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Fulltext Metastatic Thymic Carcinoma on Restaging 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography

Hoe Khoo AC, Ang SF

Indian J Nucl Med, 2020 10 21;35(4):364-366.
PMID: 33642772 DOI: 10.4103/ijnm.IJNM_123_20

Thymic carcinoma is a rare thymic epithelial cancer which is not only locally invasive but also highly aggressive disease. The prognosis for this cancer is poor and the surgery remains the mainstay of treatment. Thymic carcinomas have been shown to metastasize to the lymph nodes, lung, and liver. A 63-year old male who was successfully treated for thymic cancer in 2015, presented with metastatic disease recurrence to the spinal cord. We share interesting images of the spinal cord lesions as well as pituitary metastases that were incidentally detected on restaging 18F-fluorodeoxyglucose positron emission tomography-computed tomography.
Fulltext A Review of TENIS Syndrome in Hospital Pulau Pinang

Mahalakshmi DV, Mattoo S, Bothra S, Dhanda M, Mayilvaganan S

Indian J Nucl Med, 2019 2 5;34(1):81-82.
PMID: 30713393 DOI: 10.4103/ijnm.IJNM_147_18
Fulltext Incidental Detection of Endometriosis with 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in a Patient with Cervical Intraepithelial Neoplasia and Adenomyosis

Khoo ACH, Chew GK

Indian J Nucl Med, 2019 5 2;34(2):162-163.
PMID: 31040534 DOI: 10.4103/ijnm.IJNM_27_19

Endometriosis is commonly associated with chronic pelvic pain and its presentation varies between individuals. The only way to confirm the presence of endometriosis is via keyhole or open surgery. In the presence of hematuria, deep endometriotic infiltration needs to be considered. We share an interesting case highlighting the role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography in evaluating a posterior urinary bladder wall lesion and hypodense liver lesions in a middle-aged woman with presenting with frank hematuria in the background of treated cervical intraepithelial neoplasia and adenomyosis.
Posterior Layering of Fluorine-18 Fluorodeoxyglucose in the Urinary Bladder

Khoo ACH

Indian J Nucl Med, 2018 4 13;33(2):165-166.
PMID: 29643684 DOI: 10.4103/ijnm.IJNM_148_17

An 89-year-old man undergoing fluorine-18 fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) study posttherapy for hepatocellular carcinoma was noted to have 18F-FDG posterior layering of the urinary bladder. This phenomenon of posterior layering of 18F-FDG in the urinary bladder during PET/CT studies is physiological, and it is important to recognize to avoid misinterpretation and unnecessary investigations. The hypotheses for the cause of this phenomenon are highlighted in these interesting images including the reversed phenomenon where there is anterior layering of 18F-FDG.
Fulltext Incidental Finding of Lipomatous Hypertrophy of the Interatrial Septum during 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography for Cervical Cancer

Khoo ACH, Nasir SMBM

Indian J Nucl Med, 2018 11 6;33(4):374-375.
PMID: 30386070 DOI: 10.4103/ijnm.IJNM_89_18

Lipomatous hypertrophy of the interatrial septum is a benign but less recognized pathology of the heart caused by benign fatty infiltration of the interatrial septum which most often spares the fossa ovalis. We share images of the incidentally detected fluorodeoxyglucose (FDG) uptake in the interatrial septum during the restaging of 18F-FDG positron emission tomography/computed tomography scan of cervical cancer.
Fulltext A Review of TENIS Syndrome in Hospital Pulau Pinang

Khoo ACH, Fong LY, Hamzah F

Indian J Nucl Med, 2018 11 6;33(4):284-289.
PMID: 30386048 DOI: 10.4103/ijnm.IJNM_65_18

Introduction: The treatment for differentiated thyroid cancers (DTCs) has always been radioactive iodine 131I therapy after definitive surgical management. Clinicians are faced with therapeutic challenges when dealing with patients having thyroglobulin-elevated negative iodine scintigraphy (TENIS) syndrome (elevated serum thyroglobulin [Tg] levels but negative whole-body scans [WBSs]).
Objective: The aim of the study was to determine the prevalence of TENIS syndrome in our local setting and to evaluate the use of 18-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) in the management.
Methodology: The data from DTC patients treated in the Department of Nuclear Medicine, Hospital Pulau Pinang from December 1, 2010, to November 30, 2016, with negative WBS and elevated Tg were reviewed. These patients should have undergone 18F-FDG PET-CT to be included in the study.
Results: Only forty (10.4%) out of a total of 386 patients treated in Hospital Pulau Pinang during the study fulfilled the inclusion criteria. There were 28 women (70%) with median age of 59 years old. Thirty-four patients (85%) had papillary thyroid cancer (PTC) and six patients had follicular thyroid cancer. The use of 18F-FDG PET-CT revealed 23 patients (57.5%) with 18F-FDG avid metastases suggesting dedifferentiation of thyroid cancers. Based on this study, the probability of detecting FDG-avid disease is higher (P = 0.03) if 18F-FDG PET-CT was performed when Tg ≥15 ng/mL.
Conclusion: TENIS syndrome constitutes a significant number of cases in our setting. Our data suggest a cutoff Tg ≥15 ng/mL for performing 18F-FDG PET-CT for these patients would be more beneficial than the currently American Thyroid Association recommended cutoff of 10 ng/mL.
A Review on the Usage of Bone Single-Photon Emission Computed Tomography/Computed Tomography in Detecting Skeletal Metastases in the Post-COVID-19 Era: Is it Time to Ditch Planar and Single-Photon Emission Computed Tomography only Gamma Camera Systems?

Suppiah S, Mohd Rohani MF, Zanial AZ, Ahmad Shahrir AD, Khairuman KA, Vinjamuri S

Indian J Nucl Med, 2023;38(2):191-200.
PMID: 37456181 DOI: 10.4103/ijnm.ijnm_142_22

Planar whole-body bone scanning (WBS) is widely used to evaluate skeletal lesions seen in cancer and noncancer cases. Frequently, degenerative, or other benign bony changes may give rise to indeterminate lesions that mimic bone metastases. In the post-COVID-19 era, there is an evolutionary phase that puts importance on global development and adaptability, which encompasses to include nuclear medicine practices worldwide. Single-photon emission computed tomography/computed tomography (SPECT/CT) can be used to improve the characterization of these lesions and help to resolve the diagnostic conundrum while reducing the need for patients to undergo multiple different examinations at various imaging departments. The fusion of SPECT and CT allows morphological characterization of functional abnormality detected by focal tracer uptake on planar scintigraphy, which provides a one-stop center imaging in nuclear medicine departments. The objective of this study was to review the diagnostic accuracy of SPECT/CT in diagnosing bone metastases in a variety of oncology and nononcology cases and to determine the feasibility of performing bone SPECT/CT in all suspected cancer cases, including cases of bone infection instead of planar imaging alone. The utilization of hybrid SPECT/CT in indeterminate bone lesions detected on planar WBS can significantly increase the diagnostic confidence and accuracy of image interpretation. Recognition of patterns of disease identified using hybrid imaging can improve the management of patients with potentially lower costs in the long term. Currently, hybrid SPECT/CT machines are becoming a norm in nuclear medicine departments, thus potentially making single planar application machines obsolete in the near future. We hypothesize that in the interest of providing a meaningful interpretation of isotope bone scans, the default protocol should involve the option of acquiring SPECT/CT images rather than relying on whole-body scans only. Departments choosing to upgrade existing equipment or those choosing to invest in only one gamma camera should proactively opt for hybrid SPECT/CT systems.