Objective: Granulocytic sarcoma (GS) is a rare extramedullary manifestation in patients with acute myeloid leukemia (AML), which can precede the diagnosis or occur in the posttreatment setting. Unlike its established role in other hematological malignancies like Hodgkin's on non-Hodgkin's disease, the exact role of positron emission tomography/computed tomography (PET/CT) in AML with or without GS remains to be defined. Materials and Methods: We retrospectively reviewed PET/CT scans of 12 patients with histologically proven GS. Marrow examination of these patients identified nine patients with isolated GS (without existent leukemia) and three patients with coexistent leukemia. Results: PET/CT accurately identified all clinically evident GS in all 12 patients at initial staging and at follow-up with tumors, showing moderate to high 2-deoxy-2-fluoro-D-glucose uptake. Coexistent marrow disease was seen on PET/CT in three patients, which was confirmed on histopathology. In the same patients, PET/CT also detected additional sites of extramedullary disease in 66.6% (n = 8), which was either clinically occult or not evident on routine CT. Conclusion: PET/CT appears to be a highly sensitive imaging modality in diagnostic evaluation of GS. The most important indication of using PET/CT in these cases is to identify additional sites of clinically occult extramedullary disease, which can potentially impact treatment decisions and outcomes.

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Rhabdomyosarcoma (RMS) is a rare cancer in adults, comprising about 1% of all forms of adult cancer. Common sites of metastases are lungs, skeletal system, lymph nodes, and brain. Metastases of RMS to pancreas are infrequent. We report a case of adult orbital alveolar RMS with pancreatic metastases detected in F-18-fluorodeoxyglucose-positron emission tomography/computed tomography.

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Hepatic epithelioid hemangioendothelioma is a rare variant of mesenchymal tumor. Surgical resection or partial hepatectomy is the treatment of choice in the case of localized disease. However, in metastatic cases, chemotherapeutic drugs targeting the tyrosine kinase are being used. We hereby present 18-F-fludeoxyglucose positron emission tomography-computed tomography findings in a case of a 35-year old woman with metastatic HEHE showing significant response to Sorafenib therapy after 6 months.

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Context: Decontamination of various working surfaces with sodium pertechnetate minor spillage is essential for maintaining good radiation safety practices as well as for regulatory compliance. Aim: To observe the influences of decontaminating agents and swipe materials on different type of surfaces used in nuclear medicine laboratory work area wet spilled with 99m-technetium (99mTc) sodium pertechnetate. Settings and Design: Lab-simulated working surface materials. Experimental study design. Materials and Methods: Direct decontamination method on dust-free lab simulated new working surfaces [stainless steel, polyvinyl chloride (PVC), Perspex, resin] using four decontaminating agents [tap water, soap water (SW), Radiacwash, and spirit] with four different swipe material [cotton, tissue paper (TP), Whatman paper (WP), adsorbent sheet (AS)] was taken 10 samples (n = 10) for each group. Statistical Analysis: Parametric test two-way analysis of variance is used with significance level of 0.005, was used to evaluate statistical differences between different group of decontaminating agent and swipe material, and the results are expressed in mean ± SD. Results: Decontamination factor is calculated after five cleaning for each group. A total of 160 samples result calculated using four decontaminating agent (tap water, SW, Radiacwash, and spirit), four swipe material (cotton, TP, WP, and AS) for commonly used surface (stainless steel, PVC, Perspex, resin) using direct method by 10 samples (n = 10) for each group. Conclusions: Tap water is the best decontaminating agent compared with SW, Radiac wash and spirit for the laboratory simulated stainless steel, PVC, and Perspex surface material, whereas in case of resin surface material, SW decontaminating agent is showing better effectiveness. Cotton is the best swipe material compared to WP-1, AS and TP for the stainless steel, PVC, Perspex, and resin laboratory simulated surface materials. Perspex and stainless steel are the most suitable and recommended laboratory surface material compared to PVC and resin in nuclear medicine. Radiacwash may show better result for 99mTc labelled product and other radionuclide contamination on the laboratory working surface area.

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Rectal carcinoma with metastasis to skeletal muscle is rare. So far, 16 cases of skeletal muscle metastasis from colorectal carcinoma have been documented of which only 5 were rectal carcinomas.^[1] We discuss here the case of a 69-year old male, a known case of mucinous adenocarcinoma status post neoadjuvant chemoradiotherapy and abdomino perineal resection, who presented with low backache 4 months post surgery. He was found to have metastasis to multiple skeletal muscles without the involvement of common sites, such as liver and lung. The role of 18-FDG–PET/CT in such cases is rarely reported in the literature. This case highlights the importance of utilizing 18-FDG-PET/CT in detecting sites of skeletal muscle metastasis and thereby guides appropriate management.

