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Classical Imaging Triad in a Very Young Child with Swyer-James Syndrome
Damle, Nishikant A.,Mishra, Rohini,Wadhwa, Jasmeet Kaur The Korea Society of Nuclear Medicine 2012 핵의학 분자영상 Vol.46 No.2
Swyer-James syndrome (SJS) or Swyer-James-MacLeod syndrome is a rare disorder characterized by roentgenographical hyperlucency of one lung, lobe, or part of a lobe. As originally described, it shows a unilateral small lung with hyperlucency and air trapping on radiographs. It is postinfectious obliterative bronchiolitis due to childhood respiratory infection. In SJS, the involved lung or portion of the lung does not grow normally. The characteristic radiologic appearance is that of pulmonary hyperlucency on chest X-ray/CT caused by over-distention of the alveoli in conjunction with diminished arterial flow detected on Tc-99 m MAA pulmonary perfusion scan. Radionuclide pulmonary ventilation studies are considered difficult to perform in very young children as patient co-operation is crucial to achieve adequate tracer entry into the lungs. We present here the case of a female child aged 2 years, who presented with chronic productive cough and fever off and on for 1.5 years. She had classical features on imaging and markedly diminished ventilation on Tc-99 m DTPA aerosol study. Our case highlights the typical findings on ventilationperfusion scan (V/Q scan) and suggests that it is possible to conduct a satisfactory ventilation study with Tc-99 m DTPA aerosol even in very young children.
SPECT/CT in the Diagnosis of Skull Base Osteomyelitis
Damle, Nishikant Avinash,Kumar, Rakesh,Kumar, Praveen,Jaganathan, Sriram,Patnecha, Manish,Bal, Chandrasekhar,Bandopadhyaya, Gurupad,Malhotra, Arun The Korea Society of Nuclear Medicine 2011 핵의학 분자영상 Vol.45 No.3
Skull base osteomyelitis is a potentially fatal disease. We demonstrate here the utility of SPECT/CT in diagnosing this entity, which was not obvious on a planar bone scan. A $^{99m}Tc$ MDP bone scan with SPECT/CT was carried out on a patient with clinically suspected skull base osteomyelitis. Findings were correlated with contrast-enhanced CT (CECT) and MRI. Planar images were equivocal, but SPECT/CT showed intense uptake in the body of sphenoid and petrous temporal bone as well as the atlas corresponding to irregular bone destruction on CT and MRI. These findings indicate that SPECT/CT may have an additional role beyond planar imaging in the detection of skull base osteomyelitis.
Unusual Uptake of Prostate Specific Tracer <sup>68</sup>Ga-PSMA-HBED-CC in a Benign Thyroid Nodule
Damle, Nishikant Avinash,Tripathi, Madhavi,Chakraborty, Partha Sarathi,Sahoo, Manas Kumar,Bal, Chandrasekhar,Aggarwal, Shipra,Arora, Geetanjali,Kumar, Praveen,Kumar, Rajeev,Gupta, Ravikant The Korea Society of Nuclear Medicine 2016 핵의학 분자영상 Vol.50 No.4
$^{68}Ga$-Prostate specific membrane antigen- N,N′-bis[2-hydroxy-5-(carboxyethyl)benzyl]ethylenediamine-N,N′-diacetic acid- positron emission tomography/computed tomography or 68 Ga- HBED-CC-PSMA PET/CT, popularly known as PSMA PET/CT, is able to detect a small volume of recurrent prostate carcinoma (PC) when there is a prostate specific antigen (PSA) rise on follow-up after prostatectomy or other definitive treatment for PC. The use of PSMA PET/CT in the initial staging in PC is uncertain at this time. Clinical studies are underway to define its exact role in the management of the disease. At the same time it is important to be aware of unexpected sites of uptake of this ligand. We present here the case of a 62-year-old male patient who underwent prostatectomy for adenocarcinoma prostate. He also had a long-standing left solitary thyroid nodule (STN). Four months after surgery, he had a rising trend in serum PSA levels on three occasions, but the absolute value was less than 4 at all times. He underwent a $^{68}Ga$-PSMA-HBED-CC PET/CT, but it did not reveal any recurrent/metastatic site of disease. However, there was increased tracer uptake in the left STN. Fine needle aspiration cytology revealed features of atypia of undetermined significance, Bethesda category III. The patient underwent a left hemithyroidectomy and the histopathology showed features of a follicular adenoma.
Orbital IgG4 Disease: Imaging Findings on 68Ga-DOTANOC PET/CT
Saurabh Arora,Nishikant A. Damle,Rachna Meel,Sanjay Sharma,Seema Sen,Chandrasekar Bal,Kanak Lata,Sneha Prakash,Divya Yadav,Meivel Angamuthu 대한핵의학회 2019 핵의학 분자영상 Vol.53 No.6
Immunoglobulin G4 (IgG4)–related diseases are a spectrum of systemic inflammatory conditions of unknown etiology, which are characterized by infiltration of tissues by IgG4 plasma cells and sclerosing inflammation (Cheuk and Chan Adv Anat Pathol 17:303–32, 2010). Although this condition was initially described in relation to autoimmune pancreatitis, now it has been reported in almost every organ system of body (Zen and Nakanuma Am J Surg Pathol 34:1812–9, 2010, Masaki et al. Ann Rheuma Dis 68:1310–5, 2009). Orbital involvement by IgG4 disease can involve extraocular muscles (EOM), lacrimal glands, conjunctiva, eyelids, infraorbital nerve, orbital fat, and nasolacrimal system (McNab and McKelvie. Ophthal Plast Reconstr Surg 31:167–78, 2015, Katsura et al. Neuroradiology 54:873–82, 2012). The basis of using 68Ga-DOTANOC PET/CT in IgG4 orbital disease is the known expression of somatostatin receptors in chronic inflammatory cells (Cuccurullo et al. Indian J Radiol Imaging 27:509-16, 2017) and also avidity shown previously in other IgG4-related diseases (Cheng et al. Clin Nucl Med 43:773-6, 2018).
