Purpose One of the major challenges for all imaging modalities is accurate detection of prostate cancer (PCa) recurrence. Beyond the established 68Ga-PSMA, a novel promising PET tracer in PCa imaging is 18F-fluciclovine. For evaluating the advantages and disadvantages and the comparability, we conducted a prospective head-to-head comparison on 18F-fluciclovine and 68Ga-PSMA-11 in patients with biochemical recurrence of PCa. Methods 58 patients with biochemical recurrence of PCa after definitive primary therapy were included. Both scans were performed within a time window of mean 9.4 days. All scans were visually analyzed independently on a patient-, region- and lesion-based analysis. All the examinations were performed in the same medical department using identical scanners at any time. Results The overall detection rate for PCa recurrence was 79.3% in 18F-fluciclovine and 82.8% in 68Ga-PSMA-11 (P = 0.64). Local recurrence was detected in 37.9% on 18F-fluciclovine and in 27.6% on 68Ga-PSMA-11 (P = 0.03). Local pelvic lymph node recurrence was detected on 18F-fluciclovine versus 68Ga-PSMA-11 in 46.6% versus 50%, in extrapelvic lymph node metastases in 41.4% versus 51.7% and in bone metastases in 25.9% versus 36.2%. Lesion-based analysis showed identical findings in local pelvic lymph nodes in 39.7%, in extrapelvic lymph nodes in 22.4%, and in bone metastases in 13.8%. Conclusions The advantage of 18F-fluciclovine is detecting curable localized disease in close anatomical relation to the urinary bladder, whereas 68Ga-PSMA-11 fails because of accumulation of activity in the urinary bladder. 18F-fluciclovine is almost equivalent to 68Ga-PSMA-11 in detecting distant metastases of PCa recurrence.

No abstract

Introduction: The main differential diagnoses of secondary hyperthyroidism include thyrotropin-secreting neuroendocrine pituitary tumors (TSH-PitNETs) and resistance to thyroid hormone. As a rare cause of secondary hyperthyroidism, ectopic thyrotropin-producing neuroendocrine pituitary tumors must also be considered. Case Presentation: A 48-year-old female patient with overt hyperthyroidism and elevated thyrotropin was admitted to the endocrine outpatient clinic of a secondary care hospital in March 2018. The patient had an inconspicuous pituitary MRI and F18-F-DOPA PET-CT, but showed a tumor mass located at the pharyngeal roof. Most biochemical tests and an increased tracer uptake of the pharyngeal mass in a Ga68-DOTANOC PET-CT argued for the presence of an ectopic TSH-PitNET. After treatment with octreotide over 5 days and a consecutive normalization of free thyroxine and free triiodothyronine, the tumor was endoscopically resected. Histologically, the mass consisted of small partially spindle, partially polygonal monomorphic to mildly pleomorphic cells with immunoreactivity for thyrotropin and luteinizing hormone. Postoperatively, the patient required intermittent levothyroxine therapy. Discussion and Conclusions: Ectopic TSH-PitNETs represent an extremely rare cause for secondary hyperthyroidism. While the diagnostic process may be complicated by negative imaging studies of the pituitary gland, family history, biochemical tests, and functional imaging using gallium-labelled somatostatin analogues may be helpful in establishing the diagnosis.

There are no definitive treatment recommendations for fungal endocarditis. Surgical therapy is the first choice in prosthetic valve endocarditis, which however cannot be performed in all patients. In these cases high dose and life-long medical therapy is necessary to prevent re-infection of the valve, even if (transient) deterioration of renal and liver function occurs.

No abstract