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Osteoid osteoma is a common benign bone tumor of unknown etiology affecting the young adult with characteristic clinical and radiographic presentation in its common locations. However, when it arises in unusual intra-articular locations diagnosis may be misleading, often mimicking other entities leading to delayed management. We present a case series of three cases with intra-articular osteoid osteoma that were diagnosed with the help of correlative imaging.

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Paragangliomas are neoplasms arising from extra-adrenal chromaffin tissue. They frequently cause symptoms by overproduction of catecholamines with known predilection to multicentricity. We describe the case of a patient with bilateral carotid body tumor who underwent a baseline 68 Gallium labeled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI3-Octreotide

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Purpose: Lung metastases (LMs) and their radioiodine uptake affect prognosis in patients with differentiated thyroid carcinoma (DTC). We herein investigate the value of metabolic tumor volume (MTV) in LMs on positron emission tomography/computed tomography (PET/CT) using 2-[F-18]-fluoro-2-deoxy-D-glucose (F-18 FDG PET/CT) in predicting short-term progression after initial I-131 therapy in DTC patients. Materials and Methods: We retrospectively evaluated 111 DTC patients with LMs. Diagnostic CT and I-131 scintigraphy were performed within 1 week of I-131 therapy. Maximum standardized uptake value (SUVmax) and total MTV (MTVtotal) were compared between patients with I-131-positive and I-131-negative LMs and between patients with and without short-term progression. Correlation analyses were performed between F-18 FDG PET/CT parameters and thyroglobulin (TG) level, and predictive factors for short-term progression were analyzed by logistic regression and receiver operating characteristic curve analysis.Results: Patients with short-term progression had significantly higher SUVmax and MTVtotal than those without. TG levels were significantly correlated with SUVmax (r = 0.21) and MTVtotal (r = 0.51) after I-131 therapy. MTVtotal showed significant association (χ² = 16.5, odds ratio = 0.02) with short-term progression after initial I-131 therapy and had the highest predictive value of all the putative risk factors. Conclusions: MTVtotal in LMs on F-18 FDG PET/CT is an independent predictive factor with a high predictive value for short-term progression of DTC after initial I-131 therapy. It is recommended that F-18 FDG PET/CT be performed before planning therapy during the evaluation of DTC patients with LM.

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Purpose of the Study: Glomerular filtration rate (GFR) is the most important parameter for the assessment of renal function. GFR by plasma sampling technique is considered accurate in the selection of donors for renal transplantation. Estimated GFR (eGFR) calculations using Gates' method and Modification of Diet in Renal Disease (MDRD) and Cockcroft–Gault (CG) equations are simple methods but have not been validated in the Indian population. Hence, we aimed to assess the correlation between these three techniques. Materials and Methods: The plasma sampling technique was done using two samples at 60 and 180 min after injection of 1 mCi (37MBq) ^99mTc-diethylenetriaminepentaacetic acid (^99mTc-DTPA) in 66 healthy donors. Age, sex, height, weight, and plasma creatinine were recorded. Normalized GFR (nGFR) by two-sample method and eGFR (for Gates', MDRD, and CG) values were calculated using formulae. Results: There were 14 male and 52 female donors. Mean age was 46.56 ± 12.88 years (24–69 years). Mean height was 153.74 ± 8.35 cm, whereas mean weight was 56.97 ± 11.88 kg. Mean nGFR value was 80.4 for two-sample method while mean eGFR value for Gates', CG, and MDRD were 83.3, 89.36, and 97.47 ml/min/1.73 m² (eligibility value at our institution = 70), respectively. While the correlation between nGFR and eGFR CG and MDRD was weak moderate (correlation coefficient = 0.5), nGFR and eGFR Gates' had a moderate correlation (0.686). Mean total bias for eGFR Gates', CG, and MDRD were 2.87, 8.93, and 17.0, respectively. P₃₀of eGFR Gates', CG and MDRD were 60.6%, 57.6%, and 62.1%, respectively. Conclusions: Due to the large variability in eGFR Gates', CG and MDRD, nGFR estimation using the plasma sampling technique with ^99mTc-DTPA appears necessary while screening healthy donors for renal transplantation.

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Airway involvement, tracheobronchial nodularity, and calcification are rare occurrences and unorthodox phenomena in sarcoidosis. Here, we report such an unusual case manifesting as tracheal calcification and nodules of the central airways. Radiology and bronchoscopy provide useful diagnostic clues when combined with histopathology. This case serves as an aide-memorie for the variegated presentations of sarcoidosis and emphasizes a high index of suspicion for the entity in such unconventional circumstances. An early favorable treatment response assessment to corticosteroid therapy was shown with ¹⁸F-fludeoxyglucose positron emission tomography/computed tomography.

