient whose progression continued after transurethral tumor resection. Herein, we present a case proving intraindividual tumor heterogeneity in prostate cancer underwent PET/CT imaging with 3 different radiopharmaceuticals., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 47-year-old woman had complaint of palpable swelling in the left breast for the last 3 weeks. 18F-FDG PET/CT for staging of concomitant invasive carcinoma in the right breast and 68Ga-labeled fibroblast activation protein inhibitor 04 PET/CT imaging in an ongoing study were performed. Increased radiopharmaceutical uptake was observed in both PET/CT imaging in complex fibroadenoma located in the left breast., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 57-year-old man with familial adenomatous polyposis (FAP) and newly diagnosed colonic adenocarcinoma was referred to 18 F-FDG PET/CT for staging and 68 Ga-FAPI-04 PET/CT for ongoing trial. 18 F-FDG PET/CT showed equal intense 18 F-FDG uptake in the tumor and multiple hypermetabolic polypoid lesions in the entire colorectum. 68 Ga-FAPI-04 PET/CT showed intense 68 Ga-FAPI-04 uptake only at the colonic tumor, without uptake at polypoid lesions., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

A 50-year-old man undergone total thyroidectomy and histopathology revealed papillary thyroid carcinoma with a tumor size of 4.5 cm. The patient was referred to a nuclear medicine clinic for radioiodine therapy. Since the thyroglobulin level before the treatment was 495 ug/L, low-dose (185 MBq) I-131 scan was performed. In addition to multiple liver metastases, bone metastases were detected in the sacrum and right 7 th rib in I-131 whole body scanning and single photon emission computed tomography/computed tomography (CT) imaging at the time of initial staging. We present a case of multiple metastatic papillary thyroid carcinoma whose radioiodine treatment response and clinical outcome were evaluated with 18 F-fluorodeoxyglucose and Gallium-68 FAPI-04 positron emission tomography/CT., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2023 by Turkish Society of Nuclear Medicine Molecular Imaging and Radionuclide Therapy published by Galenos Yayınevi.)

Abstract: A 58-year-old man who underwent surgery for a well-differentiated neuroendocrine tumor of pancreatic origin was evaluated with 68Ga-DOTATATE PET/CT imaging in the follow-up period. After PET/CT findings consistent with disease remission, the patient was started on leflunomide treatment with the diagnosis of rheumatoid arthritis. The patient received leflunomide for 6 months. Then, 68Ga-DOTATATE PET/CT scan was repeated to evaluate the primary disease outcome. Besides the disease remission, we also observed alterations in DOTATATE uptakes of some tissues and organs. In this case, we present the changes in 68Ga-DOTATATE PET/CT scan findings after leflunomide use., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: We present 2 patients mimicking malignancy with intense gastric 68 Ga-FAPI-04 uptake on PET/CT. Both patients showed low to moderate 18 F-FDG uptake. Histopathology revealed chronic active gastritis. Chronic gastritis may resemble gastric malignancies by showing false-positive 68 Ga-FAPI-04 uptake., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Most patients treated with epidermal growth factor receptor inhibitors develop cutaneous advance effects. The extent and severity of treatment-related skin rashes are associated with good treatment response and prognosis. Herein, we presented increased uptake of the 18F-FDG in skin rashes after treatment with epidermal growth factor receptor inhibitors in 2 patients diagnosed with metastatic colorectal cancer., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: The 68 Ga-PSMA PET/CT imaging modality is used to evaluate biochemical recurrence, response to treatment, and staging in prostate cancer. Prostate-specific membrane antigen (PSMA) receptor activation can be seen in benign and malignant diseases as well as in many physiological tissues. Many pitfalls and artifacts have been reported when reporting 68 Ga-PSMA PET/CT. In this case, diffuse moderate PSMA receptor activation in pancreatic tissue due to the previous pancreatitis is presented in 68 Ga-PSMA PET/CT imaging modality that was performed for restaging of prostate cancer., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Urethral metastasis of bladder cancer after surgery is rare. We present a 63-year-old man who had surgery for invasive bladder carcinoma and prostate adenocarcinoma 4 years ago and referred for urethral hemorrhage. 18 F-FDG PET/CT was performed for restaging and showed intense linear 18 F-FDG activity in the proximal urethra. The patient underwent urethrectomy, and histopathology determined urethral metastasis., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

A 76-year-old man with metastatic prostate cancer was referred to 68 Ga prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) for restaging. A consecutive 18 F-fluorodeoxyglucose (FDG) PET/CT was performed due to the history of lung cancer in the left lung treated with stereotactic radiotherapy. Intense 18 F-FDG uptake was detected in the pituitary gland despite the mild uptake of 68 Ga PSMA. Contrast-enhanced magnetic resonance imaging confirmed pituitary adenoma., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2022 by Turkish Society of Nuclear Medicine | Molecular Imaging and Radionuclide Therapy published by Galenos Yayınevi.)

