Clinical Nuclear Medicine

Hepatic Angiomyolipoma Having FDG Uptake at the Similar Level of the Normal Liver Parenchyma A middle-aged woman underwent a contrast CT to evaluate a palpable upper abdominal mass. The images showed large lesion in the left lobe of the liver, and malignancy was among differential diagnoses. For this reason, FDG PET/CT was performed. Surprisingly, the level of FDG uptake by the large hepatic lesion was similar to the normal part of the liver. Pathological examination demonstrated hepatic angiomyolipoma. Received for publication January 31, 2019; revision accepted February 6, 2019. Conflicts of interest and sources of funding: This work was sponsored in part by the National Natural Science Foundation of China (grant 81571713), Capital's Funds for Health Improvement and Research (grant 2016-2-40115), and CAMS Innovation Fund for Medical Sciences CIFMS) (grant 2016-I2M-4-003, 2018-I2M-3-001). None declared to all authors. Correspondence to: Li Huo, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, #1 Shuaifuyuan, Dongcheng District, Beijing, China 100730. E-mail: Huoli@pumch.cn. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Pittsburgh Compound-B Uptake in Meningioma With Histopathologic Correlation Previous studies have reported increased Pittsburgh compound-B (PiB) uptake in meningiomas; however, histological correlation to elucidate the underlying mechanism has not yet been done. We report a case of an 82-year-old woman with an incidental intracranial tumor that showed focal increased PiB uptake. Because of tumor growth, surgical resection was performed, yielding a histological diagnosis of meningioma. Any special and immunochemical staining for amyloid did not reveal amyloid deposition in the tumor. Our findings suggest that increased PiB uptake was not associated with amyloid in this instance. Received for publication January 10, 2019; revision accepted March 7, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Nobuo Kashiwagi, PhD, Department of Radiology, Kindai University Faculty of Medicine, 377–2 Ohno-Higashi, Osakasayama City, Osaka 589–8511, Japan. E-mail: k-nobuo@med.kindai.ac.jp. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

FDG-Avid Hürthle Cell Thyroid Adenoma Incidental thyroid uptake is found in approximately 2.5% of patients who undergo FDG PET for nonthyroid malignancy; approximately a third of the FDG PET thyroid incidentalomas are malignant, including primary thyroid malignancies and metastasis. We describe a 50-year-old woman, a potential heart transplant candidate with history of breast cancer, who was found by FDG PET/CT to harbor a large thyroid mass with intense FDG uptake. Biopsy and molecular study demonstrated that the thyroid mass was a Hürthle cell adenoma. This case highlights that Hürthle cell neoplasm should be included in the differential diagnosis of a thyroid nodule with very high FDG avidity. Received for publication March 3, 2019; revision accepted March 30, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Run Yu, MD, PhD, Division of Endocrinology, UCLA David Geffen School of Medicine, 200 Medical Plaza Dr, Suite 530, Los Angeles, CA 90095. E-mail: runyu@mednet.ucla.edu. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

