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🩻 Nuclear Medicine & Hybrid Imaging
🎯 Education • Cases • Clinical Tips
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23/04/2026

☢️ Spondylolysis ☢️ A 45-year-old female with history of chronic low back and inconclusive previous bone scan and conventional imaging. SPECT/CT shows an increased bone metabolism in L5 pars interarticularis, CT shows lucent line in the pars interarticularis consistent with fracture.
🗓 Spondylolysis fatigue fracture of the pars interarticularis of the neural vertebral arch. Occurs in 5% of the population usually secondary to repetitive trauma (generally hyperextension) with M>F. It is found in about 50% of athletes population as skeletally immature individuals are prone to develop spondylosis. 90% are in L5 and 30% are unilateral. Planar wholebody scan would show a focal area of minimal to intense tracer uptake in the posterior arch at the level of vertebral body. Blood pool phase is usually normal or mildly active. If planar imaging is normal then SPECT should be done as it is more sensitive than planar imaging. SPECT/CT is the gold standard in diagnosing spondylosis, CT findings ranges from normal, degenerative, incomplete fracture to complete fracture. SPECT/CT grading of spondylosis includes Grade 1 (SPECT + / CT normal or degenerative changes), Grade 2 (SPECT + / CT incomplete fracture), Grade 3 (SPECT + / CT complete fracture), Grade 4 (SPECT - / CT complete fracture).
BoneScan

21/04/2026

☢️ Ga68-PSMA avid Paget disease ☢️ 74-year-old with total prostatectomy and rising PSA. PET/CT scan shows left proximal humerus subchondral lucencies and increased trabeculations, cortical thickening involving the epiphysis, metaphysis and proximal diaphysis with intense PSMA uptake along the cortex. There is also a small subcentimetric pelvic right external iliac node with increased PSMA uptake.
🗓 Features of Paget disease in long bones depends on the stage. Generally cortical thickening, increased marrow trabeculation and expansion are seen extending from epiphysis to diaphysis. PSMA tracers show intense uptake on PET scans, the reason behind this finding is thought to be due to the endothelial PSMA expression in neovasculature that is known to occur in Paget disease.

20/04/2026

☢️ CNS lymphoma ☢️ FDG PET/CT images demonstrate hypermetabolic intra axial focal area occupying the left parietotemporal lobe corresponding to surrounding poorly defined geographical hypodensity causing mass effect of midline structures with subsequent mild rightward shift. There is absent physiological metabolism in the left putamen likely due to surrounding vasogenic edema. Hypermetabolic right lateral ventricle obscured soft tissue fullness suggestive of choroid plexus lesion. Hypermetabolic focal area within the cerebellar vermis without definite underlying lesion. Focal area of moderate FDG uptake within the medulla oblongata without definite underlying focal lesions. Biopsy revealed NHL/DLBCL.
🗓 primary CNS NHL/DLBCL is rare aggressive extra nodal lymphoma that arises in the brain, leptomeninges, spinal cord, or eyes. Usually it involves the deep periventricular white matter, corpus callosum, or basal ganglia as a solitary mass/lesion, although multifocal is not uncommon. FDG uptake is intense relative to background activity due to high cellularity.

19/04/2026

☢️ White fat uptake ☢️ in a 9-year-old male with history of NHL referred for a PET/CT scan after intensive treatment which included regular corticosteroids as part of his regimen. You can see in the images marked diffuse FDG uptake in the subcutaneous adipose tissue and reduced uptake in blood pool and liver.
🗓️ White fat is usually not metabolically active; however, altered biodistribution of FDG in subcutaneous fat is encountered in pediatric and adult patients receiving corticosteroids as part of their treatment. The reported incidence is less than 1%.

15/04/2026

☢️ Tibiotalar pseudoarthrosis ☢️ SPECT/CT images demonstrate intense perfusion and delayed tracer uptake at the tibiotalar arthrodesis interface with no signs of fusion, extending into the adjacent distal tibial and talar body, and tracking along the tibiotalar transarticular cannulated screws. The talus is severely deformed with loss of normal architecture, irregular fragmentation and collapse of the body. Findings are consistent with pseudoarthrosis.
🗓️ Ankle pseudoarthrosis after tibiotalar fixation refers to failed fusion across the tibiotalar arthrodesis site, where persistent motion remains despite surgical stabilization. Instead of solid osseous bridging, there is incomplete union with fibrous tissue , which may lead to chronic pain, discomfort, and mechanical instability. On imaging, key findings include persistent lucency across the fusion plane, absence of continuous trabecular bridging, sclerosis of the opposing fusion surfaces. SPECT/CT typically shows increased tracer uptake at the tibiotalar arthrodesis site when the pseudoarthrosis is active suggesting persistent bone turnover from failed fusion.
BoneScan

14/04/2026

☢️ Septic femoral loosening ☢️ 68-year-old male with previous left hip hemiarthroplasty 7 years ago complaining of left thigh pain, ESR and CRP were slightly elevated. SPECT/CT images show abnormally intense and diffuse tracer uptake in multiple Gruen regions corresponding to diffuse femoral cortical thickening and periosteal reaction with periprosthetic irregular lucencies more than 2 mm, these findings were consistent with true septic loosening.
🗓️ Normal tracer uptake is expected up to 2 years post surgery in homogeneous pattern involving the acetabulum, greater trochanter and femoral tip. The diagnostic efficiency of planar bone scan is 85% SN and 72% SP. SPECT/CT improves diagnostic accuracy and better localizes activity to identify typical patterns of uptake for specific pathologies in THR. It can also identify other regions in the bone suffering from clinically relevant pathologies whether involving the prosthesis directly or in other regions.
BoneScan

