Jun Yang

Contrast-enhanced CT (CE-CT) and MRI (CE-MRI) are routine examinations for staging of pancreatic cancer (PC). This study aimed to directly compare the diagnostic performance of the novel [¹⁸F]AlF-NOTA-FAPI-04 PET/CT against these established modalities for initial clinical staging. A total of 127 patients with initial PC who had simultaneously undergone [¹⁸F]AlF-NOTA-FAPI-04 PET/CT, CE-CT and CE-MRI were enrolled in this retrospective study. Their clinical features and imaging data were evaluated and staged according to TNM classification. Histopathological findings or follow-up data or multidisciplinary team (MDT) discussion served as the reference standard for the final diagnosis. For primary tumor (T) staging, CE-CT and CE-MRI demonstrated equivalent performance and outperformed [¹⁸F]AlF-NOTA-FAPI-04 PET/CT across all T stages except T1c. However, the PET/CT modality achieved significantly higher sensitivity, accuracy, and negative predictive value for both nodal (N) and distant metastasis (M) staging (all p < 0.05). It changed the N stage in 26 patients, altering management in 5 (3.93%), and revised the M stage in 16 and 18 patients compared to CE-CT and CE-MRI, respectively, leading to major treatment changes in 15 (11.81%) and 17 (13.38%) patients. A SUVmax cutoff of 4.85 for lymph node metastasis provided moderate sensitivity (67.1%) and high specificity (93.7%). [¹⁸F]AlF-NOTA-FAPI-04 PET/CT outperforms CE-CT and CE-MRI in evaluating N and M staging except T staging in initial pancreatic cancer, leading to a more accurate clinical staging and a more rational therapeutic decision-making. [¹⁸F]AlF-NOTA-FAPI-04 PET/CT should be considered a useful diagnostic tool for initial staging of pancreatic cancer.

Accurate identification and localization are crucial for determining surgical strategies in patients with F-GEP-NETs, as these tumors often cause specific clinical syndromes due to hormone overproduction. However, conventional anatomical imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI), exhibit low sensitivity and accuracy in detecting and localizing F-GEP-NETs. This limitation stems from the frequent small size and inherent imaging heterogeneity of such tumors, which often lead to inconclusive or false-negative results. Herein, we present two illustrative cases of F-GEP-NETs (one gastrinoma and one VIPoma) that were either not visualized or yielded undefined findings on contrast-enhanced CT (CE-CT). In both instances, [¹⁸F]F-NOTA-octreotide PET/CT subsequently enabled precise identification and anatomical localization of the primary tumors. This molecular imaging technique leverages the overexpression of somatostatin receptors on the surface of most neuroendocrine tumor cells, providing superior functional characterization. These cases underscore the potential diagnostic value of [¹⁸F]F-NOTA-octreotide PET/CT in the clinical workup of patients with biochemically confirmed F-GEP-NETs in whom conventional imaging is non-diagnostic, thereby aiding in the formulation of optimal treatment strategies and personalized management plans.

Papillary thyroid carcinoma (PTC) comprises the vast majority of all thyroid cancers. Lymph node metastases may be present even when the primary tumor is small and intrathyroidal. Metastatic lymph nodes of PTC presenting as giant solitary cervical cysts with no evidence of primary tumors in the thyroid gland even by postoperative pathological examination are rare. A 33-year-old Chinese woman presented to the hospital with an incidental mass in her right neck. Ultrasonography and magnetic resonance imaging revealed a giant right cystic mass in the inferior submandibular gland. The patient underwent mass dissection. Histopathological assessment indicated metastatic papillary carcinoma from the thyroid. Total thyroidectomy and bilateral selective neck dissection were performed. Meticulous pathological examination revealed no lesions in the thyroid. After 18 months of follow-up, no signs of recurrence were noted. It is difficult and challenging to differentially diagnose between ectopic PTC and lymph node metastasis from PTC. Meticulous pathological evaluation of surgical specimens is key to making a definitive diagnosis.

The hepatopulmonary syndrome (HPS) is characterized by arterial oxygenation defect induced by intrapulmonary vascular dilatations in the setting of liver disease. We report a 57-year-old woman with a history of liver cirrhosis presented with progressive cyanosis, exertional dyspnea and a dry cough. Oxyhemoglobin saturation was 88.5% on room air. Contrast transthoracic echocardiography (cTTE) and technetium-99m-macroaggregated albumin (Tc-99m-MAA) scintigraphy showed an intrapulmonary shunting and confirmed HPS.

Background: Parathyroid carcinoma and parathyromatosis are very rare diseases in patients on hemodialysis. Its pathogenesis, clinical features, preoperative diagnosis, and surgery are challenging. We describe a rare case of recurrent hyperparathyroidism due to synchronous parathyroid carcinoma and parathyromatosis. Case presentation: A 46-year-old Chinese woman was diagnosed with end-stage renal disease and received regular hemodialysis. Four years later, she experienced discomfort due to itching and was diagnosed with drug-resistant secondary hyperparathyroidism. Parathyroidectomy was performed, and her parathyroid hormone (PTH) levels were reduced. The pathology also revealed that the four nodules were parathyroid nodular hyperplasia without evidence of malignancy. Five years after surgery, the right subcutaneous nodule and left inferior nodule were detected by multiple imaging modalities, and the nodules were accompanied by recurrence itching and elevation of PHT. A complete resection of two nodules was performed, and the patient was diagnosed with parathyroid carcinoma and parathyromatosis. At 8 months postsurgery, her PHT and serum calcium levels were stable, and there were no signs of recurrence. Conclusions: This is a rare case of synchronous parathyroid carcinoma and parathyromatosis in a patient with secondary hyperparathyroidism after parathyroidectomy. We suggest meticulous handling of parathyroid hyperplasia to avoid rupture and spillage during surgery, and precise pro-operation location by multiple imaging modalities is crucial for successful parathyroidectomy.

