Extraskeletal Lesions Research Articles

Diagnostic Accuracy of PET with Different Radiotracers versus Bone Scintigraphy for Detecting Bone Metastases of Breast Cancer: A Systematic Review and a Meta-Analysis.

Due to the importance of correct and timely diagnosis of bone metastases in advanced breast cancer (BrC), we performed a meta-analysis evaluating the diagnostic accuracy of [18F]FDG, or Na[18F]F PET, PET(/CT), and (/MRI) versus [99mTc]Tc-diphosphonates bone scintigraphy (BS). The PubMed, Embase, Scopus, and Scholar electronic databases were searched. The results of the selected studies were analyzed using pooled sensitivity and specificity, diagnostic odds ratio (DOR), positive-negative likelihood ratio (LR+-LR-), and summary receiver-operating characteristic (SROC) curves. Eleven studies including 753 BrC patients were included in the meta-analysis. The patient-based pooled values of sensitivity, specificity, and area under the SROC curve (AUC) for BS (with 95% confidence interval values) were 90% (86-93), 91% (87-94), and 0.93, respectively. These indices for [18F]FDG PET(/CT) were 92% (88-95), 99% (96-100), and 0.99, respectively, and for Na[18F]F PET(/CT) were 96% (90-99), 81% (72-88), and 0.99, respectively. BS has good diagnostic performance in detecting BrC bone metastases. However, due to the higher and balanced sensitivity and specificity of [18F]FDG PET(/CT) compared to BS and Na[18F]F PET(/CT), and its advantage in evaluating extra-skeletal lesions, [18F]FDG PET(/CT) should be the preferred multimodal imaging method for evaluating bone metastases of BrC, if available.

Role of Magnetic Resonance Imaging in Evaluation of Post Traumatic Ankle Joint

Background: The ankle joint injuries are common emergency and account for about 10% of all visits to emergency departments. This is usually due to a sprain related to sports, walking, fall, or road traffic accident. Ankle joint has a complex three-dimensional anatomy, so MRI is considered the modality of the choice in evaluating patients with ankle problems. MRI provides precise information about soft tissue, skeletal and extra-skeletal lesions. Objectives: To evaluate the role of magnetic resonance imaging (MRI) in the detection of abnormalities and injuries associated with post traumatic ankle joint. Patients and methods: A descriptive cross-sectional study was conducted from July 2019 to April 2021. Sixty patients with post-traumatic ankle joint complaints underwent MRI examination during this period. All patients performed MRI examination in the Radiology Department, Menoufia University Hospital after signing informed consent. Results: Out of 60 patients, nine (16%) were diagnosed with ligamentous injuries, 29 (48.3%) were diagnosed with tendon injuries and 35 (58.3%) were diagnosed with bone injuries. Nine (15%) were fractures, one (1.7%) was bone necrosis and 34 (56.7%) were bone contusions. 55 (91.7%) had joint effusion and 11 (18.3%) had sinus tarsi syndrome. Conclusion: MRI is the modality of choice in evaluating ankle injuries because of its high soft tissue contrast resolution and multi-planar capabilities. It is an ideal modality for global evaluation of the osseous and soft tissue structures of the ankle.

Added Value of SPECT/CT in Characterization of Extra-Skeletal Uptake of Tc-99m MDP on Planar Bone Scintigraphy in Known Cancer Patients.