Objectives: Renal cell carcinoma (RCC) comprises 85%-90% of primary renal malignant tumors originating from the renal tubular epithelium and has different genetic characteristics. This study aimed to investigate the potential predictive role of 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and metabolic parameters in overall survival (OS) analysis in patients with RCC., Methods: 18 F-FDG PET/CT images of 100 patients performed for initial staging before surgical or oncological treatments were analyzed retrospectively. Maximum standard uptake value (SUV max -T) of the primary tumor was calculated and its relationship to patient survival was analyzed. The median follow-up time was 5.61 years (0.01-8.7 years)., Results: SUV max -T levels in the patients ranged from 2.1 to 48.9 (median 5.9, mean 9.0±7.9). SUV max -T was significantly higher in RCC-related death more positive than in the negative cases (p<0.001). However, there was not any statistical significance for gender and pathological subtypes on the survival outcomes of patients (p=0.264 and p=0.784). The patients' 1-year, 3-year, and 5-year OS rates were 71%, 61%, and 57%, respectively. The highest action of SUV max -T for estimating OS was a cut-off level of 5.4, which maintained sensitivity and specificity of 81% and 75%, respectively. However, cancer staging remained independent significance for OS (p<0.001)., Conclusion: SUV max of primary tumor and cancer stage were demonstrated as significant prognostic factors for OS in patients with RCC. Evaluation of 18F-FDG accumulation with PET/CT may help plan treatment strategies and predict survival outcomes of these patients at diagnosis., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2022 by Turkish Society of Nuclear Medicine | Molecular Imaging and Radionuclide Therapy published by Galenos Yayınevi.)

Abstract: A 71-year-old man with prostate adenocarcinoma underwent 68 Ga-prostate-specific membrane antigen (PSMA) PET/CT for staging. 68 Ga-PSMA PET/CT showed the primary lesion along with bladder, rectum, bilateral seminal vesicle invasion, and metastatic pelvic lymph nodes with intense 68 Ga-PSMA uptake. Also, PET/CT showed rarely seen bilateral vas deferens invasion and metastasis to the inguinal canal. These rare metastases may be indicative of poor biological behavior and prognosis., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Prostate cancer is the most common cancer in men. 68 Ga-PSMA PET/CT is frequently used in staging and restaging prostate cancer; it is important to keep in mind the causes of false-positives when evaluating imaging. We present findings of 68 Ga-PSMA PET/CT and histopathological features of a 68-year-old prostate cancer man with neurofibroma. 68 Ga-PSMA PET/CT showed intense 68 Ga-PSMA uptake in neurofibroma., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction and Objectives: The human immunodeficiency virus [HIV] is a lentevirus, primarily infects certain cells of the immune system, thereby greatly weakens the body's own defenses against diseases. This study was aimed to explore the value and significance of 18 F-FDG PET/CT in the assessment of patients with HIV infection and to examine the presence of quantitative alterations in 18 F-FDG uptake among patients with HIV-related infections or malignant diseases in HIV-positive patients., Patients and Methods: Forty patients with HIV infection were scanned on PET/CT system. The data were registered according to immune status, antiretroviral therapy, and definitive diagnosis. All pathologic lesions and disease related areas were described, 18 F-FDG uptake patterns were evaluated. Semiquantitative analysis of 18 F-FDG uptake was performed and SUVmax were calculated., Results: Twenty-eight patients [70%] were diagnosed with HIV-related infection or malignant diseases. The sensitivity of PET/CT was shown to be 100% and the specificity 92% for concomitant diseases requiring additional treatment to antiretroviral therapy. The SUVmax and CD4 counts were not statistically different between HIV-related reactive lymphadenopathy, HIV-related malignancy, and HIV-related infections., Conclusions: The pattern of distribution of nodal/extranodal uptake on 18 F-FDG PET/CT may facilitate distinction between HIV-related generalized lymphadenopathies, HIV-related opportunistic infections, and malignancies. In this context, 18 F-FDG PET/CT should be preferred for routine use in the management of patients infected with HIV., (Copyright © 2021. Published by Elsevier España, S.L.U.)

