case study nuclear medicine

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Nuclear Medicine and PET/CT Cases (1)

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In 194 cases featuring over 450, high-quality images, Nuclear Medicine and PET/CT Cases provides a succinct review of clinically relevant cases covering the full range of nuclear medicine. Cases are grouped into sections including: Nuclear CNS Imaging, Nuclear Inflammation/Infection Imaging, Ventilation/Perfusion Lung Scintigraphy, Pediatric Nuclear Medicine, Cardiac Imaging, Bone Scintigraphy, PET/CT in Oncology, General Oncologic Imaging, Thyroid and Parathyroid, Radionuclide Therapy and Pre-Therapy Evaluation, Liver, Spleen and Biliary Tract, Gastrointestinal Tract, Renal Scintigraphy. Part of the Cases in Radiology series, this title follows the easy-to-use format of question and answer in which the patient history is provided on the first page of the case, and radiologic findings, differential diagnosis, teaching points, next steps in management, and suggestions for furthering reading are revealed on the following page. This title is an essential resource for radiology residents and practicing radiologists alike.

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Positive nuclear medicine cardiac stress test

Citation, doi, disclosures and case data.

At the time the case was submitted for publication Jayanth Keshavamurthy had no recorded disclosures.

Presentation

Elderly male with history of hypertension and dyslipidemia presents to ER with shortness of breath on exertion.

Patient Data

Abnormal stress ECG showing ST-T wave depression in V2, V3, V4 andV5 leads concerning for coronary artery disease in circumflex coronary artery territory.

Exercise stress test performed in supine and prone images. Rest images obtained in supine position.

First row -supine stress images.

Second row- rest images.

Third row-prone stress images.

Here we do the stress images first and then the rest images.

4 DM software was utilized for post-processing above.

Abnormal stress test is concerning for a large area of reversible perfusion deficit in the lateral wall with corresponding decreased wall thickening,

Emergent cardiac catheterization was performed the next morning.

Coronary artery catheterization is showing 2 vessel severe CAD and was referred to CABG.

Case Discussion

Based on the findings of ECG abnormalities during exercise stress nuclear test, chest discomfort relieved by nitroglycerin during the stress test, a large reversible perfusion deficit in the lateral and inferior wall, the patient was thought to have myocardial ischemia due to significant coronary artery disease in a left dominant circulation.

Cardiac catheterization confirmed 2-vessel disease and the patient was referred for CABG.

• 1. Ryan A. Dvorak, Richard K. J. Brown, James R. Corbett. Interpretation of SPECT/CT Myocardial Perfusion Images: Common Artifacts and Quality Control Techniques. (2011) RadioGraphics. 31 (7): 2041-57. doi:10.1148/rg.317115090 - Pubmed

1 article features images from this case

• Myocardial ischemia

10 public playlists include this case

• school presentation by Adam Jacobson
• General Nuclear Medicine Basics by Justin G Peacock ◉
• FRCR NUC by Rubi Subhash
• Nuclear Medicine Case Review by Justin G Peacock ◉
• MEDRADS - CARDIOLOGY by Ronald Crandall ◉
• cardic-5 by tuanleminh ◉
• Cardio_PFJ by Pedro Jorge
• Nuclear Medicine - Cardiac by Justin G Peacock ◉
• SHIRISH PAUL FRCR 2B NUCLEAR MEDICINE PLAYLIST by Shirish Paul Ganta
• Nuclear by Urjinkhand Bayarsaikhan

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Nuclear Medicine: Case Review Series 2nd Edition

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This new edition of Nuclear Medicine in the popular Case Review series offers self-assessment preparation for board reviews to help residents and recertifying radiologists stay on top in their field! Dr. Harvey Zeissman presents 200 case studies―covering hot topics like PET/CT, SPECT/CT, and radiation safety―with images and questions to refine and reinforce your understanding of nuclear medicine.

• Review 200 cases organized by level of difficulty, with questions, answers, and rationales that mimic the format of certification exams.
• Prepare for the challenges you’ll face on the exam and in practice with visual guidance from 400 images.
• Find more in-depth information easily thanks to cross-references to The Requisites: Nuclear Medicine.
• Stay current thanks to new images and/or updated questions, answers, and discussions for nearly every case study.
• Master the applications of nuclear medicine in bone medicine, oncology, neurology, and cardiac medicine with 40 new PET/CT cases and 5 new SPECT/CT cases.
• Manage risks thanks to 10 radiation safety cases that cover this major concern in nuclear medicine practice.
• ISBN-10 0323053084
• ISBN-13 978-0323053082
• Edition 2nd
• Publisher Mosby
• Publication date December 2, 2010
• Part of series Case Review
• Language English
• Dimensions 8.5 x 0.75 x 10.75 inches
• Print length 436 pages
• See all details

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Editorial Reviews

"This will surely be an essential book for residents who are preparing for the board examinations in nuclear medicine and radiology. The easy reading style, along with the division of the book into three gradations of difficulty, makes it an interesting challgene for the practicing nuclear medicine physician... This book is very helpful both for beginning radiologists and for those who already interpret nuclear medicine images on a daily basis."