Introduction: Extra-skeletal Tc-99m MDP uptake is not uncommon. It could be a problematic when it mimics a metastatic osseous lesion. Due to lack of proper anatomical localization, Planar bone scintigraphy (PBS) alone can't resolve this problem. Adding single photon emission tomography / computed tomography (SPECT/CT) images increases the diagnostic accuracy of planar bone scintigraphy. SPECT/CT has great impact on patients' management by preventing misinterpretation through precise localization and proper characterization of these uncertain lesions. In this study, we compared the diagnostic accuracy of SPECT/CT versus PBS in characterization of extra-skeletal lesions detected on conventional PBS in known cancer patients. Materials and Methods: This is a retrospective study including 50patients with known cancer referred for conventional (PBS) for metastatic work up. PBS was acquired followed by SPECT/CT images for the concerned area. Diagnostic performance indices from both modalities (PBS& SPECT/CT) were compared against the reference standard (clinical/imaging follow-up). Results: A total of 50 known cancer patients were included in this study (37 females, 13 males) with median age 64 years (range: 15-79). The sensitivity, specificity, and accuracy for SPECT/CT in identification of extra-osseous lesions all were 100% compared to 28%, 72% and 44% respectively for PBS. Uncertain lesions decreased from 38% to 0% by adding SPECT/CT.Only 10% of lesions showed calcium deposition, while the rest had other causes for extra-skeletal uptake. Conclusion: SPECT/CT enhances the diagnostic accuracy of planar bone scan for characterizations of extra-skeletal lesions that mimic osseous metastasis thus significantly impact patient’s management.

Myelolipoma mimicking osteosarcoma in the distal femur.

Introduction and importancePeriosteal reactions indicate malignant bone tumors, including osteosarcoma; establishing an accurate diagnosis is key to determining the most appropriate treatment strategy. We describe a rare case of myelolipoma in the distal femur metaphysis with massive extraskeletal lesions and periosteal reactions.Case presentationA 25-year-old woman was referred to our hospital to treat a gradually expanding mass around her knee that grew to the size of a baby's head. She had a history of hydrocephalus caused by congenital cytomegalovirus infection and was bedridden for life. Radiography showed a prominent osteoblastic rim and osteolytic lesion with a moth-eaten appearance. Osteosarcoma was suspected due to excessive extraskeletal invasion and periosteal reactions. T1- and T2-weighted magnetic resonance images showed a high-signal-intensity homologous lesion. Biopsy specimens contained adipose and hematopoietic tissues. A myelolipoma was diagnosed. Due to her fragility, surgical intervention was suspended. Two years after diagnosis, the tumor size did not change.Clinical discussionMyelolipomas are benign tumors that typically arise from the adrenal gland and rarely develop in the extremities. This type of tumor typically does not cause any tumor-related symptoms or endocrine disturbances and has been reported as a type of incidentaloma. To effectively manage myelolipoma patients, differential diagnosis of tumors mimicking malignant bone tumors is important.ConclusionWe successfully managed a destructive ectopic myelolipoma in the distal femoral metaphysis, with massive extraskeletal lesions and periosteal reactions. Clinicians should appropriately differentiate myelolipoma from tumors mimicking malignant bone tumors.

Impact of Early Conventional Treatment on Adult Bone and Joints in a Murine Model of X-Linked Hypophosphatemia

X-linked hypophosphatemia (XLH) is the most common form of genetic rickets. Mainly diagnosed during childhood because of growth retardation and deformities of the lower limbs, the disease affects adults with early enthesopathies and joint structural damage that significantly alter patient quality of life. The conventional treatment, based on phosphorus supplementation and active vitamin D analogs, is commonly administered from early childhood to the end of growth; unfortunately, it does not allow complete recovery from skeletal damage. Despite adequate treatment during childhood, bone and joint complications occur in adults and become a dominant feature in the natural history of the disease. Our previous data showed that the Hyp mouse is a relevant model of XLH for studying early enthesophytes and joint structural damage. Here, we studied the effect of conventional treatment on the development of bone and joint alterations in this mouse model during growth and young adulthood. Mice were supplemented with oral phosphorus and calcitriol injections, following two timelines: (i) from weaning to 3 months of age and (ii) from 2 to 3 months to evaluate the effects of treatment on the development of early enthesophytes and joint alterations, and on changes in bone and joint deformities already present, respectively. We showed that early conventional treatment improved bone microarchitecture, and partially prevented bone and joint complications, but with no noticeable improvement in enthesophytes. In contrast, later administration had limited efficacy in ameliorating bone and joint alterations. Despite the improvement in bone microarchitecture, the conventional treatment, early or late, had no effect on osteoid accumulation. Our data underline the usefulness of the Hyp murine model for preclinical studies on skeletal and extraskeletal lesions. Although the early conventional treatment is important for the improvement of bone microarchitecture, the persistence of osteomalacia implies seeking new therapeutic strategies, in particular anti-FGF23 approach, in order to optimize the treatment of XLH.