18F-FDG PET/CT Imaging of Trichoblastic Carcinoma With Nodal Metastasis Trichoblastic carcinoma is an uncommon malignant neoplasm arising from follicular germinative cells. The high-grade trichoblastic carcinoma has been reported with lymphatic and hematogenous dissemination. The authors present a 59-year-old man with gluteal cleft trichoblastic carcinoma and highlight the useful role of serial 18F-FDG PET/CT examinations in the demonstration of initial and subsequent nodal metastasis in the inguina and pelvis. Received for publication August 5, 2018; revision accepted March 30, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Ba Duong Nguyen, MD, Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259. E-mail: nguyen.ba@mayo.edu. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Comparison of Functional Deficit Zone Defined by FDG PET to the Epileptogenic Zones Described in Stereo-Electroencephalograph in Drug-Resistant Epileptic Patients Treated by Surgery Introduction The purpose of presurgical assessment is to delimit the epileptogenic zone and the functional deficit zone with a brain MRI, an electroencephalograph or even a stereo-electroencephalograph (SEEG), neuropsychological evaluation, and a cerebral FDG PET. Several studies concur that the hypometabolism of FDG PET seems to be consistent with epileptogenic zones. We compared the functional deficit zone defined by FDG PET with the results of the SEEG, for each cluster electrode contact (CEC) located in the gray matter. Methods The electrode diagram of the 15 patients (486 CECs) operated on for drug-resistant epilepsy was merged with MRI and FDG PET. The metabolisms of FDG PET and SEEG were compared using a logistic regression test. Results The presence of hypometabolism resulted in a significantly higher risk of being in the seizure onset zone and the irritative zone, particularly when it was intense. Of the deeply hypometabolic CECs, 47% were in the seizure onset zone and 76% in the irritative zone. Normal metabolism resulted in a significantly higher probability of being in the healthy zone. Conclusions This study demonstrated an association between the presence of normal metabolism and the location of CECs in the healthy zone, and between the presence of pathological metabolism and the location of CECs in the seizure onset zone and the irritative zone, with metabolism abnormalities progressively more present and more intense near the seizure onset zone. Received for publication September 28, 2018; revision accepted March 30, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Izzie Jacques Namer, MD, PhD, Service de Biophysique et de Médecine Nucléaire, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1, Avenue Molière, 67098 Strasbourg Cedex 09, France. E-mail: Izzie.Jacques.NAMER@chru-strasbourg.fr. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Utility of 18F-FDG PET/CT in Infantile Myofibromatosis Infantile myofibromatosis, a rare, nonmalignant disease seen almost exclusively in the pediatric population, can involve skin, muscle, soft tissues, bone, or viscera in either solitary or multicentric pattern. Although nonmalignant, visceral involvement in infantile myofibromatosis is a key prognostic indicator, which is associated with mortality in 75% of patients. Those with pulmonary involvement have a particularly poor outcome. This case illustrates the diagnostic utility of 18F-FDG PET/CT in defining disease extent in this unusual entity and compares it to other commonly used imaging modalities. Received for publication February 14, 2019; revision accepted March 23, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Marguerite T. Parisi, MD, MS, Department of Radiology, MS# MA.7.770, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105. E-mail: meg.parisi@seattlechildrens.org. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Finding of the "Mini Brain" May Not Be a Unique Anatomic Appearance of Spinal Plasmacytoma MRI and 18F-FDG PET/CT were performed on a 37-year-old man who was suspected with malignant spinal tumor on x-ray examination. An FDG-avid expansile lytic lesion was found in his T12 vertebra. The lesion showed a characteristic "mini-brain" appearance on MRI and CT. This extremely high specificity sign and consistent manifestation on PET image indicated plasmacytoma as the most optimal diagnosis. But finally, a giant cell tumor was confirmed after surgery. The case cautions that the specificity of the diagnostic characteristics of "mini-brain" sign for plasmacytoma or multiple myeloma may not be as high as previously reported. Received for publication January 30, 2019; revision accepted April 10, 2019. Xiao Zhong and Zhiyun Jia attributed equally to the work. Conflicts of interest and sources of funding: none declared. Correspondence to: Minggang Su, MD, From the Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China. E-mail: suminggang@sina.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Minimal-Invasive Robot-Assisted Image-Guided Resection of Prostate-Specific Membrane Antigen–Positive Lymph Nodes in Recurrent Prostate Cancer With the rapid expansion of robot-assisted surgical procedures, the need for robot-compliant image guidance technologies has also increased. Examples hereof are the integrated firefly fluorescence camera, the drop-in ultrasound probe, and the recently introduced DROP-IN gamma probe. Combined with 68Ga–prostate-specific membrane antigen–(PSMA)–11 PET/CT (staging) and 99mTc-PSMA-I&S SPECT/CT (preoperative imaging), the latter DROP-IN gamma probe technology recently allowed us to perform the first clinical cases of robot-assisted PSMA-guided salvage surgery of lymphatic metastases. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received for publication December 7, 2018; revision accepted March 3, 2019. Conflicts of interest and sources of funding: This research was supported by an NWO-TTW-VICI grant (TTW 16141). Material support was provided by Eurorad (Eurorad S.A., Eckbolsheim, France) supporting our study with a prototype DROP-IN gamma probe. None declared to all authors. Correspondence to: Fijs W. B. van Leeuwen, PhD, Interventional Molecular Imaging Laboratory, Department of Radiology, C2-S zone, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands. E-mail: F.W.B.van_Leeuwen@lumc.nl; or Tobias Maurer, MD, PhD, FEBU, Leitender Arzt, Universitätsklinikum Hamburg-Eppendorf, Martini-Klinik am UKE GmbH, Martinistraße 52 Gebäude Ost 46, 20246 Hamburg, Germany. E-mail: t.maurer@uke.de. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

FDG PET/CT in a Case of Bilateral Tuberculous Epididymo-orchitis Isolated genital tuberculosis is rare. We present a case of bilateral tuberculous epididymo-orchitis showing high FDG uptake on FDG PET/CT. In addition, the patient had a prostatic FDG-avid lesion, consistent with tuberculous prostatitis. This case indicates tuberculous epididymo-orchitis, especially in tuberculosis-endemic regions, should be considered as a differential diagnosis in patients with hypermetabolic epididymal or testicular lesions, including benign and malignant tumors, bacterial epididymo-orchitis, abscess, idiopathic granulomatous orchitis, and sarcoidosis. Received for publication March 4, 2019; revision accepted March 21, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Pengcheng Ran, MM, Department of Nuclear Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou 510120, Guangdong Province, China. E-mail: cmurpc@163.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

64CuCl2 PET/CT in a Hyperfunctioning Parathyroid Gland We report a case of incidental 64CuCl2 uptake at PET/CT imaging in a 61-year-old man with a biochemical recurrence of prostate cancer. Parathyroid hormone was slightly elevated (92.4 pg/mL; reference range, 18.4–80.1 pg/mL); serum calcium was in reference range (9.5 mg/dL; reference range, 8.6–10.6 mg/dL), whereas serum phosphate was slightly low (2.6 mg/dL; reference range, 2.7–4.5 mg/dL). This case highlights the ability of 64CuCl2, similar to radiolabeled choline, to identify the presence of hyperfunctioning parathyroid glands in patients undergoing PET/CT examination. Received for publication January 12, 2019; revision accepted March 24, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Laura Evangelista, MD, PhD, Nuclear Medicine Unit, Veneto Institute of Oncology IOV–IRCCS, Via Gattamelata, 64 35128 Padova, Italy. E-mail: laura.evangelista@iov.veneto.it. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Alexandros Sfakianakis
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