Iliac artery angiosarcoma is rare, and bone metastasis as its presenting initial symptom is extremely rare. A 67-year-old man with a history of low back pain presented with multiple MRI-identified lumbar and sacrum lesions highly suggestive of bone metastasis. On subsequent PET/CT scan, in addition to multiple vertebrae and pelvis hypermetabolism, a lesion with intense focal uptake was discovered within the lumen of left common iliac artery. Dual-time point quantitative analysis revealed that the lesion-to-liver ratio of SUVmax was significantly increased in the delayed phase. Biopsy confirmed the lesion as a primary iliac artery angiosarcoma.
Backgrounds: We performed a meta-analysis to compare 18F-FDG-PET and 18F-FDG-PET/CT for the diagnostic performance in thyroid nodules with indeterminate cytology by Bethesda classification. Methods: PubMed and Embase databases were searched for eligible studies from the earliest available date of indexing through September 2019. Only studies with clearly stated histopathology confirmation were included. Publication bias was assessed by Deeks funnel plot. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value, and diagnostic odds ratio was determined by random-effect analysis, respectively. All diagnostic estimate indexes were determined separately for PET alone and PET/CT and were compared pair-wisely using Z-test. Results: We included 214 patients from five PET alone studies and 420 patients from 8 PET/CT studies in this meta-analysis. The range of the prevalence of malignancy was 11% to 27% for PET alone studies (Median, 20%) and 4% to 50% for PET/CT studies (Median, 24%). The sensitivity (0.95 vs 0.73, P < .01), negative likelihood ratio (0.20 vs 0.53, P = .04) and negative predictive value (0.99 vs 0.91, P < .01) of PET alone are significantly better than those of PET/CT. For PET/CT, Fagan nomogram indicated that when the pre-test probability was set at 24%, the negative post-test probability could decrease to 12%. Conclusion: This meta-analysis reveals that in evaluating thyroid nodules with indeterminate cytology by Bethesda classification, the rule-out performance of 18F-FDG-PET is significantly better than 18F-FDG-PET/CT, although the latter represents a more objective and accurate technique. We hypothesize that the lack of precise localization of suspicious FDG uptake in the neck region may have contributed to this overvaluation for PET alone studies, and advocate that future studies be performed with PET/CT rather than PET alone to avoid misinterpretation and overvaluation in this scenario.
IntroductionMeckel’s diverticulum is a common congenital abnormality of gastrointestinal tract in children. Planar scintigraphy using Technetium-99m pertechnetate is widely used in the diagnosis of Meckel’s diverticulum. Single photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging may help to locate the Meckel’s diverticulum lesion. We now present a Meckel’s diverticulum case which tends to be missed.Case descriptionThe patient was diagnosed with Mecke’s diverticulum by planar scintigraphy in 2007. After seven years, a recurrence of hematochezia made the patient undergo planar scintigraphy again. However, the concentration on planar image was located at the right kidney level, we could not determine whether it was caused by physiological uptake of the right kidney or by an ectopic gastric mucosa. Using SPECT/CT technique, we confirmed that the lower part of the concentration was from a Meckel’s diverticulum from the small intestine based on the functional and anatomical information together.Discussion and EvaluationFor concentrations about the kidney level, planar scintigraphy is not enough to be diagnostic of Meckel’s diverticulum. SPECT/CT imaging may be beneficial for a definitive diagnosis. Also, fusion images may provide precise localization of the lesion. To make sure that patients obtain optimal benefit from a SPECT/CT examination, we have to balance the priority between information of anatomic location and avoiding redundant radiation to the patients.ConclusionsOur case study suggest that for cases with ambiguous planar scintigraphy images, SPECT/CT imaging should be performed to obtain a definitive diagnosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-2928-4) contains supplementary material, which is available to authorized users.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.