Role of 18F-FDG PET/CT in the Assessment of Response to Antitubercular Chemotherapy and Identification of Treatment Endpoint in Patients With Tuberculosis of the Joints: A Pilot Study.

The aim of this study was to explore the utility of 18F-FDG PET/CT in the assessment of response to antitubercular treatment (ATT) and identification of treatment endpoint. Forty patients (mean age, 35.3 years; 27 men) with clinically, radiologically, and histopathologically proven joint tuberculosis prospectively underwent clinical, biochemical, and PET/CT evaluation at baseline and after ~6, 12, and 18 months of ATT. Two patients were lost to follow-up, and 1 defaulted treatment. The remaining 37 were followed up until complete response (CR) was achieved. Images were visually and quantitatively (SUVmax ratio and metabolically active disease volume [MV]) evaluated by 2 experienced nuclear medicine physicians. Knee (n = 18) and ankle (n = 7) were the most frequently involved sites. The median MV and SUVmax ratio at baseline were 85.10 mL and 7.21, respectively. Five patients had noncontiguous vertebral involvement, 12 had pulmonary lesions, 2 had abscesses, 6 had mediastinal, and 30 had local lymph nodal involvement. Complete response was seen in 1/39, 11/37, and 30/37 patients after 6, 12, and 18 months of ATT. Significant reductions in visual analog scale score, tenderness, joint swelling, SUVmax ratios, and MVs (Friedman test, P < 0.001) were seen after each follow-up. The median time-to-CR in skeletal lesions was significantly longer than extraskeletal lesions (591 vs 409 days; Wilcoxon signed-rank test, P < 0.001). Time-to-CR in joint lesions positively correlated with MV at first follow-up (Pearson = 0.452, P = 0.005) and negatively correlated with percentage change in MV (first follow-up from baseline) (Pearson = -0.620, P < 0.001). ROC analysis yielded a cutoff of ≤71% reduction in MV at first follow-up (80.8% sensitivity, 81.8% specificity) to predict extension of ATT beyond 12 months. Using ROC analysis at second follow-up, a cutoff of ≤12.67 mL (for CR) was derived and was validated in patients at the third follow-up, with an accuracy of 84.4%. Patients with CR in PET/CT maintained disease-free state during a mean follow-up of 271 days. 18F-FDG PET/CT is an excellent tool in estimating total disease burden, assessing response to ATT and identification of treatment endpoint in joint tuberculosis.

Usefulness of 68Ga-DOTATOC PET/CT to localize the culprit tumor inducing osteomalacia

Tumor-induced osteomalacia (TIO) is an uncommon paraneoplastic syndrome presenting with sustained hypophosphatemia. Treatment of choice is removal of the tumor causing the TIO, but identification of the culprit tumor by routine imaging is challenging. This study aimed to assess the usefulness of somatostatin receptor imaging, called 68Ga-DOTATOC PET/CT, in the management of patients with TIO. Twelve patients who were suspected of having TIO underwent 68Ga-DOTATOC PET/CT. Lesion detectability and maximum standardized uptake value (SUVmax) were determined and retrospectively compared with the clinical/imaging surveillance and histopathologic diagnosis. The median duration of suspected TIO with hypophosphatemia was 7.8 years (range 2.1–21.0). Conventional radiologic and/or nuclear medicine images failed to identify the culprit tumors. However, 68Ga-DOTATOC PET/CT scans showed that 8 of the 12 patients had positive lesions, suggesting the presence of focal culprit tumors. The SUVmax of positive tumors was 1.9–45.7 (median: 11.5). Six skeletal lesions and two extra-skeletal lesions were identified. Seven of the lesions were pathologically confirmed as potential culprits of TIO. Hypophosphatemia was resolved in five patients who underwent lesion excision. The 68Ga-DOTATOC PET/CT is a useful whole-body imaging modality for the detection of causative tumors in patients with suspected TIO.