Avinash Tupalli,Nishikant Avinash Damle,ArunRaj Sreedharan Thankarajan,Bharadwaj Srinivas Mangu,Arunav Kumar,Dikhra Khan,Sambit Sagar,Chandrasekhar Bal 대한핵의학회 2020 핵의학 분자영상 Vol.54 No.1
Although prostate cancer can metastasize to any part of the body, laryngeal cartilage metastasis is extremely rare and few cases have been published so far. Here we present the case of a 65-year-old male patient, recently diagnosed with prostate adenocarcinoma, referred for staging with 68Ga-PSMA PET/CT. He was found to have extensive skeletal metastasis along with cartilage metastasis involving both thyroid and cricoid cartilages.
Arora, Saurabh,Damle, Nishikant Avinash,Passah, Averilicia,Yadav, Madhav Prasad,Ballal, Sanjana,Aggarwal, Vivek,Gupta, Yashdeep,Kumar, Praveen,Tripathi, Madhavi,Bal, Chandrasekhar 대한핵의학회 2018 핵의학 분자영상 Vol.52 No.3
Multiple endocrine neoplasia type 1 (MEN1) syndrome is characterized by combined occurrence of tumors of endocrine glands including the parathyroid, the pancreatic islet cells, and the anterior pituitary gland. Parathyroid involvement is the most common manifestation and usually the first clinical involvement in MEN1 syndrome, followed by gastroentero-pancreatic neuroendocrine tumors (NETs). Here we present a case where the patient initially presented with metastatic gastric NET and a single parathyroid adenoma was detected incidentally on $^{68}Ga$-DOTANOC PET/CT done as part of post $^{177}Lu$-DOTATATE therapy (PRRT) follow-up. Further $^{18}F$-fluorocholine PET/CT showed four adenomas for which the patient subsequently underwent subtotal parathyroidectomy.
Saurabh Arora,Nishikant Avinash Damle,Averilicia Passah,Rajni Sharma,Harish Goyal,Shreedharan Thankarajan Arunraj,Priyanka Gupta,Manisha Jana 대한핵의학회 2019 핵의학 분자영상 Vol.53 No.2
18F-DOPA PET/CT is commonly done in patients with persistent hyperinsulinemic hypoglycemia of infancy (PHHI) to look for any focal lesion in the pancreas.We present the findings in a 20-day-old neonate with PHHI who underwent 18F-DOPA PET/CT. The scan showed diffuse uptake in the pancreas with no focal lesion, physiologic excretion into the genito-urinary system, and interestingly tracer accumulation was seen in the inferior vena cava and ilio-femoral veins which is a non-physiological site for tracer accumulation. The uptake corresponded to a large venous thrombus which was confirmed by a venous Doppler.
Angel Hemrom,Geetanjali Arora,Nishikant Avinash Damle,Chandrasekhar Bal 대한핵의학회 2022 핵의학 분자영상 Vol.56 No.5
Purpose Neuroblastoma (NB) is childhood’s most common extracranial solid malignancy. We have compared two imaging modalities, 131I-MIBG and 18F-DOPA PET/CT, to evaluate NB. Also, feasibility of the application of standardised scoring systems, SIOPEN and Curie scoring systems, in 18F-DOPA PET/CT was explored. Methods Patients with histopathology-proven NB underwent 131I-MIBG (planar and SPECT/CT) and 18F-DOPA PET/CT scans, as per standard imaging protocols. Duration between scans ranged from 1 to 30 days (median = 8 days). Number of lesions in Curie and SIOPEN scoring systems applied on both modalities was compared. Results Forty-six patients were included (M:F = 29:17) with a median age of 36 months. Both 131I-MIBG and 18F-DOPA scans were positive in 39 patients and negative in four patients. 18F-DOPA PET/CT was positive in additional three patients, in which 131I-MIBG was negative (p = 0.25). Overall, 18F-DOPA identified significantly greater number of lesions than 131I-MIBG, especially metastatic skeletal lesions (p < 0.05). Significant difference was observed between Curie scores in the two modalities, unlike SIOPEN scores. However, when the cut-off age of 18 months was taken, no significant difference was seen in either of the scoring systems in both the scans (p > 0.05). CS and SIOPEN scores were significantly higher in bone marrow-positive patients. Conclusion 18F-DOPA PET/CT detected more lesions than 131I-MIBG but had little impact on staging of the disease. For evaluation of NB, both scans can be used interchangeably as per the availability. Furthermore, both SIOPEN and Curie scoring systems, standardised for MIBG, can also be used to semi-quantify disease extent in 18F-DOPA PET/CT.