Abstract: Herein, we present the results of 18F-FDG PET/CT and 68Ga-FAPI-4 PET/CT of a patient with metastatic Kaposi sarcoma. A 47-year-old man with suspected gastric cancer was referred to 18F-FDG PET/CT for diagnosis and staging. PET/CT detected increased 18F-FDG uptake in metastatic lymphadenopathies and liver lesions. 68Ga-FAPI-4 PET/CT was performed for ongoing clinical trial. Although 68Ga-FAPI-4 PET/CT may be a better alternative than 18F-FDG for the imaging of primary tumoral infiltrations in the stomach, 18F-FDG seems to be a more useful agent for the Kaposi sarcoma in determining the extent of the disease and the localization of metastatic lesions., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Gallbladder metastasis from renal cell carcinoma is a rare condition. To our knowledge, only 1 case has been reported with 18 F-FDG PET/CT findings. Herein, we report the case of a 53-year-old man with renal cell carcinoma, having gallbladder metastasis revealed with restaging 18 F-FDG PET/CT., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: We report a case of tuberculosis peritonitis in a 26-year-old woman who presented with abdominal pain, fatigue, and weight loss for the last 4 months. Abdominal US and CT demonstrated intra-abdominal massive ascites, misty mesentery, and diffuse peritoneal thickening. In addition, 3 nodular lesions were detected in the right lung. 18 F-FDG PET/CT showed hypermetabolism in lung nodules, mesenteric area, peritoneal thickening, and ascites. 68 Ga-FAPI-04 (fibroblast activation protein-specific inhibitor) PET/CT imaging was also performed; high uptakes were detected in the same regions of 18 F-FDG PET/CT. Tuberculosis diagnosis was made after histopathological examination of wedge resection of the right lung., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 38-year-old woman presented with a 4-month history of left-sided otalgia and otorrhea. Otoscopy revealed a mass in the left external auditory canal causing obliteration. A biopsy was taken, and the diagnosis was consistent with a well-differentiated neuroendocrine tumor. The patient was referred to our department for staging with 68 Ga-DOTATATE PET/CT. Increased radiopharmaceutical uptake was observed in the primary tumor and metastatic lymph nodes., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The feasibility of tracer production of 99m technetium (Tc)-prostate-specific membrane antigen (PSMA)-I&S sterile cold kit, imaging with single photon emission tomography/computed tomography (SPECT/CT), and 99m Tc-PSMA-radioguided robot-assisted laparoscopic radical prostatectomy ( 99m Tc-PSMA-RG-RALRP) technique for lymph node (LN) dissection of primary prostate cancer (PCa) patients were evaluated prospectively., Methods: Fifteen primary PCa patients with intermediate- or high-risk score according to D'Amico risk stratification who had PSMA receptor affinity with Ga-68 PSMA-11 PET/CT were enrolled. After 99m Tc-PSMA-I&S injection and SPECT/CT imaging, 99m Tc-PSMA-RG-RALRP with DaVinci XI robotic platform and laparoscopic gamma probe were performed. Radioactive rating of resected tissue was compared with post-operative histopathology. Physiological and pathological uptakes of organs and tissues for both imaging modalities were compared., Results: Physiological radiotracer distribution was similar for both imaging modalities. PCa lesions were much more visible on PET/CT. Metastatic LNs could not be visualized with SPECT/CT. Eighteen of 297 totally dissected LNs were metastatic, which were exactly the same with per-operative probe counts with sensitivity, specificity, accuracy, and negative and positive predictive value of all 100%. The median follow-up was 23.5 ± 4.6 months. tPSA reduction was > 98%. The 2.5 years biochemical recurrence-free survival, PCa-specific treatment-free survival and overall survival rates were 86,7%, 66,7% and 100%, respectively., Conclusion: Tc-99 m-PSMA-RG-RALRP is a promising technique for extended pelvic lymph node dissection (ePLND) during robotic surgery, which may shorten the operation time and reduce complication risks. If LN metastases is detected during surgery with PSMA-targeted probe, it may be an early indicator of PCa-spesific treatment planning. Tc-99 m-PSMA-I&S SPECT/CT is not as successful as Ga-68 PSMA-11 PET/CT for diagnosis of primary PCA lesions or LN metastases., (© 2022. The Author(s) under exclusive licence to The Japanese Society of Nuclear Medicine.)

Abstract: Primary renal well-differentiated neuroendocrine tumors (WDNETs), also called renal carcinoids, are extremely rare. Since first described in 1966, approximately 100 cases have been reported in the literature. However, there have been no cases shown by PET/CT to date. We presented a patient with primary renal WDNET who had undergone both 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT for diagnosis and staging. This case illustrated that 68Ga-DOTATATE PET/CT scanning could play a role in the diagnosis, staging, and follow-up of primary renal WDNETs., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

A 67-year-old female patient with metastatic gastric adenocarcinoma was referred to 18 fluorine-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) for restaging. PET/CT revealed liver metastasis and the patient received six-cycles of chemotherapy. On control 18 F-FDG PET/CT the liver lesion disappeared but newly formed multiple foci of increased uptake in the subcutaneous adipose tissues of the abdominal wall were detected. The uptake was related to nodular lesions resulting from an idiosyncratic reaction to enoxaparin and from local trauma through repeated injections., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2022 by Turkish Society of Nuclear Medicine, Molecular Imaging and Radionuclide Therapy published by Galenos Yayınevi.)

