Gallium-67 citrate has long been used for imaging of infection and inflammation. Although gallium-67 uptake due to silicone implants and silicone injections has been previously reported in the literature, very few cases are documented. We report a case of increased gallium-67 uptake in the buttocks in a patient who previously received silicone injections in the buttocks, to reemphasize silicone augmentation as a potential source of gallium-67 uptake. In addition, we present a F-18-fluorodeoxyglucose (FDG) PET/CT scan from the same patient to demonstrate mild diffuse FDG uptake in the buttocks in the region of previous silicone injection. Although FDG is well known to accumulate in areas of inflammation such as prior sites of silicone injection or silicone implantation in the breast, FDG uptake in the buttocks due to silicone injections has not been previously reported or correlated with a gallium scan.
We present a case of a patient with chronic obstructive pulmonary disease whose myocardial perfusion SPECT imaging demonstrated diffusely decreased Tc-99m sestamibi lung uptake ("lucent lungs"); our results indicate that there may be a lower limit of normal for lung-to-heart ratio, below which pathology can be inferred.
Case report. A 53-year-old male was referred for a single day gated rest/stress Tc-99m sestamibi myocardial perfusion imaging (MPI) study for the evaluation of exertional dyspnea. His medical history included hypertension and hypercholesterolemia. The patient's height, weight, and chest circumference were 5 0 11 00 , 357 pounds, and 52 in., respectively. A standard single low-dose rest (10.3 mCi)/high-dose stress (31.0 mCi) Tc-99m sestamibi protocol was used. Due to the patient's inability to exercise, a standard dipyridamole pharmacologic stress with 59.6 mg of dipyridamole was performed. The patient experienced no chest pain and there were no ST segment changes during dipyridamole infusion. All images were acquired on a GE Millenium VG with a dual 90°detector system using a 180°circular orbit and a low energy, high-resolution collimator. Images were processed with ordered subset expectation maximization (OSEM) using Myovation software on a GE Xeleris computer.Review of the rotating planar projection images demonstrated truncation of the apex and distal one-third of the left ventricle in both the stress and the rest acquisitions ( Figure 1). Reconstructed tomographic images also showed considerable artifact involving the distal third of the left ventricle rendering this study uninterpretable (Figure 2).Since the patient had already left the testing facility, immediate repeat post-stress imaging was not possible and an entire repeat study was scheduled for 2 days later. The repeat study used the same protocol with rest/ stress doses of 10.4/31.2 mCi of Tc-99m sestamibi and 60.0 mg of dipyridamole, but with a circular camera orbit having a larger radius of rotation to accommodate the patient's girth. Again, the patient experienced no chest pain, and there were no ST segment changes during dipyridamole infusion. In the repeat stress and rest rotating planar projection images, the apex and the distal one-third of the left ventricle were no longer truncated (Figure 3). The tomographic images also demonstrated no truncation artifact. There was homogeneous tracer distribution throughout the entire left ventricular myocardium, indicating no scan evidence of either scar or dipyridamole-induced ischemia (Figure 4).Discussion. Recognizing and understanding imaging artifacts is necessary for physicians to properly acquire and accurately interpret myocardial perfusion scans. The truncation artifact occurs when the patient is large relative to the field of view of the camera, causing part of the body to be outside of the camera's view. 1
We report a marked geographically inconsistent response of prostate cancer skeletal metastases to androgen deprivation therapy. Such inconsistent response to therapy has not been described previously in the literature and should be correlated with individual patient history. Further understanding of the mechanism of geographic responses to hormone deprivation therapy may have implications in the targeting of specific regions of disease for treatment in the future.
Accurate localization of areas of increased metabolic activity on PET only imaging can be challenging. Fusion of PET with CT imaging provides anatomic detail which aids in localization of functional information. As a result, the overall sensitivity and specificity of information provided by PET or CT alone is improved with combined PET/CT resulting in improved diagnosis and patient management. We report a case of an unexpected emergent finding of urinary bladder perforation on PET/CT to stress the importance of accurately interpreting the anatomic and functional data. To our knowledge, diagnosis of bladder perforation on PET/CT has not been previously reported in the literature. Failure to recognize such complications may lead to adverse outcomes.
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