Clinical Impact of F-18 FDG PET-CT on Biopsy Site Selection in Patients with Suspected Bone Metastasis of Unknown Primary Site.

We investigated the clinical role of F-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) in the identification of the primary site and the selection of the optimal biopsy site in patients with suspected bone metastasis of unknown primary site. The patients with suspected bone metastasis who underwent PET-CT for evaluation of primary site were enrolled in this study. The primary sites were identified by the histopathologic or imaging studies and were classified according to the FDG uptake positivity of the primary site. To evaluate the guiding capability of PET-CT in biopsy site selection, we statistically analyzed whether the biopsy site could be affected according to the presence of extra-skeletal FDG uptake. Among 74 enrolled patients, 51 patients had a metastatic bone disease. The primary site was identified in 48 of 51 patients (94.1%). Forty-six patients were eligible to test the association of clinical choice of biopsy site with PET positivity of extra-skeletal lesion. The extra-skeletal biopsies were done in 42 out of 43 patients with positive extra-skeletal uptake lesions. Bone biopsies were inevitably performed in the other three patients without extra-skeletal uptake lesions. The association came out to be significant (Fisher's exact test, P < 0.001). F-18 FDG PET-CT significantly contributed not only to identify the primary site but also to suggest optimal biopsy sites in patients with suspected bone metastasis.

Rosai-Dorfman Disease—Utility of 18F-FDG PET/CT for Initial Evaluation and Follow-up

The role of imaging in the management of Rosai-Dorfman disease (RDD), a rare non-Langerhans cell histiocytosis, is not clearly defined. We present an analysis of FDG PET/CT findings obtained for initial disease characterization, follow-up evaluation, and treatment planning for this disease. From an institutional pathology database (2001-2018), we identified RDD patients who underwent FDG PET/CT scans either as part of clinical care or when done as part of clinical trials. For all scans, sites of abnormal FDG uptake were assessed, and SUVmax was measured. Comparison of PET/CT findings was made with anatomic (CT/MRI-based) imaging, where available. Instances of changing treatment based on PET/CT were recorded. We reviewed 109 FDG PET/CT scans in 27 patients with RDD. Five of 27 patients had only nodal/cutaneous disease, whereas 22 patients had extranodal disease, most commonly in bone (n = 9) and central nervous system (n = 7). PET/CT identified sites of active disease in 24 of 27 patients. All identified bone and extraskeletal lesions, except for a brain lesion in 1 patient, were FDG-avid. In 6 of 20 patients (30%) with available prior CT or MRI, PET/CT demonstrated additional RDD lesions (bones: n = 5, pleura: n = 1) that were not apparent on anatomic imaging; 3 of these lesions were outside the CT field of view, and 3 were not recognized on CT. Overall, 13 of 109 PET/CT scans led to a change in management, affecting 41% (11/27) of patients. FDG PET/CT was valuable in defining disease extent and optimizing treatment strategy in patients with RDD.

Radiographic Features of Osteogenesis Imperfecta about a Female Sibship

Osteogenesis imperfecta (OI) belongs to a group of congenital osteoporosis which hallmark feature is “affecting skeleton, increasing bone fragility that fracture easily and decreasing bone density due to quantitative and/or qualita-tive abnormalities”. We report a female sibling’s involvement in 3 cases with probable recessive inheritance pattern. Only female aged between 5 and 13 years were affected with skeletal lesions in the lower limbs. The boy of this family had no skeletal or extra-skeletal lesions. Their parents had no affection and no bond of consanguinity. The observed malformations can be classified as type V or VI according to Sillence’s clinical classification. Lack of genetic test in our context has limited accuracy of the diagnosis as new data evoke a genetic classification into 12 types that leading an effective therapeutic management.

