[18F]FDG PET in the era of glucagon-like peptide-1 receptor agonists – A retrospective single-center study

Nuklearmedizin - NuclearMedicine · 2026-04-01

Liquid Biopsy of Circulating Tumor Cells and DNA in the Context of PSMA Radiopharmaceutical Therapy

Journal of Nuclear Medicine · 2025-11-13 · 1 citations

The concept of “liquid biopsy” has gained high interest in oncology and is being studied more as it is gradually getting incorporated in patient care for multiple cancer types. Liquid biopsy describes the analysis of circulating tumor cells (CTCs) or smaller pieces of cancer cells such as

Prevention and Management of Peptide Receptor Radionuclide Therapy-Induced Hypertensive Crisis in a Patient With Metastatic Pheochromocytoma

AACE Endocrinology and Diabetes · 2025-11-17 · 1 citations

Background/Objective: While peptide receptor radionuclide therapy (PRRT) with lutetium-177 DOTATATE has been increasingly used for metastatic pheochromocytoma management, PRRT-induced hypertensive crisis has been documented in prior reports. A case is reported here to demonstrate the prevention and management of PRRT-induced hypertensive crisis. Case Report: A 75-year-old male developed PRRT-induced hypertensive crisis. He had known progressive metastatic pheochromocytoma. Despite scheduled daily alpha and beta blockade, he developed symptomatic hypertensive crisis shortly after completion of lutetium-177 DOTATATE infusion in the first 2 treatments, which was managed with as-needed oral alpha blockade. Additional alpha blocker was given right before the initiation of lutetium-177 DOTATATE infusion in the third and fourth treatments. Hypertensive crisis still occurred in the third but not in the fourth treatment. He required the fifth treatment due to tumor progression but he developed another hypertensive crisis despite additional alpha blockade right before treatment. The patient became very concerned for potential hypertensive crisis in the sixth treatment. He was treated with escalating dose of metyrosine for 4 days before the treatment and did not develop hypertensive crisis. No additional alpha blockade was given. Discussion: PRRT may directly stimulate catecholamine release or cause tumor lysis in patients with metastatic pheochromocytoma, resulting in hypertensive crisis. Conclusion: PRRT-induced hypertensive crisis can happen in patients treated for metastatic pheochromocytoma. If hypertensive crisis occurs, caution should be taken on the subsequent treatments. Additional alpha blockade right before lutetium-177 DOTATATE infusion may help; in challenging cases, short-term metyrosine use may prevent PRRT-induced hypertensive crisis.

Abstract 4144537: Recurrent Myocarditis and Ventricular Arrhythmias Associated with Vascular Endothelial Growth Factor Inhibitor Use and Rechallenge

Circulation · 2024-11-12 · 1 citations

Introduction: Vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI) therapy has been associated with cardiotoxicity, particularly hypertension. Cardiomyopathy and ventricular arrhythmias (VA) have rarely been reported. Case Report: A 51-year-old male with metastatic sarcoma on pazopanib, a VEGFR-TKI, for the past 4 years presented with 1 month of increasing palpitations and lightheadedness leading to a fall. On arrival, telemetry showed paroxysmal AF with RVR rates to 120 bpm followed by incessant runs of NSVT with rates 200-240 bpm. Initial labs included BNP 191 pg/mL and HS troponin-I 6 ng/L (<5 ng/L). Lidocaine infusion, amiodarone infusion, and metoprolol were required to reduce NSVT burden. Initial TTE revealed LVEF of 30-35% from baseline 55-60%. Coronary angiography showed no significant CAD. Cardiac MRI was negative for LGE or metastatic involvement. Cardiac PET-CT revealed moderate diffuse FDG uptake with focal enhancement suggestive of an inflammatory process. Pazopanib was stopped and the patient started on GDMT and prednisone taper for treatment of myocarditis. At 2 months follow up, TTE revealed LVEF improved to 45-50% and ambulatory rhythm monitoring showed rare PVCs and few NSVT episodes. Repeat cardiac PET-CT revealed resolution of myocardial inflammation. Due to sarcoma progression, the patient started on regorafenib, another VEGFR-TKI, 3 months after initial hospitalization. About 3 weeks later, he presented with frequent NSVT which required lidocaine and amiodarone infusions for arrhythmia control. Repeat cardiac PET demonstrated myocarditis recurrence. He received intravenous pulse dose steroids followed by prednisone taper and was transitioned to oral mexiletine and amiodarone with resolution of VA. Review of ambulatory rhythm monitoring 1 week following regorafenib initiation already showed 20.6% burden of ventricular ectopy and >8000 NSVT episodes. Discussion: This patient had an unusual, delayed presentation of VEGFR-TKI induced myocarditis presenting with significant VA. Although TKI induced myocarditis is rare and the mechanism is not well understood, recurrence of myocarditis in this case with an alternative agent indicates a possible medication-class effect.