13/04/2026

☢️ Myxofibrosarcoma ☢️ FDG PET/CT scan shows hypermetabolic left proximal leg subderaml polylobular soft tissue mass with overlying contour deformity. The mass shows internal hyperdensities relative to the mass and exophyting dermal component. Biopsy revealed myxofibrosarcoma.
🗓 Myxofibrosarcoma is a malignant fibroblastic soft tissue sarcoma that affects older adults and most often arises in the extremities, with a predilection for the dermal, subdermal, and superficial soft tissues. Histologically, it shows a myxoid matrix, pleomorphic spindle cells, and curvilinear vascularity, with grade varying from low to high. On imaging it appears as a multilobulated, heterogeneous soft tissue mass, and on FDG PET/CT higher metabolic activity generally reflects greater cellularity and biologic aggressiveness.

11/04/2026

☢️ Oppenheimer ossicle ☢️ SPECT/CT bone scan shows a well corticated fragment located inferior to the right L2 inferior articular process, consistent with accessory “Oppenheimer ossicle”.
🗓 Oppenheimer ossicles are facet joint accessory ossicles, usually unilateral in approximately 4% of the population. Ossicle fusion occurs within 17-25 years of age, failure of fusion results in accessory ossicle. Most commonly occurs in the lumbar spine at the level of L2 or L3, inferior to the articular process.

09/04/2026

☢️ Burkitt’s lymphoma perineural spread ☢️ FDG PET/CT images demonstrate abnormal FDG uptake in the region of left foramen ovale (slightly expanded compared to the right side) extending inferiorly in a linear pattern to the mandibular foramen at the expected course of the mandibular nerve and inferior alveolar branch. Abnormal focal area in soft tissue fullness at the region of the greater palatine foramen can be suggestive of greater palatine nerve infiltration. Abnormal FDG uptake in splenic hypodense lesion and multifocal marrow deposits in the axial and appendicular skeleton.
🗓 Perineural infiltration in lymphoma is commonly associated with NHL aggressive subtypes. Infiltration can occur in both the central and peripheral nervous systems, leading to a range of neurological symptoms depending on the location and extent of nerve involvement. Clinically, patients may present with neuropathic pain, numbness, paresthesia, or motor deficits corresponding to the affected nerves. Imaging studies, particularly MRI, are crucial for identifying perineural infiltration, often showing nerve thickening, enhancement, or signal changes along the course of the affected nerve. FDG PET/CT may also be useful, revealing hypermetabolic activity along the nerve pathways. Perineural infiltration is associated with a poorer prognosis due to the aggressive nature of the underlying lymphoma. False negative FDG PET is due to limited spatial resolution, small tissue volume, limited uptake, location at the base of skull.

07/04/2026

☢️ Rosai Dorfman disease ☢️ FDG PET/CT shows hypermetabolic lobular soft tissue swelling of the right parotid gland, associated with hypermetabolic enlarged right cervical lymph nodes in levels II, III and IV. Biopsy confirmed Rosai Dorfman disease (S100 positive, CD1a negative).
🗓 Rosai-Dorfman disease is a non Langerhans histiocytic disorder characterized by an accumulation of histiocytes, classically in lymph nodes but also in extranodal sites. The classic immunophenotype is S100 positive, CD68/CD163 positive, and CD1a negative, which helps distinguish it from Langerhans cell histiocytosis, where CD1a is typically positive. Clinically it presents as painless cervical lymphadenopathy, but systemic disease involvement is common (e.g. skin, bone, CNS, soft tissue).

06/04/2026

☢️ Metastatic pheochromocytoma ☢️ Large gross, hypermetabolic right abdominal retroperitoneal mass likely of adrenal origin of intense FDG uptake [SUVmax= 6.6]. The mass exhibits well defined lobulated margins with cystic regions and internal coarse calcifications measuring 16.1X16 cm. There is no clear intervening plane with the adjacent musculature with further extension posteriorly to the paraspinal musculature at the level of L3 vertebra and right transverse process fracture. The mass is exerting mass effect on adjacent structures shifting the midline axis to the left and the large bowel loops anteriorly. Furthermore, the right renal structure is displaced anteriorly with no clear intervening plane showing severely dilated collecting system.
🗓 Pheochromocytomas are tumors of the adrenal gland that supposedly follow the 10% rule. 10% are extra-adrenal, 10% are bilateral, are malignant, 10% are found in children, 10% are not associated with hypertension, 10% contain calcification. Usually, they are large masses with necrotic and cystic centers, enhances avidly in the arterial and portovenous phases (portovenous > arterial). Almost always, metastatic pheochromocytoma exhibits high FDG avidity.

05/04/2026

🎯 What determines tumoral FDG uptake?

Tumoral FDG uptake is not random. It reflects the interaction between intrinsic tumor biology and the tumor microenvironment. Key determinants include GLUT1/3 expression, glycolytic activity, proliferative activity, blood flow, viable tumor cell density, and hypoxia-related signaling such as HIF-1α.

These factors influence how much FDG is delivered to the tumor, transported into the cell, phosphorylated, and retained. This helps explain why tumoral FDG uptake can vary between different tumors and even between different regions of the same lesion.

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Amman

Opening Hours

Monday	09:00 - 17:00
Tuesday	09:00 - 17:00
Wednesday	09:00 - 17:00
Thursday	09:00 - 14:00
Saturday	09:00 - 17:00
Sunday	09:00 - 17:00

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