Simultaneous PET/MRI in the Evaluation of Breast and Prostate Cancer Using Combined Na[18F] F and [18F]FDG: a Focus on Skeletal Lesions.

The purpose of this study is to prospectively evaluate the performance of sodium 18F]fluoride (Na[18F]F)/2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) simultaneous time-of-flight enabled positron emission tomography (PET)/magnetic resonance imaging (MRI) for the detection of skeletal metastases in selected patients with advanced breast and prostate cancers. The institutional review board approved this HIPAA-compliant protocol. Written informed consent was obtained from each patient. A total of 74 patients (23 women and 51 men with breast and prostate cancer, respectively) referred for standard-of-care whole-body bone scintigraphy (WBBS) were enrolled in this prospective study. All patients underwent a [99mTc]methyldiphosphonate ([99mTc]MDP) WBBS followed by Na[18F]F/[18F]FDG PET/MRI. Lesions detected by each imaging modality were tabulated and a lesion-based and patient-based analysis was conducted. On a patient-based analysis, [99mTc]MDP WBBS identified skeletal lesions in 37 patients and PET/MRI in 45 patients. On a lesion-based analysis, WBBS identified a total of 81 skeletal lesions, whereas PET/MRI identified 140 lesions. Additionally, PET/MRI showed extra-skeletal lesions in 19 patients, including lymph nodes (16), prostate (4) lung (3), and liver (2) lesions. The ability of Na[18F]F/[18F]FDG PET/MRI to identify more skeletal lesions than 99mTc-MDP WBBS and to additionally identify extra-skeletal disease may be beneficial for patient care and represent an alternative to the single modalities performed separately. Na[18F]F/[18F]FDG PET/MRI is a promising approach for evaluation of skeletal and extra-skeletal lesions in a selected population of breast and prostate cancer patients.

Role of 18F-FDG PET/CT in patients affected by Langerhans cell histiocytosis.

Langerhans cell histiocytosis (LCH) is a rare hematological disorder for which the utility of18F-FDG PET/CT is unclear. Our aim was to explore the metabolic features of LCH and the possible role of18F-FDG PET/CT in LCH evaluation. We found 17 patients with histologically proven LCH who underwent 1718F-FDG PET/CT scans for staging and 42 scans for restaging/follow-up purposes. PET/CT results were compared with those obtained from other conventional imaging modalities (bone scintigraphy, plain radiogram, computed tomography, magnetic resonance). 18F-FDG PET/CT was positive in 15/17 patients, and it detected 36/37 lesions; all bone and extraskeletal lesions, except for a cecal lesion, were18F-FDG-avid. Only 1/4 of the patients with lung LCH had hypermetabolic lesions. The average SUVmax of the FDG-avid lesions was 7.3±6.7, the average lesion-to-liver SUVmax ratio was 3.4±2.5, and the average lesion-to-blood pool SUVmax ratio was 4±3.2. In comparison to other imaging methods,18F-FDG PET/CT detected additional lesions or was able to evaluate treatment response earlier in 33/74 cases; it was confirmatory in 38/74 and detected fewer lesions in 3/74 (all three with lung LCH). 18F-FDG PET/CT seems to be useful for evaluating LCH when compared to conventional imaging, except in pulmonary cases. It can be used both for staging and restaging purposes.