Objectives: The important roles of integrins in tumor invasion, migration and proliferation are well known. In this study, we investigated the presence of integrin α3 and β1 receptors in tumor tissue, metastatic lymph node (LN) and normal thyroid tissue of patients diagnosed with thyroid cancer (TCa) and showed the prognostic and diagnostic value of these molecules as well as peptide-receptor., Methods: Sixty-one patients with TCa were included in this study. The presence of integrin α3 and β1 expression was investigated by immunohistochemical methods from tumor tissue after total thyroidectomy. TNM system was used in tumor staging. The relationship between prognostic properties such as tumor size, LN metastasis, capsular invasion and the presence of integrin α3 and β1 expression was investigated., Results: Classical type papillary TCa was the most common subtype in our study group with 31.1%. Integrin β1 was expressed in 4.9% (n=3) of normal tissue, 57.4% (n=35) of tumor tissue and 16.4% (n=10) of metastatic LN; integrin α3 was expressed in 50.8% (n=31) of normal tissue, 67.2% (n=41) of tumor tissue and 9.8% (n=6) metastatic LN. Integrin β1 expression was observed 21.3% (n=13), integrin α3 in 14.8% (n=9) and integrin α3 and β1 expression in 36.1% (n=22). Integrin β1 expression increased statistically significantly in the presence of LN metastasis and capsular invasion (p=0.022, 0.014, respectively). Furthermore, the expression of integrin α3 was found to be statistically significant in primary tumors of patients with LN metastasis (p=0.045)., Conclusion: Our study showed a significant increase in integrin α3 and β1 expression in LN metastasis or thyroid capsule invasion in tumor. Thus, it appears that the demonstration of the presence of integrin α3 and β1 expression in TCa is not only a prognostic biomarker but also has value as a potential theranostic target with peptide-bound radioactive agents., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2022 by Turkish Society of Nuclear Medicine, Molecular Imaging and Radionuclide Therapy published by Galenos Yayınevi.)

We present 2 cases of acrometastases that manifest as the first signs of underlying lung cancer. The first case is 37 year-old-man misdiagnosed and treated as having a traumatic fracture at the left thumb. The second case is a 77 year-old-man who received treatment for soft tissue infection at left hand for 4 weeks. In both cases 18 fluorine-fluorodeoxyglucose positron emission tomography/computed tomography demonstrated primary malignant lesions in the lungs consistent with primary lung cancer with acrometastases., (©Copyright 2022 by Turkish Society of Nuclear Medicine, Molecular Imaging and Radionuclide Therapy published by Galenos Yayınevi.)

Objective: This study aimed to determine the role and prognostic significance of 18F-FDG PET/CT on treatment response and survival outcomes in metastatic renal cell carcinoma patients treated with immunotherapy or tyrosine kinase inhibitors (TKIs)., Patients and Methods: Forty patients scheduled for a standard treatment protocol with TKIs (n = 17; group-1) or PD-1 inhibitors (nivolumab, n = 23; group-2) were evaluated by 18F-FDG PET/CT. Peak standardized uptake value corrected for lean body mass (SULpeak) and maximum standardized uptake value (SUVmax) were calculated, and their relationship to treatment response was evaluated., Results: Complete response (CR) in three patients, partial response (PR) in two patients and stable disease (SD) in eight patients were observed in group-1, and the results were as follows for group-2: PR in seven and SD in five patients. At a mean of 17.5-month observation period (range, 7-47), 35.2% of patients progressed, and 23.5% achieved a CR, and no recurrence was observed on PET/CT scans during follow-up. Among all patients enrolled in the study, the 5-year OS in patients with progressive disease (PD) was significantly shorter than patients with clinical benefit (CB = CR and PR and SD) (P = 0.016). Significant differences in both ΔSULpeak and ΔSUVmax were found between PD versus CB (P = 0.001 and P < 0.001, respectively)., Conclusion: 18F-FDG-PET/CT can accurately assess therapy response and predict patient outcome in metastatic RCC. 18F-FDG PET/CT may facilitate patient management by evaluating the biological and immunological responses to treatment in patients treated with TKIs or ICIs., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 35-year-old HIV-positive man with abdominal pain was referred to 18F-FDG PET/CT for metabolic characterization of mass in pancreas. PET/CT images showed intense FDG uptake in head of the pancreas, as well as diffuse moderate uptake throughout body and tail of the pancreas. Histopathological results revealed Epstein-Barr virus (EBV) associated large B-cell lymphoma and pancreatitis caused by cytomegalovirus., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)