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Frostbite or cold burn is the medical condition in which localized damage is caused to exposed skin and subcutaneous tissue due to freezing. Frostbite most likely involves body parts farthest from the heart and those with large exposed areas. At or below 0 °C (32 °F), blood vessels close to the skin start to constrict, and blood is shunted away from the extremities via the physiological feedback action of glomus bodies. This peripheral vasoconstriction helps to conserve core body temperature. In extreme cold, or when certain parts of the body are exposed to cold conditions for long periods, this protective mechanism can reduce blood flow in some areas of the body to dangerously low levels. This is followed by crystallisation of water in the tissue and subsequent death of tissues in the affected areas. In this case series, we highlight the importance of a ^99mtechnetium methylene diphosphonate (^99mTc MDP) triple phase bone scan in cases of severe frostbite to precisely delineate the ischaemic and reperfusion zones, so as to help the surgeons in carefully deciding if amputation is required and the level of amputation in such cases.

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Perineural spread (PNS) in head and neck malignancies has been associated with extremely poor prognosis. Through this interesting case, we demonstrate the PNS of a mucoepidermoid carcinoma of parotid gland with simultaneous involvement of V, VI, and VII cranial nerves identified on positron emission tomography/computed tomography.

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Diabetics have around 2-4 times increased risk of coronary artery disease(CAD) and it is the most important cause of mortality in these patients. This study was carried out to compare the sensitivity, specificity and accuracy of MPI-SPECT among diabetics and non-diabetics in the Indian population. Material and Methods: This retrospective study included 261 patients; 213 males and 48 females, with 75 diabetic and 186 non-diabetic patients. Only type II diabetics and non-diabetic patients were included in the study. Only patients who had coronary angiography (CAG) done within 6 months of the stress ^99mTc-sestamibi MPI-SPECT study were included in the study. Two arbitrary cut off points on CAG ≥ 50% and ≥ 70% were used for determination of extent of CAD. Results: Considering coronary angiography as gold standard with ≥ 50% coronary stenosis as a cut off criteria for significant stenosis the sensitivity and specificity respectively, of myocardial perfusion SPECT was 83% and 72% in diabetics and 81% and 69% in non-diabetic pateints (p value not significant). For ≥ 70% coronary stenosis as a cut off criteria for significant stenosis the sensitivity and specificity respectively, of myocardial perfusion SPECT was 87% and 61% in diabetics and 88% and 58%in non-diabetics (p value not significant). No significant difference was found in the sensitivity, specificity and accuracy of LAD, LCx and RCA coronary vessels among diabetics and non-diabetics for both ≥ 50% and ≥ 70% coronary stenosis as cut off criteria. Diabetic patients had a lower incidence of SVD compared to the non-diabetic patients. They also had a higher incidence of TVD and MVD compared to the non-diabetic patients with both ≥ 50% and ≥ 70% diameter stenosis criteria (p value significant). Conclusion: Sensitivity and specificity of ^99mTc-sestamibi myocardial perfusion imaging is similar in diabetic and non-diabetic patients in Indian population.

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Positron emission tomography (PET) using 18F-fluorodeoxyglucose (18F-FDG) is useful for staging non-small cell lung cancer (NSCLC), decide the appropriate initial management, and evaluate the response to therapy. Metastatic spreading is very common during the course of NSCLC and principal localization sites include: regional and mediastinal lymph nodes and organs such as the contralateral lung parenchyma, bone, brain, adrenal gland, pleura, and liver. Myocardial localizations are very rare, often asymptomatic, and difficult to diagnose. For this reason, only a few cases are reported in the literature. Here, we report a case of an asymptomatic patient affected by locally advanced NSCLC and high metabolic lesion of the interventricular septum.

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Avascular necrosis (AVN) of bone is defined as the cellular death of bone components due to the interruption of the blood supply; the bone structures then collapse, resulting in pain and loss of joint function. Magnetic resonance imaging (MRI) is the gold standard to diagnose AVN. We present an unusual case of AVN of talus in a patient of thalassemia major that was diagnosed on the Tc-99m MDP bone scan with equivocal findings on MRI.

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Intraluminal portal venous tumor thrombus is an infrequent association with primary gastric malignancy. Ultrasonography features such as low pulsatile flow within the thrombus, expansion of vein, and enhancement of thrombus are nonspecific findings for diagnosis. ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography scan can differentiate between the benign and malignant thrombus as well as it helps proper metastatic work up. We report such a case.