The role of 18F-FDG PET/CT in staging and restaging primary bone lymphoma

Primary bone lymphoma (PBL) is one of the rarest primary bone malignancies. Very limited data are available on the role of fluorine-18-fluorodeoxyglucose (F-FDG) PET/CT in PBL. Overall, 16 relevant patients had F-FDG PET/CT for staging or staging/restaging PBL. The cases with extraskeletal lesions such as lymphadenopathy or with osseous involvements in disseminated lymphoma were excluded on the basis of the definition of PBL. F-FDG PET/CT findings were correlated to pathologic and/or anatomic image information. F-FDG PET/CT was positive with markedly increased uptake in all known PBL lesions, with a sensitivity of 100%. In 15 of 16 (93.8%) cases, the bone lesions infiltrated the adjacent soft tissue with visible soft tissue components. Except for known primary bone lesion, F-FDG PET/CT showed additional 24 bone lesions in seven patients, which accounted for 44% of all cases. With maximum standardized uptake value of 2.5 as a cutoff for differentiating residual lymphoma from metabolically inactive disease on restaging scan, the sensitivity, specificity, positive predictive value, and negative predictive value of F-FDG PET/CT for PBL were 100% (4/4), 75% (9/12), 57% (4/7), and 100% (9/9), respectively. The diagnostic accuracy of restaging F-FDG PET/CT was 81% (13/16). Two of three false-positive scans were because of post-therapeutic osteonecrosis. F-FDG PET/CT is sensitive for showing PBL that is typically highly F-FDG avid and has the ability to depict extraskeletal soft tissue involvement and additional bone lesions on staging. More importantly, F-FDG PET/CT may accurately and reliably evaluate therapeutic response with excellent sensitivity and negative predictive value. However, false-positive F-FDG uptake poses a concern on restaging PET/CT. Post-therapeutic osteonecrosis is a potential source of false-positive findings on F-FDG PET/CT.

The application value of Wb-dwi and Spect on diagnosing osseous metastases

Objective To investigate values of Wb-dwi on diagnosis of osseous metastases compared with Spect materials. Methods 20 cases with osseous metastases underwent Wb-dwi and Spect.The bones were divided into 6 groups: skull, collarbone, trunk bone, haunch bone, upper limb bone, lower limb bone.the high uptake regions on Spect and high signal on Wb-dwi for positive groups or positive lesions were recorded.Meanwhile, the total numbers of positive groups and positive lesions in different groups were also recorded.Finally, the diagnostic sensitivity and specificity of Wb-dwi and Spect were calculated, which was based on the total numbers of positive groups. Results Wb-dwi showed 69 positive groups, the numbers of positive lesions in each group were 2, 1, 85, 55, 22, 12.Spect showed 66 positive groups, the numbers of positive lesions in each group were 4, 3, 79, 47, 20, 18.The diagnostic sensitivity and specificity on Spect were 81.1%, 80.3%.The diagnostic sensitivity and specificity on Wb-dwi were 86.9%, 84.3%.No statistical difference was assessed between the sensitivity and specificity of two methods. Conclusion Compared with Spect, the Wb-dwi can show more osseous metastasis lesions and has higher sensitivity on diagnosis osseous metastases.In additional, it can demonstrate primary tumors and extraskeletal metastasis lesions. Key words: Magnetic resonance imaging, diffusion; Tomography, emission-computed, single-photon; Single-photon emission computed tomography

Clinical significance of extraskeletal computed tomography findings on 18F-NaF PET/CT performed for osseous metastatic disease evaluation.