Abstract 4145086: Determining the Prevalence of Genetic Cardiomyopathies in Non-Ischemic Cardiomyopathy Patients Undergoing Cardiac Positron Emission Tomography-Computed Tomography: A Single Institution Experience

Circulation · 2024-11-12

Introduction: Inflammatory cardiomyopathies such as sarcoidosis are associated with increased focal 18F-FDG uptake on cardiac positron emission tomography-computed tomography (PET-CT). It has been reported that patients with genetic cardiomyopathies with desmosomal mutations may also have abnormal cardiac PET scans. The incidence and type of genetic cardiomyopathies with abnormal cardiac PET imaging remains unclear. Objective: To determine the prevalence of genetic cardiomyopathies in patients with abnormal cardiac PET imaging. Methods: Data from patients who underwent cardiac PET imaging at our institution between 2018-2024 were analyzed. Those who completed genetic testing were further identified and evaluated for mutation variant type and imaging findings. Results: Of 605 patients with non-ischemic cardiomyopathy referred for cardiac PET scans, 67 (11%, mean age 51.8 ± 15.4 years, 69% male, mean LVEF 46.5 ± 15.1%) had undergone genetic testing. Of these, 21% (n = 14) had evidence of focal inflammation and 15% (n = 10) had indeterminate PET results with assessment of focal inflammatory findings limited by incomplete suppression of physiologic metabolism at the time of imaging. Of patients with focal inflammation, 36% (n = 5) tested positive for known pathogenic gene variants: DSP (n =1), FLNC (n = 1), LMNA (n = 1), and MYH7 (n = 2). An additional 4 patients with evidence of focal inflammation had variants of uncertain significance (VUS). Among the 10 patients with indeterminate cardiac PET findings, 3 had pathogenic mutations: DSP (n = 1), HFE (n = 1), and TTN (n = 1). There was no difference in the cardiac PET imaging findings of patients with versus without genetic cardiomyopathies with regard to focality or location of FDG uptake. Conclusion: Pathogenic mutations beyond desmosomal gene variants can present with evidence of inflammation on cardiac PET. Genetic testing amongst non-ischemic cardiomyopathy patients with abnormal cardiac PET scans should be considered to evaluate for other etiologies beyond sarcoidosis.

Diagnostic and Therapeutic Application of Fibroblast Activation Protein Inhibitors in Oncologic and Nononcologic Diseases

The Cancer Journal · 2024-05-01 · 8 citations

ABSTRACT: Fibroblast activation protein inhibitor positron emission tomography (PET) has gained interest for its ability to demonstrate uptake in a diverse range of tumors. Its molecular target, fibroblast activation protein, is expressed in cancer-associated fibroblasts, a major cell type in tumor microenvironment that surrounds various types of cancers. Although existing literature on FAPI PET is largely from single-center studies and case reports, initial findings show promise for some cancer types demonstrating improved imaging when compared with the widely used 18F-fludeoxyglucose PET for oncologic imaging. As we expand our knowledge of the utility of FAPI PET, accurate understanding of noncancerous uptake seen on FAPI PET is crucial for accurate evaluation. In this review, we summarize potential diagnostic and therapeutic applications of radiolabeled FAP inhibitors in oncological and nononcological disease processes.

FAPI PET uptake patterns after invasive medical interventions: a single center retrospective analysis

European Journal of Nuclear Medicine and Molecular Imaging · 2024-05-16 · 9 citations

Swelling of the Right Arm During a Nuclear Medicine Therapy for Metastatic Pheochromocytoma

AACE Clinical Case Reports · 2024-11-18 · 1 citations

Peritoneal Scintigraphy confirming pleural-peritoneal fistula

Journal of Nephrology · 2023-08-03

PSMA-Targeted PET Radiotracer [18F]DCFPyL as an Imaging Biomarker in Inflammatory Bowel Disease

Clinical and Experimental Gastroenterology · 2023-12-01 · 6 citations

Background: Prostate-specific membrane antigen (PSMA) is highly and specifically upregulated in active-inflamed mucosa of patients with inflammatory bowel disease (IBD). We hypothesized that this upregulation would be detectable using a PSMA-targeted positron emission tomography/computed tomography (PET/CT) imaging agent, [ 18 F]DCFPyL, enabling non-invasive visualization of inflammation. A noninvasive means of detecting active inflammation would have high clinical value in localization and management of IBD. Study: We performed [ 18 F]DCFPyL imaging in three IBD patients with active disease. Abnormally increased gastrointestinal [ 18 F]DCFPyL uptake was observed in areas with endoscopic, histologic, and immunohistochemical inflammation, demonstrating partial overlap of segments of bowel with abnormal [ 18 F]DCFPyL uptake and active inflammation. Conclusion: This study demonstrates that PSMA-targeted [ 18 F]DCFPyL PET can effectively detect regions of inflamed mucosa in patients with IBD, suggesting its utility as a non-invasive imaging agent to assess location, extent, and disease activity in IBD. Keywords: IBD, disease activity, PSMA, GCPII, [ 18 F]DCFPyL