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Peptide receptor radionuclide therapy (PRRT) either using Lu-177 or Y-90 peptide radiopharmaceuticals has emerged as promising treatment modality in patients with inoperable metastatic neuroendocrine tumour (NET) including medullary thyroid cancer, because of overexpression of somatostatin receptor 2 (sstr-2) on these cells. The several investigators have used PRRT in non-iodine avid differentiated thyroid cancer patients with limited success, where other treatment modalities have failed, probably due to faint sstr-2 expression in these lesions. However Hurthle cell neoplasms being predominantly non-iodine avid lesions have shown sstr-2 over-expression. The present case of inoperable NET patient imaged and treated with radiolabelled somatostatin analogue showed incidentally detected thyroid lesion highlighting the its importance in imaging and treatment in these type of thyroid malignancies.

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A 42-year-old woman with a large pancreatic tumor had undergone ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging. Moderate metabolic activity was detected on the head of the pancreas. The tumor was resected and it was histopathologically diagnosed as malign pancreatic hemangiopericytoma (HPC). HPC is a rare soft tissue sarcoma. The tumor is considered aggressive with high rates of local recurrence and metastasis regardless the localization. Herein, we present the imaging characteristics of HPC with ¹⁸F-FDG PET/CT.

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Tc-99m labeled red blood cell (RBC) scintigraphy is one of the most sensitive tests to diagnose occult gastrointestinal (GI) bleed. Visualization of gallbladder is a rare finding in this study. Most of the previously reported cases with similar false-positive finding were associated chronic renal failure, anemia, and received multiple blood transfusions. Thus, while interpreting GI bleed scan, a thorough clinical history is of utmost importance to avoid any false-positive findings. Here, we report a case of gallbladder visualization in ^99mTc-RBC scintigraphy confirmed by single-photon emission computed tomography/computed tomography in a patient with chronic renal failure and anemia with failed renal transplant within 3 months.

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Parathyroid incidentalomas are generally discovered during thyroid surgery. ^[1]In the present case, the ectopic parathyroid adenoma was discovered as an incidentaloma in a clinical setting, during the course of clinical evaluation of atypical chest pain by gastroenterology and cardiology.

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Incidental observation of extra-striatal uptake of ^99mTc-TRODAT-1 has been reported previously in multiple space-occupying lesions of the brain. We present here a SPECT/CT scan of a 60-year old female with parkinsonism, with normal presynaptic dopaminergic transporters expression and with an intense tracer uptake in a large right-sided frontoparietal meningioma.

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Extraneural (EN) metastases and leptomeningeal (LM) metastases from certain primary central nervous system (CNS) tumors, such as pinealoblastomas, are not very common and mostly detected on autopsy. Clinical detection of this entity is, however, very rare and can be attributed to increasing overall survival or probably increased use of surveillance imaging in patients with brain tumors. We demonstrate through this case the potential adjunctive role of positron emission tomography/computed tomography in the identification of asymptomatic LM/EN metastases in high-risk primary CNS tumors.

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Overview: Minimally invasive parathyroidectomy (MIP) is an accepted surgical procedure for parathyroid adenomas. In the patients with parathyroid adenoma localized by dual phase ^99mTc-Sestamibi scan, a focused approach utilizing the gamma probe intra-operatively helps in ensuring complete resection and avoiding exploration of the other parathyroid glands. Objective: The aim of the study was to evaluate the performance of radio-guided MIP for parathyroid adenomas detected by dual phase ^99mTc-MIBI preoperatively, without intra-operative parathyroid hormone (ioPTH) monitoring for patients who had evidence of single-gland disease. Patients and Methods: A retrospective dataset of 30 patients diagnosed with solitary parathyroid adenoma operated between 2009 and 2014 were reviewed. All of the patients underwent radio-guided MIP and were followed up for at least 6 months post-operatively. The biochemical parameters (serum calcium and serum parathyroid hormone levels), imaging parameters (ultrasonography and ^99mTc-MIBI), and operative times were analyzed. Results: Our study consisted of 30 patients with 50% females, with a mean age of 42.5 + 12 years. The mean surgical duration was 20 + 12 min. All of the patients achieved biochemical cure (normalization of serum calcium) and remained eucalcemic at follow-up. No major surgical complications were noted. Conclusions: Focused parathyroidectomy using the gamma probe localization could be a potential alternative for ioPTH assay in ensuring the completeness of surgical resection of parathyroid adenoma. It is also likely to shorten operative time.

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