We report on a 62-year-old man with metastatic prostate cancer (cT3b N1) diagnosed in 2011, treated with total androgen blockage with flutamide and goserelin acetate (Zoladex). He presented with left suprascapular swelling and low-back pain after being asymptomatic for 5 years. His prostate-specific antigen was 0.049 ng/mL. F-NaF PET-CT and Ga-PSMA scan were negative, whereas Ga-DOTA NOC scan done after 10 days showed multiple somatostatin-avid hepatic and lymph node metastasis.
225Ac-based PSMA-targeted therapy has emerged as promising agent for the treatment of metastatic castration-resistant prostate cancer. Posttherapy image is used for tracer localization and dosimetry. Prior 2 photopeaks of 440 and 218 KeV were reported for posttherapy imaging. Our study of gamma ray spectrum, phantom, and clinical images show that imaging with 3 major photopeaks of 78, 218, and 440 KeV gives better quality images, high count statistics, and higher number of lesion delineations. It is therefore suggested that posttherapy imaging may be carried out using 3 major abundant photopeaks.
Bertolotti syndrome is a form of low-back pain associated with lumbosacral transitional vertebrae. We report a case of a 34-year-old woman with breast cancer presented with severe low-back pain. F-NaF PET/CT demonstrates increased radiotracer uptake at the transverse-sacral articulation corresponding to hemisacralized left transverse process of L5 vertebra. Increased tracer uptake in patients with lumbosacral transitional vertebrae seems to correlate with lower-back pain symptoms. F-NaF PET/CT can be useful in evaluation of some uncommon causes of low-back pain. Bertolotti syndrome should always be included in the differential diagnosis of lower-back pain in young patients.
The results of the present study indicate that F-NaF PET-CT retains its high diagnostic accuracy in morbidly obese patients and, by inference, can be a preferred functional modality in these patients.
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