-Radiology, review of previous edition

Product details

• Publisher ‏ : ‎ Mosby; 2nd edition (December 2, 2010)
• Language ‏ : ‎ English
• Paperback ‏ : ‎ 436 pages
• ISBN-10 ‏ : ‎ 0323053084
• ISBN-13 ‏ : ‎ 978-0323053082
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2. A CASE STUDY: NUCLEAR MEDICINE

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A head-to-head comparison of [ 68 Ga]Ga-DOTATATE and [ 68 Ga]Ga-FAPI PET/CT in patients with nasopharyngeal carcinoma: a single-center, prospective study

• Original Article
• Published: 10 May 2024

Cite this article

• Jieling Zheng 1 , 2 ,
• Guochang Wang 1 , 2 ,
• Qian Ru 3 ,
• Yun Yang 1 , 2 ,
• Wenlong Lv 4 ,
• Chunlin Ke 4 ,
• Peirong Wang 4 ,
• Xiaohui Liu 4 ,
• Li Zhang 3 ,
• Feng Liu 4 &
• Weibing Miao   ORCID: orcid.org/0000-0002-0058-4953 1 , 2 , 5 , 6  

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We aimed to compare the staging efficiency of [ 68 Ga]Ga-DOTATATE and [ 68 Ga]Ga-FAPI PET/CT in nasopharyngeal carcinoma (NPC) patients.

Thirty-nine patients with pathologically confirmed NPC were enrolled in this prospective study. Each patient underwent paired [ 68 Ga]Ga-DOTATATE and [ 68 Ga]Ga-FAPI PET/CT on 2 successive days. The accuracy of two PET/CT for assessing T, N, and M stages was compared by using head-and-neck MRI, histopathologic diagnosis and follow-up results as reference standards. The radiotracer uptake derived from two PETs was also compared.

For treatment-naïve patients, [ 68 Ga]Ga-DOTATATE PET/CT showed identical sensitivity for the primary tumours but clearer tumor delineation induced by higher tumour-to-background (TBR) ratio (19.1 ± 8.7 vs. 12.4 ± 7.7, P  = 0.003), compared with [ 68 Ga]Ga-FAPI PET/CT. Regarding cervical lymph node (CLN) metastases, [ 68 Ga]Ga-DOTATATE PET had significantly better sensitivity and accuracy based on neck sides (98% vs. 82%, P  < 0.001; 99% vs. 88% P =  0.008), neck levels (98% vs. 78%, 99% vs. 97%; both P  < 0.001) and individual nodes (89% vs. 56%, 91% vs. 76%; both P  < 0.001), and higher TBR (8.1 ± 4.1 vs. 6.3 ± 3.7, P  < 0.001). Additionally, [ 68 Ga]Ga-DOTATATE PET/CT revealed higher sensitivity and accuracy for distant metastases (96% vs. 53%, 95% vs. 52%; both P  < 0.001), particularly in bone metastases (99% vs. 49%, 97% vs. 49%; both P  < 0.001). For post-treatment patients, [ 68 Ga]Ga-DOTATATE PET/CT identified one more true-negative case than [ 68 Ga]Ga-FAPI PET/CT.

[ 68 Ga]Ga-DOTATATE PET/CT performed better than [ 68 Ga]Ga-FAPI PET/CT in visualizing the primary tumours, detecting the metastatic lesions and identifying the local recurrence, suggesting [ 68 Ga]Ga-DOTATATE PET/CT may be superior to [ 68 Ga]Ga-FAPI PET/CT for NPC staging.

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This study was supported in part by the Joint Funds for the Innovation of Science and Technology Fujian Province (No.2021Y9134), Natural Science Foundation of Fujian Province (No.2023J01564) and the Fujian Provincial Health Technology Project (No.2022QNA032).

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Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian Province, China

Jieling Zheng, Guochang Wang, Yun Yang & Weibing Miao

Department of Nuclear Medicine, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Changle District, No. 999 Huashan Road, Fuzhou, 350212, China

Department of Pathology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China

Qian Ru & Li Zhang

Department of Radiotherapy, the First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian Province, China

Li Su, Wenlong Lv, Chunlin Ke, Peirong Wang, Xiaohui Liu & Feng Liu

Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China

Weibing Miao

Department of Nuclear Medicine, Provincial Clinical Key Specialty of Fujian, Fuzhou, 350005, Fujian Province, China

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Experimental design: Jieling Zheng and Weibing Miao; Patients recruiting: Jieling Zheng, Li Su, Wenlong Lv, Chunlin Ke, Peirong Wang, Xiaohui Liu, Feng Liu; Radiopharmaceutical preparation: Yun Yang; PET imaging analyses: Jieling Zheng and Weibing Miao; Immunohistochemistry analysis: Qian Ru and Li Zhang; Statistical analyses: Jieling Zheng and Guochang Wang; Manuscript writing: Jieling Zheng; Manuscript revision: Guochang Wang and Weibing Miao. All authors have seen and approved the manuscript.

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Zheng, J., Wang, G., Ru, Q. et al. A head-to-head comparison of [ 68 Ga]Ga-DOTATATE and [ 68 Ga]Ga-FAPI PET/CT in patients with nasopharyngeal carcinoma: a single-center, prospective study. Eur J Nucl Med Mol Imaging (2024). https://doi.org/10.1007/s00259-024-06744-4

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Received : 20 January 2024

Accepted : 28 April 2024

Published : 10 May 2024

DOI : https://doi.org/10.1007/s00259-024-06744-4

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