Aims and Objectives:To assess the diagnostic utility of contrast-enhanced 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-ceCT) in localization of tumors in patients with clinical diagnosis of tumor-induced osteomalacia (TIO), in correlation with histopathological results.Materials and Methods:Eight patients (five male and three female) aged 24–60 (mean 42) years with a clinical diagnosis of TIO were included in this prospective study. They underwent whole body (head to toe) FDG PET-ceCT following a standard protocol on Philips GEMINI TF PET-CT scanner. The FDG PET-ceCT results were correlated with postoperative histology findings and clinical follow-up.Results:All the patients had an abnormal PET-ceCT study. The sensitivity of PET-ceCT was 87.5%, and positive predictive value was 100%. The tumor was located in the craniofacial region in 6/8 patients and in bone in 2/8 patients. Hemangiopericytoma was the most common reported histology. All patients underwent surgery, following which they demonstrated clinical improvement. However, one patient with atypical findings on histology did not show any clinical improvement, hence, underwent 68Gallium-DOTANOC PET-ceCT scan for relocalization of the site of the tumor.Conclusion:The tumors causing TIO are small in size and usually located in obscure sites in the body. Hence, head to toe protocol should be followed for FDG PET-ceCT scans with the inclusion of upper limbs. Once the tumor is localized, regional magnetic resonance imaging can be performed for better characterization of soft tissue lesion. Imaging with FDG PET-ceCT plays an important role in detecting the site of the tumor and thereby facilitating timely management.

Pericardial synovial sarcoma is an extremely rare tumor, and a challenging diagnosis due to nonspecific diverse presentation requiring a very strong clinical acumen along with an aggressive multimodal approach. Histopathological confirmation remains the gold standard. The optimal management is unclear because of very few cases reported in literature. Herein, we describe the findings on contrast-enhanced FDG PET-CT facilitating the staging, lesion characterization, and timely response assessment to chemotherapy.

Primary extranodal lymphomas (ENLs) are lymphomas with no or minor nodal involvement and a dominant extranodal component originating from any organ. Primary ENL originating in the genitourinary tract is extremely rare. Diffuse large B-cell lymphoma (DLBCL) is the most frequent histological subtype in primary genitourinary lymphoma. Lymphomatous involvement of genitourinary system organs is common in the setting of disseminated disease. Herein, we present a unique case of primary multicentric extranodal DLBCL of the urogenital system involving ureter, seminal vesicle, and penis detected on 18 fluro-deoxyglucose positron emission tomography with computed tomography, and to the best of our knowledge, it is the first case report with multiorgan involvement within a single (urogenital) organ system in a patient without disseminated disease, i.e., with no other nodal or extranodal organ system involvement.

Aim:This study was aimed at standardizing the “In-House fatty meal” methodology in cholescintigraphy and to determine gall bladder ejection fraction (GBEF) with this standardized meal.Materials and Methods:This is a prospective case–control study where 61 patients having right upper quadrant pain and postprandial bloating and 59 healthy volunteers were included. They underwent 99mTc-mebrofenin fatty meal cholescintigraphy following a standard protocol. Dynamic acquisitions over 120 min were done, with a fatty meal being given between 45- and 60-min. Gallbladder emptying kinetics was studied by assessing the time activity curves and calculation of GBEFs were made at 30-min, 45-min, and at 60-min and assessed.Results:The GBEF at 30-min was 74.42% ± 8.26% (mean ± standard deviation), at 45-min was 82.61% ± 6.5%, and at 60-min was 89.37% ± 4.48% in the volunteer group. The lower limit of GBEF in volunteers at 30-min was 58%, 45-min was 69%, and at 60-min was 81%. Receiver operating characteristic (ROC) analysis showed that 30-min GBEF provided the best separation between healthy and diseased subjects with an area under curve of 0.952 (95% confidence interval = 0.914–0.989). The lower limit of GBEF at 30-min was 58%.Conclusions:An in-House standard fatty meal could be a reproducible alternative to cholecystokinin as it is well-tolerated. Based on ROC curve analysis, we propose that 30-min GBEF provides good separation between healthy and diseased people with this in-House fatty meal. Hence, dynamic acquisitions beyond 30-min postingestion of the fatty meal may not be warranted.

F-FDG PET/CT study is a well-established investigation in diagnosis, treatment evaluation, and follow-up of malignant tumors. It is very important to know the normal biodistribution and physiologic uptake of F-FDG to prevent it from confusing as malignant disease. This article describes unusual but physiological uptake in the laryngeal and diaphragmatic muscles in a patient presenting as metastatic adenocarcinoma with unknown primary having hiccups.