Extraskeletal findings detected on whole-body low-dose unenhanced computed tomography (CT) as a part of F-NaF PET/CT scans can be numerous and present challenges for further management. Here, we investigate the frequency and clinical significance of extraskeletal findings among 130 consecutive patients undergoing F-NaF PET/CT for osseous metastatic disease. F-NaF PET/CT performed on 130 patients (101 men and 29 women; mean age: 61.4 years) with biopsy-proven malignancies were reviewed independently. Incidental soft tissue findings detected on unenhanced low-dose CT portions of the scans were compiled and categorized by clinical significance. A total of 275 incidental extraskeletal CT findings were observed in 114 out of 130 patients (87.7%). Seven patients (5.4%) showed clinically significant findings. One patient developed new lung nodules that were resected and proven to be metastases. Two patients showed new hypodense hepatic lesions that were highly suspicious for liver metastases. One patient with prostate cancer was found to have previously unknown retroperitoneal lymphadenopathy. Three patients showed indeterminate renal and adrenal lesions that necessitated further correlative imaging. Although CT indicated a large number of incidental extraskeletal lesions in the majority of patients undergoing F-NaF PET/CT, clinically significant incidental findings requiring further evaluation were relatively infrequently observed in 5.4% of patients. Thus, the low-dose unenhanced CT in F-NaF PET/CT performed for oncologic evaluation may indicate unexpected soft tissue lesions that can impact patient management and therefore should be interpreted by physicians skilled in CT reading, with correlation to available imaging, and familiar with established guidelines for work-up of incidental findings.

Nontraumatic Myositis Ossificans in a Muscle of Mastication

Myositis ossificans (MO) is an extraskeletal tumor-like lesion with bone formation, and is relatively rare in the head and neck region. We report herein a clinicopathological analysis of MO associated with a muscle of mastication. The patient was a 70-year-old Japanese woman who presented with a tumorous mass in the right parotid area and no history of trauma. The surgically excised tumorous lesion consisted of proliferating fibroblastic cells with no atypia in the central portion, and a formation of trabecular osteoid and/or bony tissue in the peripheral portion as the so-called “zonal phenomenon”. The final histological diagnosis was MO, and the lesion was located in the posterior belly of the digastric muscle on computer tomography. A review of the literature showed that many cases of MO predominantly affected the medial pterygoid and masseter muscle and showed a history of previous trauma. The present case represents a rare case of nontraumatic MO in the uncommon location of the posterior belly of the digastric muscle.

Semiquantitative Analysis of the Biodistribution of the Combined ¹⁸F-NaF and ¹⁸F-FDG Administration for PET/CT Imaging.

In this study, we evaluated the biodistribution of the (18)F(-)/(18)F-FDG administration, compared with separate (18)F-NaF and (18)F-FDG administrations. We also estimated the interaction of (18)F-NaF and (18)F-FDG in the (18)F(-)/(18)F-FDG administration by semiquantitative analysis. We retrospectively analyzed the data of 49 patients (39 men, 10 women; mean age ± SD, 59.3 ± 15.2 y) who underwent separate (18)F-FDG PET/CT and (18)F-NaF PET/CT scans as well as (18)F(-)/(18)F-FDG PET/CT sequentially. The most common primary diagnosis was prostate cancer (n = 28), followed by sarcoma (n = 9) and breast cancer (n = 6). The mean standardized uptake values (SUVs) were recorded for 18 organs in all patients, and maximum SUV and mean SUV were recorded for all the identified malignant lesions. We also estimated the (18)F(-)/(18)F-FDG uptake as the sum of (18)F-FDG uptake and adjusted (18)F-NaF uptake based on the ratio of (18)F-NaF injected dose in (18)F(-)/(18)F-FDG PET/CT. Lastly, we compared the results to explore the interaction of (18)F-FDG and (18)F-NaF uptake in the (18)F(-)/(18)F-FDG scan. The (18)F(-)/(18)F-FDG uptake in the cerebral cortex, cerebellum, parotid grand, myocardium, and bowel mostly reflected the (18)F-FDG uptake, whereas the uptake in the other analyzed structures was influenced by both the (18)F-FDG and the (18)F-NaF uptake. The (18)F(-)/(18)F-FDG uptake in extraskeletal lesions showed no significant difference when compared with the uptake from the separate (18)F-FDG scan. The (18)F(-)/(18)F-FDG uptake in skeletal lesions reflected mostly the (18)F-NaF uptake. The tumor-to-background ratio of (18)F(-)/(18)F-FDG in extraskeletal lesions showed no significant difference when compared with that from (18)F-FDG alone (P = 0.73). For skeletal lesions, the tumor-to-background ratio of (18)F(-)/(18)F-FDG was lower than that from (18)F-NaF alone (P < 0.001); however, this difference did not result in missed skeletal lesions on the (18)F(-)/(18)F-FDG scan. The understanding of the biodistribution of radiopharmaceuticals and the lesion uptake of the (18)F(-)/(18)F-FDG scan as well as the variations compared with the uptake on the separate (18)F-FDG PET/CT and (18)F-NaF PET/CT are valuable for more in-depth evaluation of the combined scanning technique.

