1.Hot Embolus Artifact Mimicking Disease Progression in Post‑therapy177Lu‑DOTATATE Scan: Incremental Value of SPECT/CT
Piyush AGGARWAL ; Anupriya ANWARIYA ; Anwin Joseph KAVANAL ; Ashwani SOOD ; Santosh Ranjan JENA ; Bhagwant Rai MITTAL
Korean Journal of Nuclear Medicine 2023;57(3):159-161
Peptide receptor radionuclide therapy (PRRT) has become an established treatment for patients with inoperable and/or metastatic, well-differentiated neuroendocrine tumors with overexpression of somatostatin receptor type 2 (SSTR-2). The post-therapy 177Lu-DOTATATE whole-body scan not only assesses the biodistribution of the lesions seen on pre-therapy68 Ga-SSTR PET/CT scan but also provides a quick assessment of disease status and dosimetry during treatment. Like any other radionuclide scan, the whole-body 177Lu-DOTATATE scan may also show abnormal radiotracer uptake, which may require further imaging to establish its exact etiology. Though radiotracer emboli mimicking focal pulmonary lesions have been described with 18F-FDG and 68 Ga-DOTANOC PET/CT scans, similar artifacts with post-therapy 177Lu-DOTATATE scans have not been described. Herein, we report two cases of hot emboli in the post-therapy 177Lu-DOTATATE scans.
2.Incidental Muscle Uptake of 177 Lu-DOTATATE in Peripheral Vascular Disease
Piyush AGGARWAL ; Kunal Ramesh CHANDEKAR ; Ashwani SOOD ; Shakti ZERIAL ; Rajender KUMAR ; Anindita SINHA
Korean Journal of Nuclear Medicine 2021;55(6):320-322
Somatostatin receptor (SSTR)-based imaging and therapy has emerged as well-established modality in neuroendocrine tumors. However, its role in inflammation imaging is still evolving. We present a 48-year-old male with metastatic neuroendocrine tumor who underwent lutetium-177-based somatostatin receptor-based therapy. The post-therapy scan showed a focal tracer uptake in the left calf muscle in addition to the expected tracer uptake at the primary and metastatic sites. Further, cross-sectional imaging and biochemical investigations revealed peripheral vascular disease (PVD). The incidental tracer uptake in the calf on post-therapy scan potentiates the role of somatostatin receptor scintigraphy in identifying macrophagespecific inflammatory reactions.
3.Versatile Role of 18 F-FDG PET/CT in a Patient with Pan-cerebellar Paraneoplastic Manifestation Due to Underlying Hodgkin’s Lymphoma
Piyush AGGARWAL ; Anwin Joseph KAVANAL ; Harmandeep SINGH ; Rajender KUMAR ; Rajeev RANJAN ; Jitupam BAISHYA ; Anish BHATTACHARYA
Korean Journal of Nuclear Medicine 2021;55(6):311-314
Hodgkin’s lymphoma most commonly presents as painless lymphadenopathy and systemic B symptoms like fever, night sweats, and weight loss. But rarely, it can present with unusual paraneoplastic manifestations. In the present case, we report a 30-year-old woman who presented with sub-acute onset pan-cerebellar symptoms. The serum neuronal antibody panel was negative. She underwent F-18 FDG PET/CT to evaluate the neoplastic etiology as the underlying cause, which demonstrated both the primary etiology and the paraneoplastic changes in the brain.