We present a case of a 34-year-old man who was admitted to our hospital with a six-month history of nausea and vomiting that had worsened over the past two weeks. Diagnosis of primary hyperparathyroidism (PHPT) due to a single parathyroid adenoma was confirmed by laboratory results and imaging but following pharmacological therapy the patient developed a dry cough. Single-photon emission tomography/computed tomography (SPECT/CT) with technetium-99m-diphosphonate (^99mTc-MDP) was used to assist in the diagnosis and results showed diffuse metastatic microcalcification in the lungs and stomach. The patient underwent right parathyroidectomy and ^99mTc-MDP SPECT/CT scan six months later showed a significantly reduced radioactive distribution in the lungs and none in the stomach. Diffuse metastatic microcalcification in the lungs and stomach due to PHTP is rare and can easily be misdiagnosed.

Background: Secondary hyperparathyroidism (SHPT) is a common high-risk factor for mortality in end-stage renal disease, and parathyromatosis and supernumerary parathyroid glands are very rare causes of persistent SHPT. Preoperative diagnosis and removal of all hyperplastic parathyroid glands are challenging. We report a rare case of persistent SHPT due to parathyromatosis and supernumerary parathyroid glands and successful management by multiple imaging modalities.Case presentation: A 53-year-old Chinese woman on haemodialysis experienced discomfort due to itching and bone pain due to persistent SHPT after parathyroidectomy. The supernumerary parathyroid glands and parathyromatosis were detected by multiple imaging modalities, including^99mTc-sestamibi (^99mTc-MIBI) scans, ultrasonography and four-dimensional computed tomography (4D-CT) and then excised; pathological confirmation was performed. During follow-up, her serum calcium and parathyroid hormone levels were stable in the appropriate ranges, and no complications arose.Conclusions: Because of persistent SHPH after parathyroidectomy in patients with haemodialysis, multiple imaging modalities, including^99mTc-MIBI scans, 4D-CT and ultrasonography, are helpful for detecting supernumerary parathyroid glands and parathyromatoses. Accurate preoperative localization of this rare lesion is important for management, enabling the removal of all affected parathyroid tissues.

Primary hyperparathyroidism (PHPT), which is mostly caused by a parathyroid adenoma, is fairly common in postmenopausal women but is relatively rare in pregnant women. PHPT-induced pancreatitis during pregnancy is associated with significant maternal and foetal morbidity and mortality. Diagnosis is challenging because of non-specific symptoms and changes in maternal calcium homeostasis. Information about the optimal treatment strategy for the prevention of catastrophic consequences to the mother and foetus is limited. Here, we describe a rare lethal case of severe acute necrotizing pancreatitis due to a parathyroid adenoma in a woman in her third trimester of pregnancy. A previously healthy 24-year-old Chinese woman at 37 weeks of gestation presented with persisting epigastric pain, nausea and bilious vomiting for 1 day. PHPT-induced acute necrotizing pancreatitis was diagnosed on the basis of her serum calcium, parathyroid levels and imaging results. A caesarean section and parathyroidectomy were performed at 1 day and 11 days after admission, respectively. Histological examination confirmed a right inferior parathyroid adenoma with a size of 2.0 × 1.5 cm. Following the parathyroidectomy, the patient had eucalcaemia and presented normal parathyroid hormone (PTH) levels. Although the foetus was normal, the patient died of multiple organ failure due to severe pancreatitis. PHPT-induced acute necrotizing pancreatitis is a rare clinical entity and life-threatening condition to both the mother and the foetus during pregnancy. Early diagnosis can be challenging and is crucial. Appropriate treatment according to the patient’s condition may effectively reduce maternal and foetal mortality.

Meckel's diverticulum (MD) is common congenital abnormality of gastrointestinal tract, only about 6.4% of patients become symptomatic. A smaller minority develop potential fatal complications such as hemorrhage, perforation, abscess, and bowel obstruction. A 15-year-old boy with history of appendicitis was admitted due to worsening abdominal pain and nausea for 1 day. The physical examination showed the abdomen was soft, with the diffuse tenderness to palpation and voluntary guarding. Abdominal computed tomography showed a probable MD in the distal ileum. Single photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging revealed the focal concentration at the right lower quadrant of abdomen region. After the initial management including antibiotic administration and intravenous fluid resuscitation, MD with perforation and localized suppurative peritonitis was confirmed in surgery. The patient underwent a diverticulectomy. Histological examination was confirmed as MD with focal heterotopic gastric tissue. After surgery, the patient had uneventful recovery during 3 months follow-up. Spontaneous perforation and intraabdominal abscess due to MD is very rare. Accurate diagnosis of MD remains challenging as clinical symptoms from these complications occur nonspecifically. SPECT/CT fusion imaging is critical for prompt recognition and accurate diagnosis in the successful management of this rarely life-threating complication.