Cystic Angiomatosis: A Rare Cause of Thoracic Radiculopathy: A Case Report.

Thoracic radiculopathy is a rare condition that is most frequently attributed to thoracic disc disease and diabetes mellitus. It typically presents as pain, paresthesias, dysesthesias, and loss of sensation in a dermatomal distribution across the chest, thorax, and/or abdomen. Neoplasms, skeletal deformities (e.g., scoliosis, kyphosis, and compression fractures), and other skeletal and extraskeletal diseases encompass some of the numerous disease etiologies1-4. Cystic angiomatosis (CA), a disease characterized by cystic skeletal lesions with or without extraskeletal involvement, represents an even rarer cause of thoracic radiculopathy. CA is histologically described as cystic lesions of hemangiomatous, lymphangiomatous, or mixed origin. It typically presents in the first three decades of life4-6 with no sex preference7, and has an estimated incidence rate of between 0.1 and 1.0 in 1,000,0008. It most frequently presents with skeletal and extraskeletal lesions, but it also may present with isolated skeletal lesions5,9,10. The skull, ribs, vertebrae (cervical vertebrae most frequently)7, pelvis, femora, and humeri10,11 are the skeletal structures that are most commonly involved. The spleen, liver, kidneys, pleurae, and lungs represent the most commonly affected extraskeletal structures5,9,12. Skeletal lesions are most commonly located within the medullary cavity; however, cortical involvement has been noted13. CA tends to be diagnosed in asymptomatic individuals after routine radiographs reveal diffuse cystic skeletal lesions. Symptomatic patients may present with bone pain with or without pathological fractures, localized swelling and tenderness, dyspnea, hemoptysis, ascites, and even organ failure. While the lesions may spontaneously remit, patients are at risk for permanent deformity, loss of function, and even death—especially in patients with splenic14,15 or pleural involvement12,16 or infected angiomatic lesions11. …

A new syndrome mimicking Jaffe-Campanacci syndrome: a case report

Jaffe-Campanacci syndrome (JCS) is a well-known condition with its clinical and radiological characteristics. Extraskeletal congenital anomalies of this syndrome include café-au-lait spots, mental retardation, cardiovascular abnormalities, ocular deformities, hypogonadism or cryptorchidism. Multiple non-ossifying fibromas are also characteristic bone lesions. In this article, we present a new syndrome mimicking JCS, which is characterized by a simple bone cyst and extraskeletal lesions.

English

Langerhans cell disease previously known as Histiocytosis X is a non lipidreticuloendotheliosis that presents with single or multiple lesions distributed in the soft tissues, lymph nodes, various organs and bones, especially in areas of marked reticulo endothelial activity. Histiocytosis X encompasses three conditions which include a localized form (Eosinophilic granuloma), a chronic disseminated form (Hand Schuller-Christian disease) and an acute or subacute disseminated form (Letterer-Siwe disease). Eosinophilic granuloma is characterized by solitary or multiple skeletal lesions with no extra skeletal involvement whereas Hand Schuller- Christian disease manifests with widespread skeletal and extra skeletal lesions with a chronic clinical course. Letterer-Siwe disease presents with widespread lesions of both skeletal and extra skeletal tissues with a more acute severe clinical course and a high mortality rate. Most often these patients report initially to the dentist because of the significant oral involvement including gingival swelling and mobility of teeth. Such a rare case of acute disseminated Langerhans cell disease that presented to the dental clinic is discussed in this article.